Instruction: Generate impression based on findings.

Input: 56 year old man with asymmetric septal hypertrophy referred to evaluate for etiology. Left VentricleThe left ventricle is normal in size with normal systolic function. The is asymmetric hypertrophy of the interventricular septum. The maximum wall thickness is at the mid anteroseptum and is 19mm. The posterior wall thickness is 7mm. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 87 ml/m2 (normal range: 74+/-15), the LVEDV is 166 ml (normal range 142+/-34), the LV end systolic volume index is 36 ml/m2 (normal range 25+/-9), the LVESV is 69 ml (normal range 47+/-19), the LV mass index is 66 g/m2 (normal range 85+/-15), and the LV mass is 126 g (normal range 164+/-36). There are no regional wall motion abnormalities present. There is a patch of endocardial non-transmural late gadolinium enhancement involving the basal anteroseptum. The pattern is somewhat atypical for prior myocardial infarction and suggests the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is mildly dilated. Right VentricleThe right ventricle is normal in size and systolic function. The overall RV ejection fraction is 60%, the RV end diastolic volume index is 73 ml/m2 (normal range 82+/-16), the RVEDV is 140 ml (normal range 142+/-31), the RV end systolic volume index is 30 ml/m2 (normal range 31+/-9), and the RVESV is 56 ml (normal range 54+/-17).Right AtriumThe right atrium is mildly dilated.Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild mitral regurgitation. No evidence of systolic anterior motion of the mitral leaflets. 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 pseudobovine brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size.Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. There is asymmetric hypertrophy of the left ventricle with normal systolic function (LVEF 58%). The maximum wall thickness is 19mm. There is a small burden of atypical late gadolinium enhancement in the basal anteroseptum consistent with the presence of underlying myocardial fibrosis, inflammation, or infiltration. Taken together, these findings are most consistent with the diagnosis of hypertrophic cardiomyopathy. 2. Normal right ventricular size and systolic function (RVEF 60%).3. No evidence of systolic anterior mitral annular motion or left ventricular outflow obstruction.4. Mild biatrial dilation.


Instruction: Generate impression based on findings.

Input: 51-year-old female with severe headache status post fall. Rule out intracranial bleed cervical spine fracture and dislocation. There is no evidence of intracranial hemorrhage, mass or edema. Stable areas of bilateral posterior parietal encephalomalacia. Multiple diffuse areas of periventricular white matter hypodensity consistent with small vessel ischemic disease, age indeterminate. No new cortical stroke is seen. If there is clinical concern for acute ischemia, MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.CERVICAL SPINE: Cervical spine demonstrates normal alignment. Vertebral bodies and intervertebral disk spaces are within normal limits. No evidence of fracture or malalignment. Prevertebral soft tissues and airways within normal limits. Mild multilevel degenerative disease throughout the cervical spine.C3-4 demonstrates mild left neuroforaminal narrowing. No evidence of central spinal stenosis.C4-5 and C5-6 are within normal limits. C6-7 demonstrates osteophytes and diffuse disk bulge without evidence of central spinal stenosis.C7/T1 within normal limits.

Output: 1. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.2. Mild multilevel degenerative changes without evidence of fracture or malalignment.


Instruction: Generate impression based on findings.

Input: 52-year-old female rule out CVA. Left finger-to-nose dismetrix. Unstable gait, falling to left x 1 week This examination is within normal limits for patient's stated age of 52. In particular no evidence of stroke, hemorrhage, mass-effect, hydrocephalus or midline shift is detected. The ventricular system and cortical sulci and all CSF cisterns are within normal limits. Images through posterior fossa remains essentially unremarkable. Considering the provided clinical data an MRI examination is recommended.The bony message of calvarium, pneumatization of paranasal sinuses and mastoid air cells are also unremarkable.

Output: Negative CT examination of brain without infusion.


Instruction: Generate impression based on findings.

Input: 50 year-old man with Hodgkin's lymphoma status post chemotherapy now with altered mental status, focal neurologic deficits. Rule out CVA and increased intracranial pressure. There is no evidence of intracranial hemorrhage, mass or edema. There are no CT findings of stroke. If stroke remains a clinical concern, MRI is more accurate for detection of acute ischemia.The ventricles are normal in size and configuration. The suprasellar, basilar, and quadrigeminal cisterns are normal appearance.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Normal brain CT.


Instruction: Generate impression based on findings.

Input: 45-year-old female with history of well-differentiated retroperitoneal liposarcoma. Evaluate for recurrence. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No evidence of disease recurrence. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small amount of free pelvic fluid has decreased compared to the December 2015 examination and most likely physiologic in etiology.OTHER: No significant abnormality noted

Output: No evidence of disease recurrence.


Instruction: Generate impression based on findings.

Input: Clinical question: Stroke versus seizure. Signs and symptoms: Left facial droop. Nonenhanced brain MRI:No acute intracranial process and negative diffusion-weighted images.There are moderate primarily periventricular and minimally subcortical foci of FLAIR hyperintensity in bilateral cerebral hemispheres which are nonspecific however considering patient's stated age of 77 this appearance is often represent small vessel ischemic strokes. The anatomical morphology and signal intensity of brain parenchyma is otherwise unremarkable on FLAIR and T2-weighted sequences. The susceptibility MR sequence however demonstrate several bilateral parenchymal punctate foci of susceptibility consistent with chronic microhemorrhages. These findings do not correspond with the regions of small vessel ischemic strokes.The cortical sulci, ventricular system and CSF spaces are within normal for age.The signal void of major intracranial arterial branches are identified.Calvarium is intact. There is soft tissue thickening and hemorrhage of the right frontal scalp without underlying bony abnormality and likely representing posttraumatic finding as was noted on prior CT.All paranasal sinuses, bilateral mastoid air cells and middle ear cavities demonstrate normal signal intensity.

