Instruction: Generate impression based on medical findings.

Input: Dyslexia and alexia [R48.0], Reason for Study: ^Reason: rule out posterior circ stroke History: alexia, agraphia Brain MRIThere is no evidence of acute ischemic or hemorrhagic lesion on the scan.On the gradient echo images, there are scattered susceptibility lesions bilateral hemispheres indicating either calcification or chronic hemorrhage.Patchy bihemispheric periventricular white matter FLAIR/T2 high signal intensity lesions are seen which indicate mild to moderate degree nonspecific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Brain MRA3D time of flight MOTSA MRA brain images with maximum intensity projections of the anterior/posterior intracranial circulation demonstrate normal ICAs, MCAs and ACAs. Vertebrobasilar system appears to be normal. Left PCA is fetal origin.

Output: 1. No evidence of acute ischemic or hemorrhagic lesion.2. Non specific small vessel ischemic disease.3. Normal brain MRA.


Instruction: Generate impression based on medical findings.

Input: Left shoulder pain. Rule out rotator cuff tear ROTATOR CUFF: The rotator cuff appears normal without evidence of tear.SUPRASPINATUS OUTLET: There are small cysts in the distal clavicle which may reflect early osteoarthritis or sequela of prior trauma. The acromioclavicular joint otherwise appears normal. There is no frank fluid within the subacromial/subdeltoid bursa.GLENOHUMERAL JOINT AND GLENOID LABRUM: Glenohumeral joint alignment is within normal limits. There is a small amount of fluid within the joint but no frank effusion. Linear intermediate signal intensity separates the anterior/inferior labrum from the underlying glenoid and then propagates superiorly through the substance of the anterior labrum and continues posterior through the superior labrum as a SLAP tear. Overall, the tear appears to extend from the from the 12 o'clock to 5 o'clock position anteriorly and from the 12 o'clock to the 10 o'clock position posteriorly.BICEPS TENDON: The tendon of long head of biceps appears normal.

Output: 1.No evidence of rotator cuff tear2.Labral tear as described above.


Instruction: Generate impression based on medical findings.

Input: Female, 72 years old, with left lower extremity swelling and distal lower extremity weakness. The L5 vertebral body demonstrates transitional morphology. Vertebral body heights are preserved and alignment is grossly anatomic. No pathologic marrow replacement, edema or enhancement is seen. An enhancing right paraspinal mass at T12 does not appear to have significantly changed in size. The visualized distal spinal cord and conus are within normal limits. A conjoined left L5-S1 nerve root is redemonstrated. No pathologic intrathecal enhancement is seen.L1-2: Facet arthropathy. Disc bulging. Mild generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L2-3: Facet arthropathy. Disc bulging. Moderate generalized spinal canal stenosis. Mild bilateral foraminal narrowing. No interval changes. L3-4: Advanced facet arthropathy and ligamentum flavum thickening. Disc bulging. Moderate generalized spinal canal stenosis with some crowding of the cauda equina. Moderate bilateral foraminal narrowing. No interval changes. L4-5: Facet arthropathy. Bulging disc. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. No interval changes. L5-S1: No significant spinal canal or foraminal stenosis. Conjoined left L5-S1 nerve root is seen. Mild ill-defined enhancement is seen within the paraspinal musculature of the lower back, right side more than left. No fluid collections are detected.

Output: 1.No change in the severity of multilevel disc and posterior element degeneration.2.A right paraspinal mass at T12 does not appear to have changed significantly.3.Mild inflammation is suspected in the paraspinal musculature of the lower back. This may be related to strain or prolonged recumbency.4.No new findings are seen which would account for the patient's symptoms.


Instruction: Generate impression based on medical findings.

Input: Bilateral forearm pain and upper extremity numbness. There is right C4-5 uncovertebral hypertrophy with moderate neural foraminal stenosis. There is a small posterior disc-osteophyte complex at C6-7 and facet hypertrophy with perhaps mild right neural foraminal stenosis, but no significant spinal canal or left neural foramen stenosis. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.

Output: 1. Right C4-5 uncovertebral hypertrophy with moderate neural foraminal stenosis. 2. Small posterior disc-osteophyte complex at C6-7 and facet hypertrophy with perhaps mild right neural foraminal stenosis, but no significant spinal canal or left neural foramen stenosis.


Instruction: Generate impression based on medical findings.

Input: There are scattered punctate foci of T2 hyperintensity primarily within the subcortical white matter without associated restricted diffusion, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Bubbly secretions are noted within the left sphenoid sinus suggesting acute sinus disease. The remaining paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Mild chronic small vessel ischemic disease.2.Bubbly secretions are noted within the left sphenoid sinus suggesting acute sinus disease.


Instruction: Generate impression based on medical findings.

Input: Male, 52 years old, with metastatic lung cancer to the brain, planning exam for stereotactic radiosurgery. A nonenhancing lesion within the left inferior frontal lobe has not significantly changed in size. On T2-weighted images, this lesion measures 10 x 6 mm.A 6 mm mildly enhancing lesion along the right occipital lobe cortex is unchanged. A 5 mm mildly enhancing lesion along the right superior parietal lobule cortex is unchanged.A lobular lesion within the left cerebral hemisphere showing questionable minimal internal enhancement is redemonstrated. On T2-weighted images, this lesion measures 10 x 10 mm showing no significant interval change.No evidence of any new intracranial lesions is seen. The above lesions cause no significant edema or mass effect. Morphology of the brain parenchyma is otherwise unremarkable. The ventricles are stable and normal in size.

Output: Multiple nonenhancing or minimally enhancing lesions are demonstrated both supra and infratentorially. No significant change is seen in any of these lesions, and no new lesions are detected.


Instruction: Generate impression based on medical findings.

Input: Preoperative planning for laser ablation surgery: epilepsy. There is no significant interval change in the lesion with extensive susceptibility effect and an adjacent developmental venous anomaly within the periatrial white matter of the left temporal lobe. There is also no significant interval change in the smaller lesion with extensive susceptibility effect in the posterior left cingulate gyrus. There is no evidence of acute infarct or vasogenic edema. There are a few nonspecific foci of high T2 signal scattered within the cerebral white matter. The ventricles and basal cisterns are unchanged in size and configuration. There is an unchanged left middle cranial fossa arachnoid cyst. 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 change in the probable cavernous malformations in the left cerebral hemisphere.


Instruction: Generate impression based on medical findings.

Input: Unspecified abnormalities of gait and mobility [R26.9], Reason for Study: ^Reason: rule out structural lesions including MS, stenosis, nerve root impingement History: gait abnormality and neck pain There is normal cervical lordosis. The cranial-cervical junction is normal. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The paraspinal soft tissues and musculature are unremarkable.Degenerative changes are specified by the intervertebral level as follows: C2-C3: no neuroforaminal narrowing or spinal stenosis. C3-C4: diffuse minimal bulging of disc with slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C4-C5: diffuse minimal bulging of disc with slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C5-C6: diffuse minimal bulging of disc with slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C6-C7: slightly prominent osteophyte-disc complex left more than right, no neuroforaminal narrowing or spinal stenosis. C7-T1: no neuroforaminal narrowing or spinal stenosis.

Output: 1. Degenerative changes of mid cervical spine discs including C34, C45 and C56 with minimal left side neuroforaminal stenosis but no significant spinal canal stenosis.2. Spinal cord signal intensity appears to be normal.


Instruction: Generate impression based on medical findings.

Input: Clinical question: Evaluate for postop hemorrhage. Signs and symptoms: Headache. Nonenhanced head CT: Examination demonstrates a surgical cavity in the right frontal lobe containing fluid and air density as well as very minimal blood product. It measures approximately 35 x 36 -mm in size.There is a small focus of high density measuring approximately 4 x 4.5-mm in size suspected of a small acute hematoma immediately lateral to the surgical cavity in the right frontal lobe.Extensive residual surrounding vasogenic edema and very minimal subarachnoid hemorrhage is present. A small residual vasogenic edema in the left frontal lobe is also present and unchanged since prior brain MRI from 5 -- 3 -- 13. The overall mass effect of this finding and resultant midline shift to the left immediately adjacent to the tumor remains fairly similar to preoperative study. Stable normal size of the supratentorial ventricular system and unchanged since prior study.Expected postoperative changes of right frontal craniotomy.

Output: 1.Surgical cavity at the site of previously known right frontal lobe tumor with fluid/air and very minimal blood content.2.Minimal subarachnoid hemorrhage in the vicinity of surgical cavity and an approximately 4 x 4.5-mm accurate hematoma lateral to the surgical cavity.3.Postop changes and residual vasogenic edema extensively in the right frontal and minimally in the left frontal and associated mass effect remains similar to prior study.


Instruction: Generate impression based on medical findings.