Output: 1.No acute intracranial process and negative diffusion-weighted images.2.Findings consistent with moderate chronic nonhemorrhagic small vessel ischemic strokes primarily in the periventricular and minimally in the subcortical white matter.3.Several punctate foci of susceptibility representing chronic microhemorrhages in bilateral cerebral hemispheres which are not in the small vessel ischemic strokes.4.Right frontal scalp edema and hemorrhage. Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 60-year-old female with Chiari malformation and syrinx, please do with cSF flow study, evaluate spine for abnormalites/changes History: follow up There is mild reversal of the normal cervical lordosis. There is multilevel disc desiccation with multilevel degenerative endplate marrow signal. Vertebral body heights are intact. Cerebellar tonsils again extend 8-9 mm below the level of the foramen magnum, unchanged in extent or morphology. CSF flow demonstrates a small amount of biphasic CSF flow immediately posterior to the cerebellar tonsils.Redemonstrated is focal prominence of the central canal within the cord extending from C1-C2 to C2-C3. There is also cystic dilatation of the central canal extending from C5-C6 to T2-T3, measuring 4 x 4 mm in maximum dimension, with at least one septation, unchanged.C2-C3: No significant spinal or neuroforaminal stenosis, unchanged.C3-C4: No significant spinal or neuroforaminal stenosis, unchanged.C4-C5: Mild posterior disc osteophyte complex (with a slightly less prominent left paramedian disc component) and uncovertebral joint hypertrophy without significant spinal or neural foraminal stenosis. There are no new stenoses.C5-C6: Mild posterior disc osteophyte complex and uncovertebral joint hypertrophy. No significant spinal stenosis. Moderate bilateral neural foraminal stenosis. These findings are unchanged.C6-C7: Mild posterior disc osteophyte complex. No spinal canal stenosis. Moderate to severe bilateral neural foraminal stenosis. These findings are unchanged.C7-T1: No significant spinal or neuroforaminal stenosis, unchanged.Prominence of the palatine tonsils bilaterally. There is asymmetry of the piriform sinuses, right greater than left. These findings are unchanged.

Output: 1.Stable Chiari I malformation with cystic dilatation of the central canal, likely representing syringohydromyelia.2.Stable degenerative changes and stenoses.3.Persistent, yet stable, prominence of the palatine tonsils bilaterally as well as is asymmetry of the piriform sinuses, right greater than left.


Instruction: Generate impression based on findings.

Input: Male, 31 years old, with history of scoliosis and right-sided low back pain. Five lumbar type vertebrae are assumed with rudimentary ribs at L1. Trace retrolistheses of L3 relative to L4, and L4 relative to L5 are seen. Vertebral body heights are preserved. A focal convavity of the right superior endplate of L5 is seen with surrounding edema. Elsewhere no edema or pathologic marrow signal abnormality is seen. Deformity and overgrowth of the left L5-S1 facet complex is seen with an atypical AP orientation of the joint line. The posterior arch of S1 also appears to be unfused. The visualized distal spinal cord, conus and cauda equina nerve roots are unremarkable. No epidural abnormalities are seen. L1-2: Minimal disk bulge. No significant spinal canal or neuroforaminal stenosis. L2-3: Mild disk bulge with a right paracentral protrusion. No significant spinal canal stenosis. Mild foraminal narrowing. L3-4: Facet arthropathy. Disk bulge with a right paracentral protrusion. Moderate spinal canal narrowing with particular effacement of the right lateral recess. Moderate right foraminal narrowing. L4-5: Facet arthropathy and ligamentum flavum thickening. Disk bulge. Mild spinal canal narrowing. Moderate foraminal narrowing. L5-S1: Facet arthropathy and ligamentum flavum thickening. No significant spinal canal stenosis. Moderate left foraminal narrowing.

Output: 1.A Schmorl's node deformity is seen, potentially of recent onset with mild edema, at the right aspect of the L5 superior endplate. 2.Deformity and anomalous anatomy of the left L5-S1 facet complex could be congenital or post-traumatic in etiology. In either event, bony overgrowth of the joint may indicate accelerated osteoarthritis. Likely congenital non-fusion of the posterior arch of S1 is seen.3.Multilevel disk degeneration is seen with bulging and superimposed protrusions as above. A moderate spinal canal stenosis results at L3-4 with particular effacement of the right lateral recess.


Instruction: Generate impression based on findings.

Input: 41-year-old female with a history of bilateral cerebral peduncle cavernomas and acute bleed seen on MRI examination at an outside hospital. Ill defined hyperdensities are noted within the cerebral peduncles bilaterally, the left lesion being located nearer to the thalamus. These lesions are in identical location to the cavernomas characterized by MRI in 2004, at which time there was edema and larger size of the left-sided lesions suggestive of recent hemorrhage.There is no visible edema surrounding cerebral peduncle lesions, nor is there mass effect in this location or elsewhere in the brain. Findings are therefore most consistent with chronic cavernomas, and it is doubtful that there has been any recent change. If there is a high degree of concern regarding this finding, MRI could be obtained or the outside MRI could be compared with the prior from 2004. Outside of the cerebral peduncle lesions, the appearance of the brain is normal with preserved gray-white matter differentiation and no additional lesions identified. There is no midline shift or basal cistern effacement. Ventricles and sulci have normal size and configuration. No abnormal fluid collections.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized. Orbits unremarkable

Output: Ill-defined hyperdense lesions within the cerebral peduncles, corresponding to cavernomas in these locations previously characterized by MRI in 2004. There is interval reduction size of the left sided lesion since 2004, and there is no convincing evidence of edema or mass effect from either of the lesions based on CT. Therefore, it is felt to be unlikely that there has been recent hemorrhage in this location. MRI examination could be considered for further evaluation if there is a high degree of concern regarding change in symptoms or hemorrhage--it can more sensitively detect edema and would allow same modality comparison with prior study. The outside MRI can be compared to the UC prior if it is available.


Instruction: Generate impression based on findings.

Input: 76 year female. Pain, swelling. Evaluate for ligamentous or meniscal injury. MENISCI: Complex branching signal abnormality in the anterior horn of the lateral meniscus extending into the body consistent with a complex tear. Globular signal abnormality in the posterior horn of the medial meniscus consistent with intrasubstance degeneration without a discrete tear.ARTICULAR CARTILAGE AND BONE: Small bone contusion in the lateral tibial plateau without a discrete linear component. Small tricompartmental osteophytes.Diffuse marked cartilage thinning of the lateral tibiofemoral compartment and moderate thinning of the medial tibiofemoral compartment without a focal defect. Focal partial thickness defect in the lateral facet of the patella.LIGAMENTS: High T2 signal within the ACL consistent with inflammatory change though there is no evidence of a tear as distinct fibers are still seen. PCL is intact. MCL and lateral ligamental complex are intact.EXTENSOR MECHANISM: Mild redundancy to the patellar tendon which remains intact, correlate with physical exam for patellar tendon laxity.ADDITIONAL

Output: 1. Complex tear in the anterior horn of the lateral meniscus extending into the body.2. Diffuse tibiofemoral compartment articular cartilage thinning, greater in the lateral compartment. Focal partial thickness cartilage defect in the lateral facet of the patella.3. Mild redundancy to an intact patellar tendon, correlate with physical exam for patellar tendon laxity.


Instruction: Generate impression based on findings.