Input: Absent sensation below nipple, rule out cord compression The vertebral bodies are appropriate in the overall alignment and height. The spinal cord has normal signal characteristics and overall morphology. There is no compromise of the spinal canal in the cervical, thoracic, or lumbar spine. No epidural collections are not demonstrated.

Output: This is a limited exam specific for the exclusion of cord compression only and does not exclude more subtle lesions such as intrinsic cord abnormalities. No spinal canal stenosis or cord compression is identified.Due to the screening nature of this protocol details are not as evident on imaging as dedicated protocols of the spine.


Instruction: Generate impression based on medical findings.

Input: 64 years Female (DOB:7/27/1952)Reason: 64F w new onset LUE weakness, L eye burliness, decreased sensation to L face History: as abovePROVIDER/ATTENDING NAME: ERIC SHAPPELL MAHESH PADMANABAN The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The right vertebral artery is very small.Incidental noted is made of partial empty sellaThe 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: Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related.


Instruction: Generate impression based on medical findings.

Input: 81 years, Male, Reason: staging exam History: high grade prostate cancer newly diagnosed. PELVIS:PROSTATE:Prostate Size: 4.9 x 2.8 x 3.1 cmPeripheral Zone: There is a large lesion extending from the right base to apex (501/14) with low signal on ADC/T2 which extends beyond the posterior capsule and invades the right neurovascular bundle. Increased T1 signal in the left peripheral zone likely represents hemorrhage from prior biopsy.Central Gland: Heterogeneous lesions in the central gland likely represent benign prostatic hypertrophy.Seminal Vesicles: No involvement.Extracapsular Extension: Right posterior extracapsular extension into the right neurovascular bundle.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Large right peripheral zone lesion extending from the right base to apex with extracapsular extension into the right neurovascular bundle.2.No lymphadenopathy.


Instruction: Generate impression based on medical findings.

Input: Dysphagia. Neck lump. PET/CT scan showed soft tissue mass posterior to the trachea, potentially from the known thyroid cancer. The patient has rising globulin. He received RAI 55 years ago. History of papillary thyroid cancer; status post total thyroidectomy and right modified radical neck dissection on December 19, 2014. He had two positive lymph nodes in the central neck and 0/24 nodes in the right lateral neck. He also had invasion of the middle thyroid vein on the right, and minimal extrathyroidal extension into the strap muscles on the right. Subsequently, he underwent radioactive iodide treatments but was told that he had persistence and recent thyroglobulin levels have increased. There are changes of previous thyroidectomy. There is a rightward-eccentric, infiltrative, mildly STIR-hyperintense mass located just inferior to the posterior part of the cricoid cartilage. It demonstrates diffusion restriction diffuse contrast enhancement. The mass posteriorly displaces the uppermost esophagus with no intervening fat plane. It also displaces the trachea anteriorly with high likelihood of invasion into the trachealis muscle and the right posterolateral aspect of the first tracheal ring. It causes mild tracheal narrowing. Craniocaudally, it measures 2.5 cm and abuts the posterior arch of the cricoid cartilage without grossly eroding into it. It wraps around 50% of the circumference of the upper-most trachea and measures axially 4.3 cm x 3.0 cm. Focally decreased T1 signal within the right side of the mass probably reflects susceptibility artifact. Previous PET CT showed a surgical clip in a similar location. The larynx is unremarkable without definite invasion into the cricoid or thyroid cartilages. There is also no definite invasion into the adjacent vertebral bodies of C7 and T1. There is also no vascular encasement and major neck vessels are patent.There is no discrete cervical lymph node enlargement. The major salivary glands are unremarkable.There is complete opacification of the right maxillary sinus with inspissated secretions. There is partial opacification of the ethmoid and left maxillary sinuses and fluid in the right sphenoid sinus. Both orbital lenses have been replaced.Included lung apices are notable for posterior apical pleural thickening was present on the previous PET/CT.

Output: 1.Soft tissue mass involving the upper-most part of the tracheoesophageal groove with signs of invasion into the upper-most trachea, likely representing either a local recurrence given proximity to surgical clips, or regional lymph node metastasis related to the known thyroid cancer.2.There is no separate cervical lymphadenopathy.3.Opacification of the paranasal sinuses including complete opacification of the right maxillary sinus and fluid in the right sphenoid sinus may reflect sinusitis in the proper clinical setting.


Instruction: Generate impression based on medical findings.

Input: The two surgeries for pituitary tumor evaluate size and placement. 70 year old male. There is a 25 x 21 mm sagittal dimension mass centered in the pituitary fossa which on the 11/ 2008 MRI exam measured 22 x 20 millimeters paired on axial dimensions it measures 23 x 21 mm and axial dimensions and is unchanged since the prior CT paired it has suprasellar extension indenting itself into the optic chiasm.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells and demonstrates a minor opacities in the right mastoid air cells present on the previous exams as well.. The visualized portions of the orbits are intact.

Output: 1.Sellar and Suprasellar mass known to represent a macroadenoma. It appears slightly larger than the 11/5/08 MRI exam.2.


Instruction: Generate impression based on medical findings.

Input: Cirrhosis of liver, HCV, evaluate for blockage of biliary ducts, elevated alkaline phosphatase and GGT ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour and diffusely heterogeneous hepatic parenchymal signal. No suspicious arterially enhancing hepatic focus delineated. Mildly enlarged perihepatic and periportal lymphadenopathy, stable to mildly decreased in size compared to earlier exam and most likely reactive in etiology. Status post cholecystectomy. Not significantly changed from prior study is mild intrahepatic biliary duct dilatation. Common bile duct normal in size, distalmost CBD not well seen, similar in appearance to prior study. SPLEEN: Stable nonenhancing hypointense foci in spleen, may reflect sequela of prior ischemic insult.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Decreasing residual T1 hyperintensity seen in left adrenal region, for example, component measuring 3.8 x 2.1 cm on prior exam now measures 0.9 x 0.5 cm, persistent left adrenal nodularity, image 61 series 10.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Spinal degenerative disease and scoliosis.OTHER: Status post sternotomy. Cardiomegaly.

Output: 1. Not significantly changed from prior study is mild intrahepatic biliary duct dilatation. Common bile duct normal in size, distalmost CBD not well seen, similar in appearance to prior study. Findings may reflect combination of postcholecystectomy state/benign stricturing. No definite enhancing lesion seen.2. Cirrhotic liver. No suspicious liver lesion. Mildly enlarged perihepatic and periportal lymphadenopathy, stable to mildly decreased in size compared to earlier exam and most likely reactive in etiology. 3. Decreasing left adrenal hemorrhage, persistent left adrenal nodularity.


Instruction: Generate impression based on medical findings.

Input: 66 years Male (DOB:9/20/1950)Reason: evalaute for spinal stenosis History: neuorclaudication symptomsPROVIDER/ATTENDING NAME: MONICA B. VELA MONICA B. VELA 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 a dextrocurvature to the lumbar spine present.At L5-S1 there is moderate right-sided facet hypertrophy present at this level and mild left-sided facet hypertrophy. There is loss of disc space height this desiccation and a diffuse disc bulge at this level. There is a very mild encroachment of the nerve roots of the right lateral recess at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disc space height, disc desiccation and bilateral facet and ligamentum flavum hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion present at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a left far lateral disc protrusion associated with the left-sided endplate osteophytes which displaces the left-sided exiting nerve root after it exits the neural foramen. There are associated endplate reactive changes.At L1-2 there is no significant compromise to spinal canal or neural foramina.

Output: There are multilevel degenerative changes present in the lumbar spine with some mild encroachment of the nerve roots at the right lateral recess at L5-S1. Mild degree of spinal stenosis present at L4-5. There are some displacement of the left-sided exiting nerve root at L2-3 related to a left far lateral disc protrusion. There is a sigmoid curvature to the lumbar spine.


Instruction: Generate impression based on medical findings.

Input: Headache, nuchal rigidity, intraventricular hemorrhage, possible tumor There is diffusion restriction involving the splenium and body of the corpus callosum compatible with acute ischemic infarction. There is an approximately 2.4 x 1.3 cm expansile area involving the body of the corpus callosum with peripheral T1 hyperintensity consistent with acute/subacute hemorrhage, compatible to recent head CT findings. There is redemonstration of intraventricular extension of hemorrhage. The lateral ventricles are not significantly distended. On intracranial arterial wall imaging sequences, diffuse segmental arterial luminal stenosis of bilateral supraclinoid internal carotid arteries, especially beyond the level of distal dural ring are demonstrated. In addition, bilateral distal vertebral arteries especially beyond the level of dural coverage appear to be narrowed in luminal diameter. However, no definite arterial wall thickening are seen. In addition, there is no evidence of wall enhancement. Other intracranial vasculature including bilateral proximal MCAs and basilar artery also appear slightly stenotic. On post contrast T1 images, there are diffuse leptomeningeal enhancements which suggest leptomeningitis. No midline shift is appreciated.