Input: A 64 year old female with history of hypertension, hyperlipidemia and lung sarcoidosis. She has evidence of supraventricular tachycardia. A cardiac MRI in 2009 showed no evidence of cardiac sarcoid. Referred now to cardiac MRI for follow up. Left VentricleThe left ventricle is normal in size with normal systolic function. The overall LV ejection fraction is 58%, the LV end diastolic volume index is 66 ml/m2 (normal range: 65+/-11), the LVEDV is 120 ml (normal range 109+/-23), the LV end systolic volume index is 28 ml/m2 (normal range 18+/-5), the LVESV is 50 ml (normal range 31+/-10), the LV mass index is 32 g/m2 (normal range 67+/-11), and the LV mass is 61 g (normal range 114+/-24). There are no regional wall motion abnormalities present. There is no late gadolinium enhancement to suggest the presence of an underlying fibrosing, infiltrative, or inflammatory process.Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 57%, the RV end diastolic volume index is 69 ml/m2 (normal range 69+/-14), the RVEDV is 125 ml (normal range 110+/-24), the RV end systolic volume index is 30 ml/m2 (normal range 22+/-8), and the RVESV is 53 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in sizeAortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is no significant mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is no significant tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium. PericardiumThere is no obvious pericardial disease.Extracardiac FindingsMediastinal lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. Normal LV size and systolic function (LVEF 58%) without evidence of underlying myocardial fibrosis, inflammation, or infiltration.2. Normal RV size and systolic function (RVEF 57%).3. See extra-cardiac findings.


Instruction: Generate impression based on findings.

Input: 63-year-old woman with history of recurrent rectal cancer status post subtotal vaginectomy. PELVIS:UTERUS, ADNEXA: Patient is status post subtotal vaginectomy. There is circumferential, nodular thickening of the remaining vagina (901/29) with enhancement. Bilateral ovaries are seen.BLADDER: There is a Foley catheter within the bladder. There is diffuse, circumferential wall thickening of the bladder, nonspecific; however at the level of the base, heterogeneously enhancing soft tissue signal suspicious for neoplastic extension.LYMPH NODES: Multiple nodules within the presacral space and along the peritoneal reflections described below.BOWEL, MESENTERY: Patient is status post proctocolectomy with right lower quadrant abdomen ostomy. Within the presacral space, there is now confluent, near circumferential soft tissue thickening along the peritoneal reflections which enhances avidly. This enhancing soft tissue abuts the obturator internus musculature bilaterally (1101/265). Additionally, there are nodular soft tissue deposits in the presacral space (601/20) with at least one nodular focus seen abutting the right obturator internus muscle as well. For reference, a presacral nodule measures 11 x 8 mm. The majority of these lesions are solid, however there is a mixed cystic/solid deposit immediately anterior to the sacrum (901/46), newly appearing from earlier exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Vaginal wall thickening and nodular, irregular enhancing soft tissue in the surgical cavity suspicious for locally advanced recurrent disease with possible involvement of bladder (specifically base), please refer to details above.


Instruction: Generate impression based on findings.

Input: Drainage, pain. Known osteomyelitis. Orthopedic evaluation. There is thickening and sclerosis of the diaphysis of the third metatarsal, compatible with chronic osteomyelitis. The head of the third metatarsal appears separated from the diaphysis with erosion suggesting acute osteomyelitis (likely corresponding to the "abscess" seen on the recent MRI examination). Osteolysis of the proximal phalanx of the third toe also indicates acute osteomyelitis, and poor definition of the proximal margin of the middle phalanx of the third toe is suggestive of acute osteomyelitis as well. Deformity of the second metatarsal head and bases of the first, second and fourth proximal phalanges may reflect prior infection or trauma, but I see no osteolysis these bones on the current study. Moderate osteoarthritis affects the first metatarsophalangeal joint. Deformity of the head of the fourth proximal phalanx likely reflects prior surgery. Deformity of the neck of the fifth metatarsal likely reflects an old healed fracture.

Output: Osteomyelitis of the third metatarsal, third proximal phalanx, and third middle phalanx, with other findings as described above.


Instruction: Generate impression based on findings.

Input: 32 years Female (DOB:9/21/1983)Reason: s/p cerebral edema History: seizurePROVIDER/ATTENDING NAME: FERNANDO D GOLDENBERG FERNANDO D GOLDENBERG The CSF spaces are appropriate for the patient's stated age with no midline shift. There are several periventricular and subcortical white matter lesions present. One adjacent to the trigone of the right lateral ventricle measures approximately 16 x 7 mm axial dimensions. The others are punctate in size. The right periventricular white matter lesion associated with adjacent enlargement of the trigone of the right lateral ventricle.No abnormal enhancing lesions are appreciated intracranially. The postcontrast imaging is somewhat degraded due to patient motion 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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: 1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. One lesion adjacent to trigone of the right lateral ventricle may represent a small focus of encephalomalacia from unknown cause.2.No abnormal intracranial mass lesions are appreciated.3.Examination is somewhat degraded due to patient motion which may obscure more subtle abnormalities.


Instruction: Generate impression based on findings.

Input: Reason: Pt w/ desmoid fibromatosis of the right lower abdomen s/p excisional biopsy in October - please eval for recurrence History: Desmoid fibromatosis s/p excision on 10/19/2016 PELVIS:UTERUS, ADNEXA: Multiple intramural and subserosal fibroids are noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen subcutaneous soft tissue nodule in the right pannus appears removed. Marker is noted overlying this region. There is mildly enhancing linear soft tissue nodularity at this region, given recent surgery favor enhancing scar tissue.OTHER: No significant abnormality noted.

Output: Interval removal of subcutaneous nodule in the right pannus. There is mildly enhancing linear soft tissue nodularity at this region. Given recent surgery favor enhancing scar tissue, but follow-up may be helpful.


Instruction: Generate impression based on findings.

Input: Male, 18 months old, with complex febrile seizures. The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.The medial temporal structures are symmetric and unremarkable. The pituitary region is within normal limits for age. Brainstem and cerebellar vermis are normally formed and unremarkable. The cerebral hemispheres are normally formed and the cerebellar tonsils terminate above the level of the foramen magnum. Corpus callosum is fully formed and intact. The pattern of white matter myelination is appropriate for age.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Patchy opacification is seen through the paranasal sinuses and in the right mastoid air cells.

Output: Unremarkable evaluation of the brain with no specific findings to account for the patient's seizures.


Instruction: Generate impression based on findings.

Input: Demyelinating disease: right sided numbness and hyperreflexia. Brain: Thre are multiple, greater than 10, supratentorial and infratentorial T2 hyperintense white matter lesions. A lesion in the right superior frontal gyrus demonstrates patchy enhancement and a lesion in the right corona radiata demonstrates open ring enhancement directed away from the ventricle. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Cervical Spine: There are subcentimeter T2 hyperintense lesions within the spinal cord involving the bilateral dorsal columns at C3-4 and in the left hemicord at C6. There is straightening of the cervical spine alignment in the sagittal plane, but no spondylolisthesis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Multiple intracranial white matter lesions are compatible with demyelinating disease, such as multiple sclerosis, with signs of active inflammation is a few lesions.2. Lesions in the cervical spinal cord are also compatible ith demyelinating disease, such as multiple sclerosis.