Output: 1. Diffuse leptomeningeal meningeal enhancement is compatible with meningitis.2. Acute ischemic infarctions involving the body/splenium of the corpus callosum.3. Hemorrhages involving the corpus callosum with intraventricular extension is likely related to hemorrhagic transformation of corpus callosum infarct.4. Segmental, diffuse intracranial (intradural) arterial luminal narrowings without wall thickening nor evidence of enhancement indicating secondary arterial vasospasm possibly due to leptomeningitis or RCVS. Possibility of vasculitis is considered less likely. Follow-up MRI with vascular wall imaging sequence is recommended. 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: Pituitary macroadenoma: recent transsphenoidal hypophysectomy and left endoscopic anterior ethmoidectomy and maxillary antrostomy. Pituitary: There are recent postoperative findings related to transsphenoidal hypophysectomy and left endoscopic anterior ethmoidectomy and maxillary antrostomy. There is a 10 mm diameter cavity with presumed hemostatic material containing blood products within the residual pituitary tumor, which otherwise measures approximately 22 mm in craniocaudal dimension with persistent mass effect upon the optic apparatus and extension into the bilateral cavernous sinuses. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is fluid and mild mucosal thickening in the left maxillary sinus, as well as partial opacification of the ethmoid air cells. Otherwise, there appears to be packing material in the posterior nasal cavity and sphenoid sinuses. The orbits are grossly unremarkable.Brain: There is no evidence of acute infarct. The brain parenchyma appears unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.

Output: 1. Recent postoperative findings related to transsphenoidal hypophysectomy and left endoscopic anterior ethmoidectomy and maxillary antrostomy. There is a small cavity with presumed hemostatic material containing blood products within the residual pituitary tumor, which measures approximately 22 mm in craniocaudal dimension with persistent mass effect upon the optic apparatus. 2. No evidence of acute infarct.


Instruction: Generate impression based on medical findings.

Input: C2 lesion. Additional history per chart, newly diagnosed left kidney cancer with metastases to lung and bone. There is an enhancing mass measuring approximately 3 cm x 3 cm x 2.5 cm in the AP, transverse, and craniocaudal dimensions centered at the level of the right transverse foramen of C2 with likely encasement of the right vertebral artery. There is osseous destruction and adjacent soft tissue extension. There is involvement of the right C2-C3 neural foramen as well as the right prevertebral muscle structure. There is no extension into the spinal canal. The dens and lamina of C2 remain intact. No additional lesions are seen in the cervical spine.There are small foci of T2 signal abnormality involving the cervical cord including the dorsal paramedian C2-C3 level, right lateral C3 level, and ventral C4 level in the midline.Vertebral body heights in the cervical spine are normal. There is grade 1 anterolisthesis of C3 on C4 as well as minimal retrolisthesis of C5 on C6. There are multilevel degenerative changes as described below: C2-3: No significant compromise to the spinal canal or left neural foramen. Right neural foramen is diffusely involved with tumor.C3-4: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C4-5: Small disc osteophyte complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C5-6: Disc osteophyte complex and ligamentum flavum thickening contribute to mild to moderate spinal canal stenosis. There is also mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy.C6-7: No significant compromise to the spinal canal or right neural foramen. Minimal left neural foraminal narrowing.C7-T1: No significant compromise to the spinal canal or neural foramina.

Output: 1. 3 x 3 x 2.5 cm enhancing mass at the right lateral C2 level with involvement of the right C2-C3 neural foramen and encasement of the right vertebral artery is highly suspicious for metastasis. No medial extension into the spinal canal or evidence of mass effect on the cord.2. Small foci of cord signal abnormality from the to C2 to the C4 levels are nonspecific but may be related to demyelinating disease or prior inflammatory myelitis and can be correlated with history. 3. Mild to moderate multilevel degenerative changes in the cervical spine as detailed above.


Instruction: Generate impression based on medical findings.

Input: Full term infant. Respiratory insufficiency and abnormal involuntary movements. Evaluate for infarct. There is minimal T1-hyperintense, T2-hypointense material layering in the posterior horns of the lateral ventricles consistent with blood products as there is prominent susceptibility. There is a similar intensity subdural hemorrhage posteromedially in the the posterior fossa, more pronounced on the right with a maximum thickness of 4 mm, without resultant mass effect on the brain. Trace subdural blood products are also identified along the tentorium cerebelli and posterior falx. All of these show susceptibility artifact.A 3 mm but somewhat elongated focus of T1-hyperintense, T2-hypointense signal in the left parietal periventricular white-matter without susceptibility artifact may represent sequela of prior insult. The brain parenchyma otherwise shows no significant abnormality. Myelination is appropriate for age. There is no mass effect or midline shift. The ventricles and the other CSF-containing spaces are normal in size.Mild diffuse T2 hyperintensity throughout the scalp especially near the vertex likely reflects residual caput succedaneum. Scalp swelling is slightly more focal in the right parieto-occipital scalp and may represent minimal subgaleal effusion. There is no displaced skull fracture.

Output: 1.Minimal intraventricular hemorrhage without hydrocephalus.2.Minimal posterior fossa subdural blood products without mass effect on the brain, likely birth related.3.Minimal intraparenchymal left parietal hemorrhage.4.Mild caput succedaneum and probable small right parieto-occipital subgaleal effusion.


Instruction: Generate impression based on medical findings.

Input: Female, 57 years old. Reason: ?hydrocephalus History: headache There is redemonstration of a right cerebellar mass with surrounding vasogenic edema and compression of the fourth ventricle. There is stable ventriculomegaly of the lateral ventricles. Slight herniation of the right cerebellar tonsil into the foramen magnum is again noted. No areas of hemorrhage are identified.The calvaria and skull base are radiographically normal. Skull lesion seen on recent bone scan is not visualized on this study. There is opacification of the mastoid air cells bilaterally, left greater than right.

Output: Right cerebellar mass with associated vasogenic edema and compression of the fourth ventricle and crowding of the foramen magnum is not significantly changed since the prior examination.


Instruction: Generate impression based on medical findings.

Input: 53 years, Male, pleural mesothelioma with lung metastases. Presents with nasal field defect in the left eye. There is marked mucosal thickening within the left nasal cavity, with no underlying lesion identified. There is no restricted diffusion to suggest acute ischemia. There are multiple areas of periventricular and subcortical T2 hyperintensity. There is also T2 hyperintensity within the globus pallidi and pons. The globus pallidi are otherwise unremarkable. There is no intracranial hemorrhage. The ventricles are within normal limits in size and configuration. There is no abnormal meningeal enhancement. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Bone marrow signal and extracranial soft tissues are within normal limits. Incidental note is made of asymmetric mucosal swelling within the left nasal cavity.

Output: Nonspecific T2 hyperintense lesions within the periventricular and subcortical white matter, and pons most likely secondary to chronic microvascular ischemic disease. However there are additional areas of T2 hyperintensity within the globus pallidi bilaterally, which are atypical, and may be due to a combination of chronic microvascular ischemic disease and/or remote toxin exposure such as carbon monoxide.


Instruction: Generate impression based on medical findings.

Input: Reason: PTT rupture History: Pain TENDONS: There is abnormal T2 signal hyperintensity surrounding the posterior tibialis tendon at the level of the medial malleolus, indicating tenosynovitis, but the tendon remains intact throughout its course. There is a split tear of the peroneal brevis tendon. The remainder of the flexor and extensor tendons are intact.LIGAMENTS: The ligaments are intact.ARTICULAR SURFACES AND BONE: Bone marrow signal is within normal limits. There is a type II accessory navicular. The ankle mortise is intact. There is mild degenerative spurring at the tibiotalar and subtalar joints.ADDITIONAL

Output: 1.Mild tenosynovitis of the posterior tibialis tendon which remains intact throughout its course.2.Split tear of the peroneal brevis tendon.3.Mild degenerative changes in the hindfoot.4.Small joint effusion and mild edema in the subcutaneous tissues.


Instruction: Generate impression based on medical findings.

Input: Stage IV melanoma: restaging. There is a subcentimeter of high T2 signal in the left corona radiata. There is no evidence of intracranial hemorrhage, mass, or acute infarct. 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: A subcentimeter of high T2 signal in the left corona radiata may represent a chronic lacunar infarct. Otherwise, no evidence of intracranial metastases.


Instruction: Generate impression based on medical findings.

Input: 27 year old man with history of LV dysfunction in setting of anthracycline chemotherapy for AML, referred for evaluation of LV function. Study was performed without contrast at the request of the referring clinician.Left VentricleThe left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%, the LV end diastolic volume index is 111 ml/m2 (normal range: 74+/-15), the LVEDV is 224 ml (normal range 142+/-34), the LV end systolic volume index is 59 ml/m2 (normal range 25+/-9), the LVESV is 120 ml (normal range 47+/-19), the LV mass index is 56 g/m2 (normal range 85+/-15), and the LV mass is 113 g (normal range 164+/-36). LV systolic dysfunction is global.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 48%, the RV end diastolic volume index is 95 ml/m2 (normal range 82+/-16), the RVEDV is 193 ml (normal range 142+/-31), the RV end systolic volume index is 49 ml/m2 (normal range 31+/-9), and the RVESV is 100 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 trace mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no pericardial effusion.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with mildly reduced systolic function. The overall LV ejection fraction is 46%. LV systolic dysfunction is global. Compared to prior MRI on 4/23/14, LV function has slightly increased (from 44% to 46%)2. The right ventricle is normal in size with mildly reduced systolic function. The overall RV ejection fraction is 48%.


Instruction: Generate impression based on medical findings.

Input: Disorder of brain, unspecified [G93.9], Reason for Study: ^Reason: hx brain lesion. Eval for change History: none- surveillance There is no evidence of acute ischemic lesion.There are multifocal various sized bihemispheric susceptibility lesions including prominent left posterior temporal-parietal, left frontal and right frontal lobe lesions, unchanged since prior scan.Today's scan shows minimal peripheral enhancement of the left posterior temporo-parietal lesion which showed relatively intense enhancement.Therefore, the diagnostic possibility of the lesion goes toward a cavernous malformation than metastatic lesion. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: 1. Interval decrease of enhancement of the left posterior temporo-parietal lobe lesion with remained susceptibility artifacts indicate possible diagnosis cavernous malformation. Follow up imaging is recommended.2. Multifocal various sized non enhancing susceptibility lesions within bihemispheric distribution suggest the diagnosis of multiple cavernous malformation.


Instruction: Generate impression based on medical findings.

Input: 35 years, Female, Reason: possible urethral diverticulum and hematuria History: hematuria. PELVIS: FemaleUTERUS, ADNEXA: A tampon is present within the vagina. There is a left-sided nabothian cyst.There is a multiseptated cystic along the left anterior aspect of the vagina, posterior to the urethra which measures 1.4 x 1.1 x 5.1 cm (5/21 and 8/33). This lesion extends above the origin of the urethra. No definite communication with the urethra is identified, however, evaluation is limited due to lack of intravenous contrast.BLADDER: There is a punctate cystic foci along the left anterior aspect of the urethra (5/15) without definite communication.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1.Cystic lesion between the bladder and urethra which extends above the origin of the urethra. No definite communication with the urethra is identified, however evaluation is limited due to lack of intravenous contrast. At this point, differential diagnosis includes a Gardner duct cyst or a urethral diverticulum, with a Gardner duct cyst favored. However, it is recommended that the patient return for post contrast sequences as this may be helpful.2.Punctate cystic foci adjacent to the distal urethra without definite communication is nonspecific.


Instruction: Generate impression based on medical findings.

Input: 61 years Female (DOB:11/30/1954)Reason: Left hemi sensory disturbance and face pain History: abovePROVIDER/ATTENDING NAME: THOMAS J. KELLY THOMAS J. KELLY The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 22 x 15 mm axial dimension CSF collection adjacent to the right cerebellar hemisphere which could represent a small arachnoid cyst.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 right vertebral artery is very small. There appears to be fetal origin of the right posterior cerebral artery.The cerebellar tonsils extend 1 mm below the level of the foramen magnum.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.No intracranial lesions appreciated which can explain the patient's hemisensory disturbance. There is a small arachnoid cyst present in the posterior fossa.2.There is a small right-sided vertebral artery which could simply be congenital. If there is clinical concern for right vertebral artery disease, specific imaging of vertebral arteries may be of benefit.


Instruction: Generate impression based on medical findings.

Input: Male; 77 years old. Reason: Probable renal cell carcinoma by prior MRI. Please evaluate progression History: As above ABDOMEN:LIVER, BILIARY TRACT: T2 hyperintense lesions in both lobes of the liver do not demonstrate enhancement and are consistent with cysts, similar to prior study. No suspicious hepatic lesions. Mild diffuse hepatic steatosis. Portal and hepatic veins are patent.SPLEEN: T2 hyperintense splenic lesion has slightly increased in size and measures up to 15 x 10 mm (series 805/300), previously 13 x 8 mm; the lesion demonstrates gradual internal enhancement on delayed phase images, most suggestive of a benign hemangioma, which can grow. Additional nonspecific, smaller T2 hyperintense splenic lesions are not significantly changed, likely due to additional benign lesions.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small exophytic, peripherally enhancing lesion arising from medial aspect of lower pole which measures 9 mm, previously 9 mm, which again may be due to a renal cell carcinoma (series 801/132). Additional nonenhancing simple and hemorrhagic cysts in both kidneys, not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable levoscoliosis lumbar spine.OTHER: No significant abnormality noted.

Output: Unchanged enhancing 9 mm lesion arising from the inferomedial right kidney, which again may be due to a small renal cell carcinoma.


Instruction: Generate impression based on medical findings.

Input: 65-year-old man with painful left side Horner's syndrome. History of lung cancer status post surgery, chemotherapy and radiation. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are unchanged scattered punctate foci of white matter T2 hyperintensity. There is unchanged encephalomalacia in the left occipital lobe. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact.Neck: There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. There is an asymmetric appearance of the left internal carotid artery flow void, with areas of higher intraluminal signal. The osseous structures are unremarkable. The airways are patent. There is left apical scarring.

Output: 1.No evidence of metastatic disease in the head or neck, although portion of the neck are obscured by artifact on certain sequences.2.Unchanged minimal chronic small vessel ischemic disease and left occipital lobe cortical encephalomalacia.3. Asymmetric appearance of the left internal carotid artery flow void may be attributable to artifact or atherosclerotic plaque, although a dissection cannot be excluded. However, if there is persistent concern for dissection, dedicated vascular imaging is recommended.


Instruction: Generate impression based on medical findings.

Input: 84-year-old female with severe right shoulder pain ROTATOR CUFF: There is intermediate signal within the supraspinatus tendon at its myotendinous junction without extension to the articular or bursal surface, favored to represent tendinopathy. There is fatty atrophy of the supraspinatus, infraspinatus, subscapularis, and teres minor muscles. No discrete full thickness tear is evident. SUPRASPINATUS OUTLET: Moderate osteoarthritis of the acromioclavicular joint with osteophytes. The humeral head is high riding.GLENOHUMERAL JOINT AND GLENOID LABRUM: Severe narrowing of the glenohumeral joint with osteophytosis compatible with severe osteoarthritis. The glenoid labrum is blunted with osteophytes arising from the glenoid rim compatible with degenerative fraying and fragmentation.BICEPS TENDON: The long head of the biceps tendon is intact.ADDITIONAL

Output: 1.Supraspinatus tendinopathy with fatty atrophy of the rotator cuff muscles and deltoid muscle. No discrete fluid-filled tear is evident. 2.Severe osteoarthritis affects the glenohumeral joint and moderate osteoarthritis affects the acromioclavicular joint.3.Other findings as above.


Instruction: Generate impression based on medical findings.

Input: 34-year-old female with lower abdominal pain for two weeks and elevated white blood cell count. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: There is a small, subcentimeter hypodense lesion in the body of the pancreas (series 3 image 43/162). Recommend follow up with MRI to further characterize this lesion.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense, well circumscribed lesion in the lower pole of the left kidney, likely a simple cyst and without clinical significance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There are two cystic lesions in the left adnexa with surrounding inflammation compatible with pelvic inflammatory disease. There may be a left sided tubo-ovarian abscess and it is recommended to follow-up with pelvic ultrasound to further characterize this lesion.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is fluid in the left paracolic gutter. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted

Output: 1. There are two cystic lesions in the left adnexa with surrounding inflammatory changes consistent with pelvic inflammatory disease. There is also some concern for possible tubo-ovarian abscess and it is recommended to follow up with pelvic ultrasound to further characterize the left adnexa. 2. There is a small subcentimeter hypodense lesion in the body of the pancreas which should be followed up with MRI to further characterize its nature.


Instruction: Generate impression based on medical findings.

Input: 44 year old with biopsy proven right breast cancer with metastatic right axillary lymph node presents for I-SPY research MRI, pre-chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts.Marked parenchymal enhancement is noted bilaterally.Biopsy proven index cancer is present as an enhancing mass at posterior 3 o'clock position in the right breast, measuring 19 x 25 x 25 mm (AP x LR x CC). Marker clip is identified within the mass. Biopsy proven satellite lesion is present as an enhancing mass at anterior 3 o'clock position in the right breast, measuring 9 x 9 x 7 mm, with internal marker clip. There are several small masses and non mass enhancements between these two masses. In addition, there is an enhancing mass measuring 6 mm at lateral retroareolar region of right breast. Overall measurement from the index mass to the proven satellite lesion is 55 mm, and to the most anterior lateral retroareolar mass is 79 mm.There is extensive fluid filling dilated ducts in the right outer breast. There is no distinct suspicious enhancement around these duct.In the right axilla, a biopsy proven metastatic lymph node is visualized at upper aspect with internal marker clip, measuring 11 mm in maximum diameter.No abnormal enhancement is seen in the left breast. No abnormal lymph nodes are identified in left axillary region.