Instruction: Generate impression based on findings.

Input: 73-year-old female with acute mental status changes evaluate for metastases. Again seen are multiple areas of hypoattenuation in the bilateral cerebellar hemispheres, basal ganglia, and the bilateral parietal lobes consistent with metastatic disease. No new definite metastatic lesions are seen. If there is clinical concern for a new metastatic lesion, contrast enhanced CT or MRI recommended.There are multiple areas of periventricular and subcortical hypoattenuation consistent with small vessel ischemic disease of indeterminate age. There is redemonstration of the low density focus in the brainstem which likely represents a chronic infarction.Hyperdense material in the left globe is evident, compatible with patient's known intra-ocular metastasis with possible hemorrhage.There is no evidence of intra-or extra axial hemorrhage, mass effect, or midline shift. The size of the ventricles remains stable. The visualized mastoid air cells and paranasal sinuses are clear.

Output: 1.No significant interval change in multiple intracranial metastatic lesions. If there is clinical concern for a new metastatic lesion, contrast enhanced CT or MRI is recommended.2. Stable hyperdense material in left globe, compatible with patient's known intra-ocular metastasis with possible hemorrhage.


Instruction: Generate impression based on findings.

Input: There are postsurgical changes involving the right inferior frontal lobe, insula, and anterior temporal lobe. There is ill-defined mildly expansile confluent T2 hyperintensity surrounding the resection cavity. There is ex vacuo dilatation of the right lateral ventricle similar to previous. There is persistent linear enhancement along the medial margin of the resection cavity and along the ependymal lining of the right frontal horn and corpus callosum, which now measure up to 10 mm. However, there is interval increase in size of foci of subcentimeter enhancement along the lateral margin of the body and trigone of the right lateral ventricle. There is no midline shift. There is bilateral mastoid fluid, right more than left.

Output: Posttreatment findings in the right cerebral hemisphere with increase in size of foci of enhancement along the lateral margin of the body and trigone of the right lateral ventricle, which may represent tumor progression versus treatment effects.


Instruction: Generate impression based on findings.

Input: Reason: Low Back Pain that Radiates to Right Leg. History: Low Back Pain that Radiates to Right Leg. Vertebral body heights are within normal limits. There is mild retrolisthesis of L5 on S1. There is mild edema in the pedicles at L5-S1 on the right associated with facet arthropathy at this level. There is multilevel disc desiccation with mild disc space loss at L5-S1. No abnormal signal within the cord or conus which ends at L1-L2..T12-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L1-L2: No significant disc disease. No spinal canal or neural foraminal stenosis.L2-L3: No significant disc disease. No spinal canal or neural foraminal stenosis.L3-L4: No significant disc disease. No spinal canal or neural foraminal stenosis.L4-L5: Mild facet arthropathy. No spinal canal canal stenosis. Mild bilateral neural foraminal stenosis.L5-S1: Diffuse disc bulge. Right-sided facet arthropathy with minimal fluid distention producing moderate neuroforaminal stenosis and may be impinging on the L5 nerve root. A small synovial cyst is present posterior to the facet joint with surrounding inflammatory changes in the soft tissues. No left neural foraminal stenosis. No spinal canal stenosis. Atrophic left kidney with small cysts.

Output: 1.Mild degenerative changes, worst at L5-S1 where there is right-sided facet arthropathy and moderate right neural foraminal stenosis with possible impingement on the exiting right L5 nerve root.2.Prominent inflammatory changes in the soft tissues surrounding the right L5-S1 facet joint are likely degenerative in etiology.


Instruction: Generate impression based on findings.

Input: 52 years Male (DOB:9/17/1963)Reason: eval for ischemia, stroke, emboli History: concern for stroke got TPA at OSH, LV thrombusPROVIDER/ATTENDING NAME: NITASHA H. SARSWAT SIRTAZ ADATYA MRI of the brainNo diffusion weighted abnormalities are appreciated.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:The MRA is partially degraded due to patient motion artifact.Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The right vertebral artery is larger than the left vertebral artery.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.

Output: 1.There is no evidence for intracranial or extracranial cerebrovascular occlusive disease.2.No evidence for acute ischemic cerebral infarction.3.No evidence for intracranial mass lesion.


Instruction: Generate impression based on findings.

Input: Female, 77 years old. Reason: MNG w L sided nodule w increased vasc in Dec 2013. Please reassess. History: hyperthyroidism RIGHT LOBE MEASUREMENTS: 2.1 x 1.8 x 5.5 cm.LEFT LOBE MEASUREMENTS: 1.8 x 1.7 x 5.0 cm.ISTHMUS MEASUREMENTS: 0.3 cmRIGHT LOBE: Heterogeneous echotexture, with multiple nodules with calcifications. A right upper pole nodule measures 0.9 x 0.8 x 0.8 cm. An additional right lobe nodule measures 1.2 x 1.2 x 1.0 cm. A right lower pole nodule measures 1.1 x 1.5 x 1.3 cm. These measurements are not significantly changed from prior.LEFT LOBE: Heterogeneous echotexture, with multiple nodules with ossifications. A dominant nodule in the left upper pole with calcifications measures 1.7 x 1.1 x 1 .0 cm, previously 1.3 x 1.0 x 0.9 cm, minimally increased.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Multiple complex thyroid nodules as detailed above, stable from prior, with equivocal enlargement of a single left thyroid nodule.


Instruction: Generate impression based on findings.

Input: 67 years Female (DOB:1/4/1949)Reason: eval for stenosis or abnormality History: chronic low back pain, and Bilateral Radic pain in legsPROVIDER/ATTENDING NAME: EDWIN RAMOS EDWIN RAMOS Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. The conus medullaris on sagittal imaging is grossly intact. There is some exaggeration of the lumbar lordosis. Incidental note is made of sacral perineural cysts.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a moderate degree of facet hypertrophy at this level. There is mild anterior subluxation of L5 on S1.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is moderate facet hypertrophy at this level.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild to moderate facet hypertrophy at this level.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina. There is mild posterior subluxation of L1 on L2. There are chronic endplate reactive changes and Schmorl's nodes at this level.

Output: 1.There are degenerative changes present in the lumbar spine without significant compromise to spinal canal or exiting nerve roots. However, there is mild subluxation at L1-2 and L5-S1.2.Perineural cysts are present within the sacral spinal canal. Often these are asymptomatic.


Instruction: Generate impression based on findings.