Output: 1. Biopsy proven index cancer and satellite mass in the right inner breast with multiple additional masses and non mass enhancements.2. Biopsy proven right metastatic axillary lymph node.3. No MRI evidence for malignancy in the left breast or left axilla. BIRADS:6 - Known cancer. RECOMMENDATION:X - No Letter.


Instruction: Generate impression based on medical findings.

Input: 45 years Male (DOB:5/23/1971)Reason: assessment for cause of dysarthria; further evaluation of punctate hypodensity in R thalamus on CT wo History: dysarthria after induction chemotherapy for AML (high dose cytarabine and mitoxantrone)PROVIDER/ATTENDING NAME: OLATOYOSI M ODENIKE There are punctate foci of signal loss and susceptibility weighted imaging left orbital gyrus, in the left inferior frontal gyrus as well as in the left frontal centrum semiovale. Additional punctate foci of signal loss and susceptibility imaging are present within the left cerebellar hemisphere.No abnormal enhancing mass lesions are appreciated within the brain parenchyma.The cerebellar tonsils extend 4 mm below the level of foramen magnum.The punctate hypodensity in the right thalamus and the CT scan probably represents a tiny perivascular space. It is bright on T2 imaging and dark on FLAIRNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.The right parotid gland extends into the buccal region. The left parotid gland is not identified on this exam it the exception of an accessory component of the left buccal tissues. Deep lobes of the parotid glands are not identified.

Output: 1.There are several microhemorrhages present in the left frontal lobe and the left cerebellar hemisphere. These are nonspecific. One possibility is that this is related to prior trauma though it is nonspecific related to other pathology.2.The punctate hypodensity in the right thalamus and the CT scan probably represents a tiny perivascular space3.No evidence for acute ischemic cerebral infarction.4.Low-lying cerebellar tonsils are borderline for Chiari I malformation.5.The parotid glands appear to be small and hypoplastic.


Instruction: Generate impression based on medical findings.

Input: Liver cyst, complex. Evaluate for biliary cyst adenoma. Liver ultrasound with enlarging cyst. ABDOMEN:LIVER, BILIARY TRACT: 4.9 x 3.3 cm right hepatic lobe lobulated cystic lesion with multiple thick septations (series 7, image 25), not significantly changed in size from prior US allowing for differences in technique. No calcifications or enhancing solid nodularity in this lesion on post-contrast sequences.Small scattered simple hepatic cysts are noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Septated complex cystic lesion in the right hepatic lobe, not significantly changed in size from recent US. This may represent a biliary cystadenoma, other possibility is a complex cyst.


Instruction: Generate impression based on medical findings.

Input: 45-year-old male with right shoulder pain after surgery in September 2015. ROTATOR CUFF: No significant abnormality noted.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: There is a linear tear that fills with gadolinium of the anterior inferior labrum without displaced fragment.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: Linear tear of the anterior inferior labrum without other significant abnormality.


Instruction: Generate impression based on medical findings.

Input: Clinical question: History of lung cancer, please compare to prior study and measure. Signs and symptoms: None. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate stable post surgical/treatment changes of left frontal region without interval change or recurrence of disease.Findings at the site include a focus of cortical and subcortical encephalomalacia at the resection site.Additionally examination demonstrate diffuse T2/FLAIR hyperintensity of bilateral hemispheric white matter similar to prior exam and consistent with post treatment/radiation change.Ventricular system are mildly dilated similar to prior study and with maintained midline.Small focus of encephalomalacia in the right inferior frontal lobe and the surrounding gliosis and without intravenous enhancement is again noted and representing focus of treated metastatic lesion.Calvarium demonstrate postop changes and unremarkable otherwise.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.

Output: 1.No acute intracranial process or evidence of new findings since prior study.2.Stable extensive post treatment and surgical changes for treatment of metastatic lesions since prior study.3.No detectable metastatic lesion on this exam.4.Stable diffuse white matter FLAIR hyperintensity of cerebral hemispheres consistent with posttreatment/radiation change.


Instruction: Generate impression based on medical findings.

Input: The pituitary gland enhances homogenously. There is no evidence of sellar or parasellar lesions. The infundibulum is intact and situated in the midline. There is an intact posterior pituitary bright spot. The optic apparatus is intact. There are nonspecific scattered foci of T2 hyperintensity in the partially-imaged cerebral white matter.

Output: No evidence of pituitary adenoma or other sellar lesion. 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: 35-year-old with history bilateral breast cancers. Prior benign MRI guided biopsy of the left breast. There is scattered fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.No abnormal enhancement is seen in either breast. Postsurgical changes in each breast are noted. No abnormal lymph nodes are identified in either axillary region.

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


Instruction: Generate impression based on medical findings.

Input: Thoracic spine pain. Compared to prior CT chest of 8/17/2011, there has been slight interval progression of diffuse metastatic disease involving the thoracic spine, from T1 to T8 levels. For example, there is increased lytic lesion at T2 level. There is involvement of both anterior and posterior columns. There is soft tissue mass component of the spine metastasis, with epidural components extending into the spinal canal and neural foramina, with likely impingement of spinal cord and exiting nerves. These findings can be further characterized with MRI.There is compression fracture of T6 and T4 levels, which appears unchanged. Endplate depression of T5 is also noted, and also appears unchanged.Rib metastasis is present.There is tortuous thoracic aorta, with atherosclerotic changes.

Output: 1. Progression of diffuse metastatic disease in the thoracic spine, with epidural components that likely result in spinal cord and nerve impingement. Correlation with MRI thoracic spine is recommended.2. Pathological compression fractures at T4, T5, and T6 levels, not significantly changed. No evidence of new fracture.3. Rib metastasis. Please correlate with CT chest.


Instruction: Generate impression based on medical findings.

Input: 70-year-old with fat malabsorption. Concern for obstructing lesion in the pancreatic head. ABDOMEN:LIVER, BILIARY TRACT: The liver is normal in morphology. There is diffusely decreased parenchymal signal and signal dropout on the in phase images compatible with iron deposition. No focal mass lesion.There are multiple dependent stones within the gallbladder. No intrahepatic or extrahepatic biliary ductal dilatation. Common bile duct is normal in size and contour.SPLEEN: The splenic parenchyma has diffusely decreased signal compatible with iron deposition.PANCREAS: The pancreas is mildly atrophic, but maintains normal signal. No obstructing lesion is identified within the limits of a noncontrast exam. There is pancreatic divisum with the main duct draining into the minor papilla (series 501 image 22). The main pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There are multiple cysts in the kidneys bilaterally. One cyst in the superior pole of the left kidney is minimally complex containing a few thin septations. No mass lesion or hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes from Roux-en-Y gastric bypass.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Pancreatic divisum without associated dilatation of the main pancreatic duct. No obstructing mass lesion is identified within the pancreatic head.2.Cholelithiasis without evidence of choledocholithiasis. No biliary ductal dilatation.3.Findings of hemosiderosis with increased iron content in the liver and spleen.


Instruction: Generate impression based on medical findings.

Input: Left optic neuritis. There are multiple, greater than 10, foci of high T2 signal in the supratentorial and infratentorial white matter. Many of the lesions display T1 hypointensity, but do not enhance. There may also be high T2 signal lesions in the bilateral intraorbital optic nerves versus volume averaging, but the sequences are not optimized for evaluation of this anatomy. 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 skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: Findings compatible with supratentorial and infratentorial demyelinating lesions, but no evidence of active inflammation. There may be demyelinating lesions in the bilateral intraorbital optic nerves versus volume averaging, but the sequences are not optimized for evaluation of this anatomy.


Instruction: Generate impression based on medical findings.

Input: Male, 34 years old, with GBM, s/p 2 cycles of Avastin, compare to 4/7/16 scan. Postoperative findings are again seen compatible with prior left frontal lobe tumor resection. The resection cavity is not significantly changed in size and the fluid in the cavity continues to progress slowly toward CSF signal on FLAIR images.Since the prior examination, soft tissue thickening inferior to the resection bed has progressed. Two previously small cystic cavities within this tissue, presumably related to prior instrumentation, have expanded. Irregular enhancement associated within this thickened tissue has also progressed. In particular, there is progressive extension of enhancement into the genu of the corpus callosum.No new areas of focal parenchymal signal abnormality or pathologic enhancement are detected elsewhere. Periventricular T2 hyperintensity, particularly around the frontal horns, has not significantly changed and is likely treatment related. The ventricles are stable in size and morphology.

Output: Soft tissue thickening inferior to the left frontal resection cavity has progressed along with associated enhancement. There is, in addition, further extension of enhancing tissue into the genu of the corpus callosum. These findings are concerning for progressive tumor with inflammation or treatment related effect considered less likely.


Instruction: Generate impression based on medical findings.

Input: 83-year-old male with severe foot pain with ulcer, rule out osteomyelitis There are postsurgical changes of transmetatarsal amputation as seen on prior radiographs. There is edema within the lateral aspect of the foot and immediately adjacent to the stump. There is also ulceration and skin thickening in the soft tissues immediately adjacent to the stump with edema approaching the bone, however there is no definite signal abnormality to indicate osteomyelitis. There is edema within the fifth metatarsal stump without associated low T1 signal, likely representing reactive osteitis. Linear T1 signal through the fifth metatarsal stump may represent an old nondisplaced fracture. Edema is also seen within the subcutaneous tissues along the posterior aspect of lower leg and medial aspect of the ankle. No focal fluid collection is present.

Output: Ulceration along the distal stump with edema extending to the bones, however there is no definite evidence of osteomyelitis.


Instruction: Generate impression based on medical findings.

Input: Neck pain, arm pain, history of C4-C7 with instrumentation. Mid back pain and numbness. CERVICAL: There are postsurgical changes of anterior cervical discectomy and fusion from C4 through C7. Interbody grafts, anterior plate, and screws can be better assessed with radiographs or CT, but demonstrate no gross evidence of displacement compared to radiograph from 2/25/2014.Spinal canal caliber is significantly improved from the C4 to C7 levels without residual spinal canal stenosis at these levels. There is a disc bulge at the C3-C4 level which contributes to mild spinal canal stenosis and appears slightly worse since prior MRI. No cord signal abnormality. Additional details described level by level as below: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: Mild disc bulge and uncovertebral hypertrophy. There is mild spinal canal stenosis. There is mild right and moderate to severe left neural foraminal stenosis.C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal. There is mild right and no significant left neural foraminal stenosis.C6-7: No significant compromise to the spinal canal or right neural foramen. There is mild to moderate left neural foraminal narrowing related to facet arthropathy and uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal. Mild to moderate left neural foraminal stenosis related to facet arthropathy. Right neural foramen is patent.THORACIC: Vertebral body heights in the thoracic spine are normal. There is a small Schmorl's node involving the inferior endplate of T8. There is mild levocurvature of the upper thoracic spine and dextrocurvature of the mid to lower thoracic spine.There are mild to moderate degenerative changes. At T2-T3 and T3-T4, there are right paracentral disc protrusions which contact the right ventral cord. At T6-T7, a left paracentral disc protrusion contacts the left ventral aspect of the cord. Small disc bulge at T7-T8 without stenosis. Small central protrusion at T8-T9 without stenosis. Scattered mild multilevel ligamentum flavum thickening and facet arthropathy also noted. There is no high-grade spinal canal stenosis at any level in the thoracic spine. No cord signal abnormality. There is also multilevel mild to moderate neural foraminal narrowing in the upper thoracic spine which is suboptimally evaluated due to motion degradation.

Output: 1. Postsurgical changes of anterior cervical fusion from C4 through C7. Previously seen spinal canal stenosis from C4-C5 to C6-C7 has resolved. There is mild spinal canal stenosis at the C3-C4 level related to disc bulge. No cord signal abnormality. Multilevel neural foraminal stenosis, particularly on the left, as detailed above.2. Mild to moderate degenerative changes in the thoracic spine without high-grade spinal canal stenosis at any level.


Instruction: Generate impression based on medical findings.

Input: Enhancing, intrinsically T1 hyperintense treated metastatic lesion in the right superior frontal gyrus is essentially stable to minimally increased in size, measuring 1.1 x 0.9 cm (series 1201, image 117), previously measuring 1.0 x 0.8 cm. Area of enhancement in the center of the lesion has become more bilobed in appearance. There is a nonenhancing cystic degenerative appearing component located just laterally. Marginal surrounding FLAIR hyperintensity is again noted. This lesion is also associated with susceptibility artifact.There is subtle interval increase in size of the punctate enhancing metastasis in the right superior occipital lobe, now measuring up to 6 mm, previously 4 mm. The left posterior temporal occipital metastatic lesion appears stable to minimally increased in size measuring 5 x 4 mm, previously measuring 4 x 4 mm. This lesion also is more confluent in enhancement and is also associated with susceptibility artifact. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are stable scattered nonspecific punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which may represent mild chronic small vessel ischemic changes in a patient of this age. A tiny anterior right parietal developmental venous anomaly is again seen. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental nonenhancing cystic structure associated with the pineal gland is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. Stable heterogeneous appearance with overall diffusely decreased T1 signal intensity of the calvarium, with more normal-appearing marrow in the clivus. Postoperative changes are seen from previous bilateral antrostomies. Patchy mild opacification of the ethmoid air cells and possible small air-fluid levels in the bilateral maxillary sinuses.

Output: 1. Stable to subtle interval increase in size of bilateral supratentorial metastatic lesions. There is a definite gradual increase in size of these lesions when compared to the more remote exam on 10/6/2015.2. Stable appearance of nonspecific, nonenhancing punctate foci of T2/FLAIR hyperintensity within the white matter.3. Possible small air-fluid levels in the bilateral maxillary sinuses. Correlate clinically for acute sinusitis.


Instruction: Generate impression based on medical findings.

Input: 44 year-old female history of mass seen on prior ultrasound. ABDOMEN:LIVER, BILIARY TRACT: Segment 6 lesion correlating to prior ultrasound measuring 2.7 x 2.0 cm demonstrating mildly increased T2 and decreased T1 signal abnormality with rapid relatively diffuse contrast enhancement with iso to slightly hyperenhancement on delayed series. On hepatobiliary phase there is relatively decreased uptake within the lesion. There is a small amount of fat noted within the periphery as well as mild homogeneous restricted diffusion.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Segment 6 lesion with imaging characteristics most compatible with a hepatic adenoma.


Instruction: Generate impression based on medical findings.

Input: There is a subcentimeter focus of mild restricted diffusion overlying the posterior limb of the left internal capsule which has a "ring" appearance demonstrating a lack of restricted diffusion centrally. This correlates with a minimal hypointense ring on ADC with central hyperintensity. T2 imaging demonstrates this to be hyperintense, T1 is hypointense, and there is no contrast enhancement. There is also no associated susceptibility abnormality or mass effect.There are multiple foci of T2 hyperintensity throughout the periventricular and subcortical white matter without associated mass effect, restricted diffusion, susceptibility abnormality, or enhancement.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.

Output: 1.Resolving, late subacute lacunar infarct overlying the posterior limb of the left internal capsule. There is no acute ischemia.2.Chronic small vessel ischemic disease.


Instruction: Generate impression based on medical findings.

Input: Evaluate hemangioma. ABDOMEN:LIVER, BILIARY TRACT: The left hepatic lobe partially exophytic hemangioma measures approximately 12.5 x 8.4 cm (series 301/26), compared to 12.1 x 8.1 cm previously.Multiple additional lesions with similar imaging characteristics are not significantly changed in size or number.The segment 6 mildly T2 hypointense lesion with imaging characteristics suggestive of focal nodular hyperplasia measures approximately 3.4 x 3.2 cm (series 902/1 57), compared to 3.4 x 3.0 cm previously.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Essentially stable hemangiomatosis with the dominant left hepatic lobe hemangioma measuring approximately 12.5 x 8.4 cm.Stable segment VI lesion with imaging characteristics of a FNH.


Instruction: Generate impression based on medical findings.

Input: 40-year-old male with a history of neurofibromatosis type I, evaluate margins of neurofibromas deep within the buttocks. Several sequences are limited by patient motion artifact.There are several subcutaneous masses overlying the gluteus maximus compatible with small nerve sheath tumors appearing similar to those seen on the prior study. No large tumor along the expected course of the proximal sciatic nerve or elsewhere deep within the buttocks.Small nerve sheath tumors are noted along the right S3 and S4 nerve roots appearing similar to the prior study. There are tiny nerve sheath tumors anteriorly and within the pelvis.There is mild poorly-defined edema type signal within the lateral portion of the gluteus maximus muscle at the level of the proximal femur. The signal is nonspecific and could represent a mild strain. Of note, a similar finding was present in retrospect on the prior study.Bone marrow signal intensity is normal. Mild osteoarthritis affects both hips with what appears to be bilateral CAM deformities. Mild signal abnormality in the acetabular labra bilaterally, which may reflect tearing. The hamstring tendons appear normal.

Output: 1. Multiple small nerve sheath tumors compatible with patient's stated diagnosis of neurofibromatosis type I. However, no dominant deep buttock lesion is identified.2. Mild edema type signal within the gluteus maximus laterally, as described above, is nonspecific and could represent a strain. However, similar findings were present on the prior study.3. Other findings as described above.