Input: 70 year old male with cirrhosis and gallstones. ABDOMEN:LIVER, BILIARY TRACT: Nodular liver contour and fissural prominence are compatible with cirrhosis. Bands of increased T2 signal are indicative of superimposed fibrosis. Unchanged right hepatic cyst. No suspicious hepatic lesions identified. Stable mild dilatation of the common bile duct to 9 mm (series 11, image 1). No intrahepatic ductal dilatation or intraductal filling defects noted. Cholelithiasis. Patent hepatic vasculature with enlarged main portal vein. Recanalized umbilical vein and venous collaterals in the subcutaneous tissues of the ventral abdominal wall are compatible with portal hypertension. SPLEEN: Unchanged splenomegaly, also compatible with portal hypertension. PANCREAS: No significant abnormality noted. No pancreatic ductal dilatation. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left renal cyst. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Findings compatible with cirrhosis and portal hypertension as described above, without suspicious hepatic lesion identified. 2.Cholelithiasis.


Instruction: Generate impression based on findings.

Input: 51-year-old with a left breast calcifications who will undergo stereotactic biopsy. The patient presents for a research MRI. She has family history of breast cancer in an aunt. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally.No suspicious enhancement is seen in either breast. There are several scattered cysts, some with thin wall enhancement. Additionally, two adjacent enhancing foci (measuring 3 mm and 2 mm) in the right central breast have central non-enhancing areas and high T2 signal compatible with a benign etiology, probably small fibroadenomas or lymph nodes. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. Specifically, no suspicious enhancement at the area that was biopsied in the left breast. BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter.


Instruction: Generate impression based on findings.

Input: EXAM: MRI BREAST BILAT CAD WWO, 1/21/2016 9:12 AMREASON FOR STUDY: Imaging surveillance of the negative left breast and the reconstructed right breast. There are postsurgical changes from right breast mastectomy with TRAM reconstruction. A few fat necrosis are noted in the anteromedial and posterolateral aspect of the reconstructed right breast. A 8 x 0.9 cm small amount of fluid collection is noted along the right aspect of the TRAM. No suspicious enhancement in the reconstructed right breast.Left breast:There is scattered fibroglandular tissue in the left breast. Mild parenchymal enhancement is noted in the left breast. Post reduction changes are noted in the left breast. Sagittal susceptibility artifact is noted in the stable 8 mm enhancing mass in the left breast 3:00 position. This is compatible with a known history of benign biopsy. No abnormal enhancement is seen in the left breast. Fat necrosis is also noted in the upper inner left breast.No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy in the reconstructed right breast or the native left breast. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Routine Diagnostic Mammogram.


Instruction: Generate impression based on findings.

Input: History of diarrhea and abdominal pain with eating. Evaluate for small bowel inflammation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Suboptimal distention by oral contrast. This limits the sensitivity of this study. Given this limitation there is no abnormal bowel dilatation, wall thickening, enhancement or restricted diffusion. No perienteric inflammatory changes. No evidence of fibrostenotic disease. No evidence of fistula or sinus tract formation. Trace right pericolic gutter fluid is within physiologic limits.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Right adnexal physiologic cyst.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Somewhat suboptimal study due to poor small bowel distention; the patient was unable to finish the oral contrast prior to examination. No evidence of active inflammation of the small bowel or fibrostenotic disease.


Instruction: Generate impression based on findings.

Input: 61-year-old male with elevated PSA, previous negative biopsy PELVIS:PROSTATE: Limited examination due to patient motion and artifact created by endorectal coil.Prostate Size: 6.7 x 5.5 x 4.9 cm.Peripheral Zone: The peripheral zone is thinned. No definite lesion is identified.Central Gland: Marked degree of benign prostatic hypertrophy. Seminal Vesicles: No significant abnormality noted.Extracapsular Extension: None.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Marked degree of benign prostatic hypertrophy with thinned peripheral zone. No definite lesion is identified.


Instruction: Generate impression based on findings.

Input: 23 year old male with history of hypertrophic cardiomyopathy with fibrosis presenting for repeat cardiac evaluation. Left VentricleThe left ventricle is normal in size and systolic function. The overall LV ejection fraction is 60%, the LV end diastolic volume index is 71 ml/m2 (normal range: 74+/-15), the LVEDV is 147 ml (normal range 142+/-34), the LV end systolic volume index is 29 ml/m2 (normal range 25+/-9), the LVESV is 59 ml (normal range 47+/-19), the LV mass index is 55 g/m2 (normal range 85+/-15), and the LV mass is 115 g (normal range 164+/-36). There are no regional wall motion abnormalities present. In the mid inferoseptal wall, near the right ventricular insertion point, there are patchy areas of late gadolinium enhancement corresponding to the thickest area of the myocardium. The remaining myocardium appears to be free of LGE. The thickest area of myocardium measures 16 mm in the mid infero-septal wall. The hypertrophy is primarily in the inferoseptal wall. There is no systolic anterior motion of the mitral valve seen. Left AtriumThe left atrium is normal in size. Right VentricleThe right ventricle is normal in size with normal systolic function. The overall RV ejection fraction is 51%, the RV end diastolic volume index is 70 ml/m2 (normal range 82+/-16), the RVEDV is 146 ml (normal range 142+/-31), the RV end systolic volume index is 34 ml/m2 (normal range 31+/-9), and the RVESV is 71 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 mild mitral regurgitation.Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild 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 (main PA 27 mm).Venous AnatomyThe SVC and IVC are normal in size and drain normally into the right atrium.PericardiumThere is no obvious pericardial disease.Extracardiac FindingsThis study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with normal systolic function (LVEF 60%). 2. The right ventricle is normal in size with normal systolic function (RVEF 51%)3. Findings consistent with hypertrophic cardiomyopathy with maximal septal thickness of 16 mm in mid inferoseptal wall corresponding to an area of patchy late gadolinium enhancement. There is LGE at the RV insertion points. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Sarcoidosis [135], Reason for Study: ^Reason: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid History: re-evaluate osseous lesions seen on prior study, hx osseous sarcoid Pituitary: Lesions replacing normal bone marrow signal intensity involving right side of the clivus, inferior to the sella, and right petrous apex, bilateral greater wings of the sphenoid, bilateral pterygoid processes of the sphenoid, right mandibular condyle and neck, as well as the partially imaged C1 and C2 vertebrae. These lesions show non homogeneous enhancement on Gad enhancement. Minimal enhancement around the dorsal aspect of the clivus indicating possible epidural extension.The pituitary gland and infundibulum are not enlarged and demonstrate normal enhancement characteristics. The optic apparatus is intact. Brain: There is no evidence of acute ischemic or hemorrhagic lesion. Mild nonspecific small vessel disease do not show any interval change since prior scan. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There is a subcentimeter Thornwaldt cyst within the midline posterior nasopharynx, no change since prior scan.

Output: 1. No change of multifocal skull base including clivus, petrous apex, sphenoid greater wing, pterygoid process and right mandible lesions since prior scan.2. Normal pituitary gland.3. No evidence of acute ischemic or hemorrhagic lesion.4. No intracranial parenchymal abnormal signal intensity nor abnormal enhancement.


Instruction: Generate impression based on findings.