Instruction: Generate impression based on medical findings.

Input: Intermittent back pain. History of bone metastasis is from lung cancer. There is bone marrow edema surrounding the focal T1-hypointense, T2-hyperintense, contrast-enhancing lesions involving the anterior superior L2 vertebral body, left posterolateral L2 vertebral body, and left L5 vertebral body/pedicle junction. There is also a metastatic lesion involving the left L3 transverse process associated with abnormal signal and contrast enhancement in the ipsilateral vertebral body and pedicle marrow as well as the adjacent paraspinal soft tissues. Smaller osseous lesions are present in the spinous processes of T10, L3 and L4. There is no displaced pathologic fracture or osseous expansion. Similar metastatic involvement is present in the partially imaged right iliac bone and right sacral ala. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. There is mild disc bulges and desiccation at L4-L5 and L5-S1. The disc bulges, combined with facet arthropathy and ligamenta flava thickening, result in mild-to-moderate left and mild right L5-S1 and mild bilateral L4-L5 neural foraminal narrowings. There is no significant spinal canal stenosis. The caudal spinal cord displays normal signal and morphology. The tip of the conus medullaris lies at upper L2 level. There is a small lower sacral perineural cyst. There are multiple, poorly contrast-enhancing right renal masses, which are not completely imaged, compatible with metastasis. The left kidney is absent. There are small, nonspecific para-aortic lymph nodes.

Output: 1.Multiple spine and pelvic osseous metastasis, but no displaced, pathologic fracture, or osseous expansion. However, these metastatic osseous lesions are associated with surrounding marrow edema. The lesion in the left L3 transverse process is associated with abnormal signal in the adjacent soft tissues as well.2.Mild lower lumbar spondylosis worst at the left L5-S1 neural foramen causing mild-to-moderate stenosis. No significant spinal canal stenosis.3.Multiple right renal masses are not completely imaged, but compatible with metastasis. Please refer to the report of the abdomen/pelvis CT scan from May 25, 2016 for additional details. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on medical findings.

Input: History mantle cell lymphoma. Brain: There is now diffuse enlargement and enhancement of bilateral trigeminal nerves and new enhancement along the bilateral cranial nerve 7 and 8 complexes, particularly in the internal auditory canals, right greater than left, as well as the bilateral oculomotor nerves and bilateral cranial nerve 10 and 11 complexes. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a right transfrontal Ommaya catheter. There is extensive confluent cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small left maxillary sinus retention cyst.Cervical Spine: There is persistent diffuse enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots. Otherwise, there is no evidence of tumor or abnormal enhancement within the cervical spinal canal. The spinal cord displays normal signal and morphology. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is unchanged mild multilevel degenerative spondylosis, but no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Interval increased and new enhancement and enlargement involving multiple cranial nerves, which is suggestive of lymphoma progression.2. Persistent diffuse enlargement of multiple bilateral cervical and upper thoracic extraforaminal enhancing nerve roots likely related to lymphoma.


Instruction: Generate impression based on medical findings.

Input: Compared to 12/10/2015, there is interval decrease in the size of some of the cystic components of the craniopharyngioma. The cystic component involving the left prepontine cistern demonstrates decrease in size from approximately 12 x 14 mm to 5 x 9 mm. There is improvement in mass effect on the left aspect of the pons. Previously seen fluid level within this component is no longer appreciated. In the right ambient cistern, a cystic component with T1 hyperintensity measures 10 x 10 mm which is overall not significantly changed in size however there is susceptibility effect and increased areas of T1 hyperintensity compatible with evolution of blood products and perhaps component of proteinaceous material. There is no new mass effect. There continues to be involvement of the prepontine, cerebellopontine angle, right ambient and right quadrigeminal cisterns, as well as the right middle cranial fossa, with associated mass effect upon the brainstem, right medial temporal lobe, and hypothalamus-optic apparatus complex. No enlarging enhancing component. Leftward displacement of the pons and contour deformity involving the right lateral aspect of the midbrain is not significantly changed. There is unchanged volume loss of the left cerebellar hemisphere associated with increased T2 signal, which may be attributable to crossed cerebellar diaschisis versus chronic injury. The basilar artery is tortuous and encased by the tumor. There is stable position of right transfrontal catheter with the tip in the right prepontine cyst. The ventricular system appears to be unchanged. There are foci of susceptibility effect within the right temporal lobe resection cavity, consistent with hemosiderin deposition, and within portions of the tumor particularly in the suprasellar cistern, which likely represent calcifications.

Output: Compared to 12/10/2015, there is further regression of some of the peripheral cystic components of the complex suprasellar and posterior fossa craniopharyngioma, particularly in the left prepontine region where there is associated improvement in mass effect.


Instruction: Generate impression based on medical findings.

Input: History of metastatic carcinoid tumor. Interval follow-up exam. ABDOMEN:LIVER, BILIARY TRACT: There is redemonstration of multiple T2 hyperintense enhancing lesions throughout the liver. Accounting for differences in technique, the majority of the lesions appear slightly smaller compared to prior. The reference segment 7 lesion measures 2.1 x 1.5 cm (series 8 image 22), previously 2.1 x 1.9 cm. No new lesions are identified.There is stable prominence of the common bile duct measuring 11 mm, previously 12 mm. No obvious stricture or mass lesion.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic divisum without pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal cyst and additional bilateral T2 bright foci which are too small to characterize but also likely represent additional cysts.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Slight interval decrease in size of multiple hepatic metastatic lesions compatible with treatment response. No new lesions are identified.2.Stable mild dilatation of the common bile duct.


Instruction: Generate impression based on medical findings.

Input: Intracranial mass. There is an irregularly rim-enhancing mass centered in the right temporal stem that measures up to approximately 3 cm, with multiple adjacent smaller peripherally-enhancing nodules and extensive surrounding edema involving right thalamus, right middle cerebral peduncle, right basal ganglia, and right frontal lobe. There is a small amount of susceptibility effect in the dominant mass, but no evidence of acute intracranial hemorrhage or acute infarct. There are areas of T2 hyperintensity in the right parietal lobe white matter without corresponding enhancement. There is effacement of the temporal horn of the right lateral ventricle and mild midline shift to the left, but no herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are retention cysts in the left maxillary sinuses.

Output: A dominant mass centered in the right temporal stem that measures up to approximately 3 cm, with multiple satellite lesions likely represents a high grade glial neoplasm. Nonenhancing white matter lesions in the right parietal lobe are nonspecific.


Instruction: Generate impression based on medical findings.

Input: Adrenal mass seen on the prior CT. History of sweating, anxiety, hypertension. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Left adrenal enlargement measuring 4.2 x 3.9 cm. This enlargement is predominantly cystic with internal fluid-fluid compatible with hemorrhage. The thin rim of adrenal tissue does not enhance suspiciously or have an associated soft tissue nodule/mass evident.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted. No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Punctate focus of diffusion restriction in the right psoas, partly imaged, likely represents a neurofibroma.OTHER: No significant abnormality noted otherwise.

Output: Left adrenal hemorrhage, without adrenal mass identified. A follow-up MRI in 3-6 months is recommended to assess for an underlying mass as a potential etiology for hemorrhage.


Instruction: Generate impression based on medical findings.

Input: cT1N0 nasopharynx squamous cell carcinoma status post treatment. There are post-treatment findings in the neck. There has been continued interval decrease in size of the right posterior nasal cavity mass, which now measures up to approximately 4 mm, previously 6 mm. There is no evidence of significant cervical lymphadenopathy based on size criteria. There is elevated T2 signal in the trapezius muscles bilaterally, which may be due to denervation effects. The thyroid and major salivary glands are unremarkable. The major cervical arterial flow voids appear to be intact. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable.

Output: Post-treatment findings in the neck with continued interval decrease in size of the nasal cavity mass.


Instruction: Generate impression based on medical findings.

Input: Right knee pain. Possible medial meniscus tear. MENISCI: The medial and lateral menisci are intact.ARTICULAR CARTILAGE AND BONE: The articular cartilage of all three compartments is intact. Bone marrow signal is within normal limits. LIGAMENTS: The cruciate and collateral ligaments are intact. EXTENSOR MECHANISM: The extensor mechanism is intact.ADDITIONAL

Output: 1. Intact menisci and ligaments.2. Questionable loose body vs medial PLICA adjacent to the medial patellar facet.


Instruction: Generate impression based on medical findings.