Input: 78-year-old male with HCC status post transarterial radioembolization. Please evaluate for interval change. ABDOMEN:LIVER, BILIARY TRACT: Multiple foci of the T2 hyperintense, T1 hypointense, nonenhancing lesions are seen throughout the right hepatic lobe, several of which are new in the interval particularly at the hepatic dome. Small foci of T1 hyperintensity along the periphery of hepatic segment 5 (series 1002 image 253) is unchanged and favored to represent small hemorrhage. No arterially enhancing lesions are identified. The portal vein is patent.SPLEEN: No significant abnormality noted.PANCREAS: No pancreatic ductal dilatation. No focal parenchymal lesion.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral simple renal cysts.RETROPERITONEUM, LYMPH NODES: Interval enlargement of portacaval lymph nodes measuring 5.6 x 3.7 cm (series 904 image 312) (prior 2.4 x 1.9 cm) and new enlarged retroperitoneal lymph nodes (series 904 images 48, 192, 240) are also noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: 1.Interval development of new T2 hyperintense lesions of the right hepatic lobe anteriorly at the dome without evidence of arterial enhancement, however enlargement of portacaval and new retroperitoneal lymph nodes are concerning for disease progression.


Instruction: Generate impression based on findings.

Input: Ms. Lisec is a 31 year old female with a personal history of left breast invasive ductal carcinoma with calcifications measuring up to 4.9 cm on mammogram and metastatic disease in the left axillary lymph node. She presents today for imaging response of the tumor to the chemotherapy. There is heterogeneous amount of fibroglandular tissue in both breasts. Mild parenchymal enhancement is noted bilaterally.RIGHT BREAST:No abnormal enhancement is seen in the right breast.LEFT BREAST:There is no residual abnormal enhancement seen in the left breast, consistent with complete imaging response after neoadjuvant therapy. Previously identified linear nonmass enhancement in the inferior aspect of the left breast is not seen on today's exam either.AXILLAE:Biopsy proven left axillary lymph node has now decreased in size measuring 0.8 cm versus 1.1 cm on the prior. Susceptibility artifact from the biopsy clip is identified in this left axillary lymph node. There is no suspicious lymph node in the right axilla.

Output: (1) Complete MR-imaging response of the known left breast malignancy and decrease in size of known metastatic left axillary lymph node. Based on recent diagnostic workup, there are multiple residual pleomorphic calcifications in the superior and upper outer left breast, that measure up to 5 cm and 3 cm respectively. If breast conservation therapy is desired, then double wire localization would have to be performed. (2) No MRI evidence of malignancy in the right breast.BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: 36 year old with known right breast cancer and metastatic right axillary lymph node presents for research MRI of I-SPY protocol (3rd time point). There is heterogeneous amount of fibroglandular tissue in both breasts.Moderate parenchymal enhancement is noted bilaterally.A known cancer is again identified at posterior depth in the right breast, 11 o'clock position, measuring in total extent 13 x 8 x 9 mm (AP x LR x CC) and previously 18 x 16 x 19 mm. The primary mass now measures 8 x 8 x 9 mm with a small focus of enhancement anterior to the mass which is included in the total extent given above. There has been resolution of the linear non mass enhancement extending inferior and anterior from the known cancer which previously measured 31 x 6 x 8 mm.  An enlarges lymph node is again seen in the right axilla, with maximum diameter of 9 mm (previously 15 mm) . No abnormal enhancement is seen in left breast. No abnormal axillary lymph nodes are identified in left axillary region.

Output: Decrease in size of known cancer in the right breast and metastatic right axillary lymph node as described above.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter.


Instruction: Generate impression based on findings.

Input: Back pain. There are multilevel small posterior disc-osteophyte complexes, but no significant spinal canal stenosis. Aside from edema along the endplates at several levels related to degenerative spondylosis, the vertebral bone marrow signal is unremarkable. The vertebral column alignment is within normal limits. The vertebral body heights are preserved. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There are several T2 hyperintense lesions in the liver.

Output: 1. Small posterior disc-osteophyte complexes at multiple levels of the thoracic spine without spinal cord compression.2. Several probable cysts in the liver. Please refer to the prior abdomen CT report for additional details.


Instruction: Generate impression based on findings.

Input: 36-year-old female with psoriasis and persistent pain and stiffness in the foot/toes. Evaluate for abnormalities. A marker was placed dorsal to the first metatarsophalangeal joint. Mild osteoarthritis affects the first metatarsophalangeal joint with small osteophytes and subchondral cysts within the first metatarsal head. There is a small amount of fluid within the joint but we see no enhancement to suggest a synovitis. The flexor hallucis longus tendon is unremarkable. The remainder of the visualized tendons are unremarkable. The remaining visualized soft tissue structures are normal. The bone marrow signal intensity is normal.

Output: Mild osteoarthritis affects the first metatarsophalangeal joint.


Instruction: Generate impression based on findings.

Input: The aortic arch demonstrates conventional anatomy. There origins of the bilateral vertebral arteries are patent. There is no evidence of flow-limiting stenosis or aneurysm involving the vertebral or basilar arteries. There is high-grade stenosis of the left superior cerebellar artery approximately 1 cm beyond its origin. There is atherosclerotic calcification at the bilateral carotid artery bifurcations without evidence of significant stenosis.

Output: High-grade stenosis of the left superior cerebellar artery approximately 1 cm beyond its origin. The vertebral and basilar arteries are patent without evidence of flow-limiting stenosis or aneurysm.


Instruction: Generate impression based on findings.

Input: Reason: Elevated PSA History: history of elevated PSA and negative biopsy x2 PELVIS:PROSTATE:Prostate Size: 4.8 x 2.2 x 2.7 cmPeripheral Zone: There is diffuse low T2 signal which exhibits mild low signal on ADC and early enhancement throughout the peripheral zone. This is most prominent in the apex on the right, similar to the prior exam.Central Gland: Multiple BPH nodules.Seminal Vesicles: No significant abnormalityExtracapsular Extension: No significant abnormalityBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.

Output: Scattered areas of low T2 signal throughout the peripheral zone are likely related to chronic prostatitis given negative biopsies.


Instruction: Generate impression based on findings.

Input: Diagnosis: Localized swelling, mass and lump, head Essential (primary) hypertensionDiagnosis Edits: |Clinical question: HISTORY OF RIGHT MANDIBLE MASSSigns and Symptoms: HISTORY OF RIGHT MANDIBLE MASS Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a mass centered in the right mandible associated with contrast enhancement and some mild enlargement. There is disruption of the cortex along the right anterior lateral aspect of the mass with some mild protrusion of the mass through this defect. Masses high signal on T2 and low signal on T1 and without diffusion restriction. No flow voids are identified within the mass to suggest arteriovenous malformation.Within the visceral space the thyroid gland demonstrates multiple small nodules the largest one of which measures 9 x 12 mm axial dimensions. It is high signal on T2 and relatively lower signal on T1. The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. There are patchy high signal foci on T2 imaging in the brainstem which are most likely vascular related. The visualized portions of the orbits and paranasal sinuses are intact. The paranasal sinuses and mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There are multilevel degenerative changes present in the cervical spine with reversal of the normal cervical curvature at C3-4, loss of disc space height, disc desiccation and endplate and uncovertebral osteophytes resulting in encroachment of right-sided exiting nerve roots at C6-7 and C5-6 and some narrowing of the spinal canal due to endplate osteophytes at C3-4, C4-5 and C5-6 .MRA neck:The right inferior alveolar artery is asymmetrically larger than the left side and courses along the superior aspect of the mass. No convincing evidence for arteriovenous malformation. The anterior aspect of the mandible was not included on this exam.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. There is fetal origin of the right posterior cerebral artery.

Output: 1.An expansile mass along the right mandible suspected represent a hemangioma. There is a small amount of extraosseous extension along the right anterolateral aspect of the mass. However, the entire mandible was not included on the MR angiogram. As a result of the convenience of the patient and noncontrast MRA of the mandible with specific attention this area would be helpful.2.Multiple thyroid nodules.3.Multilevel degenerative changes are present in the cervical spine.


Instruction: Generate impression based on findings.

Input: Reason: evaluate menisci History: medial joint line pain, effusion, "popping" Several sequences are limited by patient motion artifact.MENISCI: There is blunting of the body and posterior horn of the medial meniscus that may be due to tearing or prior partial meniscectomy. There is also increased signal intensity within the remaining body and posterior horn of the medial meniscus which extends to the femoral articular surface and likely to the tibial articular surface as well, indicating a complex tear with extension of signal abnormality through the periphery of the body of the meniscus and decompression into small parameniscal cysts. The signal abnormality includes a fluid-filled defect along the femoral articular surface of the body of the medial meniscus. There appears to be additional tearing of the peripheral fibers of the posterior horn of the medial meniscus. The lateral meniscus appears intact.ARTICULAR CARTILAGE AND BONE: There is full-thickness degeneration of the articular cartilage of the medial femoral condyle above the torn posterior meniscal horn. More anteriorly, along the medial femoral condyle, there is also a more focal full-thickness articular cartilage defect above the free edge of the anterior horn of the medial meniscus. There is superficial fraying of the articular cartilage of the medial tibial plateau. There is a full-thickness defect with delamination of the articular cartilage of the lateral facet of the femoral trochlea. There is heterogeneity of the medial facet and central portions of the femoral trochlea representing additional areas of degeneration. The articular cartilage of the lateral compartment appears relatively intact. There are tricompartmental osteophytes.LIGAMENTS: The cruciate and collateral ligaments appear intact. EXTENSOR MECHANISM: The extensor mechanism appears intact.ADDITIONAL

Output: 1. Complex tearing of the medial meniscus.2. Osteoarthritis, particularly affecting the medial and patellofemoral compartments.3. Joint effusion and Baker's cyst.


Instruction: Generate impression based on findings.

Input: A 24 year old female with known systemic lupus erythematosus, now hospitalized with chest pain and positive troponin, echocardiography showed normal left ventricular systolic function. Referred to cardiac MRI to evaluate for myocarditis/pericarditis secondary to lupus flare. Left VentricleThe left ventricle is normal in size with low normal systolic function. The overall LV ejection fraction is 52%, the LV end diastolic volume index is 80 ml/m2 (normal range: 65+/-11), the LVEDV is 155 ml (normal range 109+/-23), the LV end systolic volume index is 38 ml/m2 (normal range 18+/-5), the LVESV is 74 ml (normal range 31+/-10), the LV mass index is 44 g/m2 (normal range 67+/-11), and the LV mass is 85 g (normal range 114+/-24). There is mild global hypokinesis in the basal segments. There is subtle, focal myocardial late gadolinium enhancement involving the epicardial portion of the basal inferolateral wall suggesting the presence of an underlying fibrosing, infiltrative, or inflammatory process. There is additionally increased signal in that region on SSFP imaging suggesting edema vs inflammation. No evidence of myocardial infarction. Normal native myocardial T1-times. The global relative enhancement ratio, the T2-STIR edema ratio and the extracellular volume fraction are in the normal range. These findings suggest normal interstitial fibrosis burden.No intracavitary thrombus was seen.No myocardial iron overload.Left AtriumThe left atrium is normal in size. The LA volume is 75 ml.Right VentricleThe right ventricle is normal in size with low normal systolic function. The overall RV ejection fraction is 50%, the RV end diastolic volume index is 86 ml/m2 (normal range 69+/-14), the RVEDV is 168 ml (normal range 110+/-24), the RV end systolic volume index is 43 ml/m2 (normal range 22+/-8), and the RVESV is 84 ml (normal range 35+/-13). Right AtriumThe right atrium is normal in size. Aortic ValveThe aortic valve opens widely and there is no significant aortic regurgitation.Mitral ValveThe mitral valve opens widely and there is mild to moderate mitral regurgitation. Pulmonic ValveThe pulmonic valve opens widely. There is no significant pulmonic regurgitation.Tricuspid ValveThe tricuspid valve opens widely. There is mild tricuspid regurgitation.AortaThere is a left sided aortic arch with a normal brachiocephalic branching pattern. The aortic root is normal in size.Pulmonary VeinsAll four pulmonary veins drain normally into the left atrium.Pulmonary ArteryThe main pulmonary artery is normal in size. Venous AnatomyThe SVC and IVC drain normally into the right atrium. PericardiumThere is a trivial pericardial effusion without evidence of significant pericardial inflammation or edema.Extracardiac FindingsSeveral large bilateral axillary lymph nodes are noted. This study is not designed for the specific evaluation of extra-cardiac findings; therefore, the differentiation between artifacts and real extracardiac pathology may be difficult. If clinically indicated, a separate dedicated evaluation should be considered.

Output: 1. The left ventricle is normal in size with low normal systolic function, the LVEF is 52% with evidence of a small amount of subtle late gadolinium enhancement and edema in the basal inferior and inferolateral walls. These findings support the diagnosis of mild myocarditis without evidence of myocardial infarction. 2. The right ventricle is normal in size with low normal systolic function, the RVEF is 50%. 3. There is mild to moderate mitral regurgitation. 4. No evidence of pericarditis.5. Significant bilateral axillary lymph adenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.


Instruction: Generate impression based on findings.

Input: Evaluate any change in size of the cranial bone lesion. Immediately preop. Nonenhanced head CT:A lytic bony lesion of the right parietal lobe along its inferior aspect measuring 12.8 times 6-mm in size. This lesion is similar to prior study in measurement. There is significant thinning of the inner table of the skull however the outer table of the skull is still in tact. There is no epidural soft tissue thickening at this site. Further evaluation with an enhanced MRI or CT is recommended to exclude epidural spread of tumor. The calvarium is otherwise intact. There is no evidence of intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns and gray -- white matter differentiations are within normal.