Input: Ulnar sided wrist pain. Direct tenderness over hamate. Evaluate right wrist for hamate fracture and TFCC/wrist ligament injury. There is contrast within the radiocarpal joint and its recesses, as expected. Although there is a small amount of fluid within the distal radioulnar joint, I see no gadolinium within the distal radioulnar joint nor do I see a tear of the articular disk of the triangular fibrocartilage complex. Gadolinium is present, however, within the soft tissues along the medial and volar aspects of the distal ulna, and there is also a small amount of contrast within the extensor carpi ulnaris tendon sheath. Furthermore, the ulnar sided capsular structures, including the meniscal homolog, are indistinct. These findings suggest a "peripheral" tear of the triangular fibrocartilage complex with an intact articular disk. Furthermore, the extensor carpi ulnaris tendon is subluxed medially from its groove suggesting a subsheath injury. The ulnar sided attachment of the subsheath is not well visualized and I suspect is torn. The tendon is subluxed on both pronation and supination. The remaining tendons appear normal. No contrast is seen extending into the midcarpal joint to suggest a tear of the scapholunate or lunotriquetral ligament. Bone marrow signal intensity is within normal limits; specifically, the hamate appears normal. See no abnormalities of the ulnar and median nerves.

Output: "Peripheral" tear of the triangular fibrocartilage complex with an intact articular disk, as well as an extensor carpi ulnaris subsheath injury with tendon subluxation, as described above. I see no fracture.


Instruction: Generate impression based on medical findings.

Input: Reason: Arthrofibrosis S/P patellar tendon repair History: stiff knee MENISCI: There is slight truncation of the free edge of the body of the lateral meniscus which may reflect prior partial meniscectomy or chronic attritional tearing. Otherwise the lateral meniscus appears intact. The medial meniscus appears intact.ARTICULAR CARTILAGE AND BONE: Moderate to severe osteoarthritis affects the patellofemoral joint with focal full-thickness articular cartilage loss along the femoral trochlea, centrally, and additional full-thickness cartilage loss along the lateral facet. There is additional degeneration of the articular cartilage of the patella. The medial and lateral compartment articular cartilage appears intact.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: There is linear signal abnormality extending vertically through the patella presumably related to prior patellar tendon repair. There is deformity of the patellar tendon, the distal half of which appears thickened with the proximal half appearing thinned. Although the thinned proximal fibers can be followed to the patella on the sagittal sequences, they are less well-defined on the axial series and we are uncertain if these low signal fibers reflect residual patellar tendon or simply scar tissue related to chronic rupture. Furthermore, there is a 2 cm ossicle replacing the lateral fibers of the proximal patellar tendon. The quadriceps tendon appears slightly thickened but appears intact.ADDITIONAL

Output: 1. Surgical changes compatible with prior patellar tendon repair with deformity of the patellar tendon as described above that may in part represent scar tissue from chronic rupture.2. Osteoarthritis of the patellofemoral joint and other findings as described above.


Instruction: Generate impression based on medical findings.

Input: 56 years Female (DOB:2/4/1960)Reason: L sided wekaness, slurred speech History: s/p TPA, pls see abovePROVIDER/ATTENDING NAME: FERNANDO D. GOLDENBERG FERNANDO D. GOLDENBERG The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is some asymmetric subtle difference in the in signal intensity of the right middle cerebellar peduncle compared to the left. This is not confirmed on coronal imaging. There is no clear-cut mass effect associated with this is possible is related to artifact.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 opacities in the sphenoid sinus and left posterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: There is no evidence for acute ischemic cerebral infarction. No intracranial lesion is appreciated which would explain the patient's left-sided weakness and slurred speech.


Instruction: Generate impression based on medical findings.

Input: There are approximately 10 punctate foci of T2 and FLAIR hyperintensity within the supratentorial white matter, primarily within the bilateral frontal lobes. These are nonspecific in appearance and distribution and may be related to prior inflammation, ischemia or perhaps demyelination. No infratentorial lesions. There is no abnormal intracranial enhancement or diffusion abnormality. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles, sulci and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. Mild cerebellar tonsillar ectopia is noted, with descent of the tonsils approximately 5 mm below the level of the foramen magnum. MRI ORBITS

Output: 1. Scattered punctate foci of T2/FLAIR hyperintensity within the supratentorial white matter are nonspecific in appearance and distribution and may be related to prior inflammation, ischemia or perhaps demyelination (although not typical for demyelination).2. There is significant motion degradation of the orbital MRI sequences which limits evaluation for optic neuritis. Within this limitation however no obvious signal abnormality within the optic nerves or orbital mass is evident.3. Low-lying cerebellar tonsils incidentally noted.


Instruction: Generate impression based on medical findings.

Input: MRI Brain: There are unchanged post-treatment and post-biopsy findings with encephalomalacia and hemosiderin staining in the right cerebellar hemisphere. Areas of high T2 signal, most notably in the right periventricular parietal white matter, are unchanged. There are also unchanged foci of susceptibility effect in the left anterior cingulate gyrus and right globus pallidus. There is no evidence of acute 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. The skull, orbits, and scalp soft tissues are unremarkable. There is mild mucosal thickening in the right maxillary sinus.MR Spectroscopy: Spectroscopy was performed at multiple TEs of the dominant right periventricular parietal lesion as well as normal contralateral white matter. The spectroscopic patterns obtained from the lesion and from the contralateral normal tissue demonstrate minimal difference, if at all.

Output: Sequelae of treated lymphoma of the right cerebellar hemisphere and left cingulate gyrus, which appear stable. Areas of signal abnormality in the right parietal periventricular region are stable as well with no evidence of new lesions. Spectroscopic assessment of one of the right parietal periventricular lesions demonstrates no evidence of any aggressive or actively proliferative process.


Instruction: Generate impression based on medical findings.

Input: Male, 76 years old, with progressive left temporal GBM. Functional assessment of speech is required for surgical planning. Of the tested language paradigms, the most reliable language related cortical activation was seen with the verb generation and sentence completion paradigms. While language related activity was variably observed in both hemispheres depending on the paradigm, overall language cortical activation is left dominant. Broca's area activity is seen on both paradigms in it's expected location of the left inferior frontal gyrus, primarily pars triangularis and pars orbitalis. Wernicke's area activity is best visualized on the sentence completion paradigm where it is seen along the posterior aspect of the superior left temporal sulcus. On comparison to the most recent outside MRI, both Broca's and Wernicke's areas appear to be well removed from the enhancing lesion in the left temporal lobe, but both areas are closed approached by the non-enhancing T2 signal abnormality which surrounds the lesion.

Output: Successful functional MRI for language mapping with Broca's and Wernicke's areas identified on the left as above.


Instruction: Generate impression based on medical findings.

Input: Reason: change in brain lesions, pituitary? History: daily headaches. History of right carotid body. Ganglia,. There is a 1.5 cm lesion in the right frontal lobe with extensive susceptibility compatible with a prior hemorrhagic infarct. Surrounding FLAIR signal in the right centrum semiovale is slightly increased posteriorly. No evidence of new hemorrhage.Areas of increased T2 signal with associated susceptibility and mildly increased T1 signal in the right occipital lobe are unchanged and suggestive of laminar necrosis secondary to prior ischemia.No new areas of abnormal signal. No evidence of restricted diffusion. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. Absence of flow void in the right internal carotid artery with dilatation of the left internal carotid artery appears similar to the prior exam. Prominent ventricles may reflect a mild degree of volume loss. The orbits, skull and scalp soft tissues are grossly unremarkable. The paranasal sinuses are unremarkable. T1 hyperintense thickening along the pituitary stalk measuring 4 mm is unchanged.

Output: 1.Right frontal lobe hemorrhagic infarct with slightly increased surrounding T2 signal, within the expected progression of this lesion. 2.Right occipital laminar necrosis is unchanged.3.Absent flow-void in the right internal carotid artery is unchanged.4.Nonspecific pituitary stalk lesion is unchanged.


Instruction: Generate impression based on medical findings.

Input: 52-year-old female with left breast multicentric breast cancer, presents for needle localization. On review of the prior studies, breast MRI dated 7/20/2016 and mammogram dated 6/21/2016. Target spiculated mass morphology is located in the left breast in the superior region located anterior 12 o’clock, with adjacent 'lock-shaped' clip. Another target focal asymmetry with few pleomorphic calcifications at the left upper inner quadrant is located at the 2:00 position, also with adjacent biopsy clip.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 7 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Wire placement was performed for the two sites, anterior 12:00 lesion and posterior 2:00 lesion. Repeat two view orthogonal mammograms reveal the spring wire to be in excellent position. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Tremblay performed the procedure under direct supervision of Dr. Abe, who was present during the procedure at all times.Orthogonal digital specimen radiographs obtained from the more anterior target reveals the spiculated mass, lock shaped biopsy marker and spring wire to be within the specimen. Of note, spiculations extend to the anterior and superior margins of the specimen. Findings discussed with Dr. Jaskowiak , and additional tissue was resected along the margins (no image).Orthogonal digital specimen radiographs obtained from the more posterior target, reveals the clip and spring wire to be within the specimen. Additional tissue from lateral margin was excised (no image).

Output: Successful double needle localization of the left breast anterior upper mass and upper outer focal asymmetry.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.