Output: 1.Stable small lytic right parietal bone lesion since prior study.2.Negative none diffuse head CT otherwise. A


Instruction: Generate impression based on findings.

Input: 21 years, Male, GBM of the spinal cord S/P chemo and RT (last day Oct 3, 2016). Brain: Brain parenchyma appears within normal limits. There is no significant parenchymal signal abnormality or intracranial mass is evident. There is a small extra-axial collection at the ventral craniocervical junction extending into the retroclival region without significant mass effect on the ventral brainstem. No midline shift or herniation. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is minimal scattered paranasal sinus mucosal thickening. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: Postsurgical changes of biopsy and C1-C5 laminectomy are seen in the interval. There is an expansile lesion with T2 hyperintensity centered at the C2-C4 levels with mild T2 hyperintensity superiorly extending to the C1 level. Compared to prior MRI from 7/19/2016, there appears to be decrease in overall cord swelling and decrease in the very high T2 signal reflective of decrease in vasogenic edema component of the lesion, with the residual T2 signal abnormal likely primarily reflect infiltrating tumor. There are more discrete cavitary/necrotic areas involving the cervical cord at the C2-C3 level which may reflect postbiopsy change. There is also interval increase in more solid-appearing enhancement involving the primarily the dorsal aspect of the cord from the mid C2 to the mid C3 levels as well as mild patchy enhancement involving the right ventral and right lateral aspects of the cord at the C2 and C3 levels.Cord signal abnormality extends to the inferior C4 level. More inferiorly there is diffusely increased epidural enhancement likely reflecting reactive, post treatment changes. No significant spinal canal stenosis is evident.There is a small postop fluid collection posterior to the dura measuring up to 7 mm in thickness and extending from the C1-C3 levels. No associated mass effect on the cord.Thoracic spine: There is mild, diffusely increased enhancement involving the epidural space in the thoracic spine which is favored to be reactive and related to posttreatment change. No discrete nodular enhancement or mass within the thoracic spine is evident.The thoracic spine is in normal alignment. The vertebral body and disk heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is developmental narrowing of the thoracic spinal canal. There is otherwise no significant disk bulge, herniation, spinal canal or foraminal stenosis within the thoracic spine.

Output: 1. Postoperative changes related to biopsy of enhancing cervical cord tumor centered at the C2-C3 level consistent with known glioblastoma. Compared to 7/19/2016 there appears to be decrease in vasogenic edema in the cervical cord and increase in areas of solid and patchy enhancement from the mid C2 to the C3-C4 levels. These findings may reflect post treatment change given recent chemoradiation, although progressive tumor is not entirely excluded.2. No evidence of direct tumor extension or metastasis in the brain or thoracic spine.


Instruction: Generate impression based on findings.

Input: Female, 20 years old, with worsening migraine frequency, right-sided. Assess for mass lesion. Also with lower extremity numbness. Brain:No evidence of signal abnormality, edema or mass effect is seen. No pathologic parenchymal or extra-axial enhancement is detected. A small right frontal developmental venous anomaly is noted incidentally.There is no evidence of intracranial hemorrhage or any abnormal extra axial fluid collection. Ventricles are normal in size and morphology.Spine:Alignment is anatomic. Vertebral body morphology and signal characteristics are normal. No evidence of marrow edema is seen.The visualized spinal cord shows normal signal intensity and morphology.Very small central disk protrusions are seen at C5-6 and C6-7. These do not contact the spinal cord and results in no significant spinal canal stenosis. The neural foramina are patent throughout.

Output: 1. Unremarkable evaluation of the brain with no specific findings to account for the patient's worsening migraines.2. Minimal degenerative disk disease in the cervical spine which, again, would not explain the patient's symptoms.


Instruction: Generate impression based on findings.

Input: History of dizzy spells with vertigo on and off since December 2009.. CT of brain without infusion:No evidence of hemorrhage, edema, mass-effect, midline shift or hydrocephalus is detected.There is a slight prominence of the superior cerebellar cistern with a questionable mass effect on the superior aspect of vermis. Although this may be entirely within normal range however I cannot entirely exclude possibly of a cyst in this location. Images through the rest of posterior fossa are entirely within normal limits.Cortical sulci, ventricular system and all other CSF cisterns remain within normal limits. Considering the extent of patient's symptoms further follow-up with an MRI is recommended in particular to exclude possibly to a cyst in the superior cerebellar cistern.

Output: 1.Questionable cyst in the superior cerebellar cistern as detailed.2.Unremarkable CT examination of brain otherwise.3.Considering patient's clinical symptoms follow-up with an MRI is recommended.


Instruction: Generate impression based on findings.

Input: 6 month follow up of syrinx and pain. There is unchanged mild prominence of the central canal in the thoracic spinal cord at the T8-9 level. The spinal cord otherwise displays normal signal and morphology. There is no evidence of intraspinal mass lesions. The vertebral column alignment is unchanged. There is congenital fusion of C2 and C3 and rudimentary disc at T4-5. The vertebral body and disc space heights are otherwise preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The paravertebral soft tissues are unremarkable.

Output: 1. Unchanged mild prominence of the central canal in the thoracic spinal cord. 2. Mild cervicothoracic scoliosis.3. Congenital fusion of C2 and C3.


Instruction: Generate impression based on findings.

Input: 16-year-old female with pain in the left shoulder. ROTATOR CUFF: The rotator cuff appears intact.SUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: Underlying bone marrow signal intensity is within normal limits. There is no underlying bony defect.BICEPS TENDON: The long head of the biceps tendon appears intact.ADDITIONAL

Output: There is marked irregularity along the anterior inferior aspect of the glenoid labrum, which may reflect postsurgical changes, or less likely, re-injury. Intact rotator cuff.


Instruction: Generate impression based on findings.

Input: Male, 26 years old, with CNS lymphoma on MTR chemotherapy, now with recurrent intermittent headaches. Evidence of a small left parietal craniotomy is seen from prior biopsy. Since prior examinations, large areas of homogeneous enhancement involving the left corpus callosum and cingulate gyrus and the left parieto-occipital junction have resolved. Substantial edema associated with these lesions has also resolved leaving only mild patchy areas of chronic appearing FLAIR hyperintensity.No new pathologic intracranial enhancement is seen. No edema or mass effect is detected. Scattered nonspecific FLAIR hyperintense foci are nonspecific. No evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.

Output: 1.Interval resolution of enhancing lesions seen previously in the left cerebral hemisphere.2.Edema associated with these lesions has also resolved leaving only mild residual signal abnormality perhaps representing gliosis.3.No new or acute intracranial lesions are detected.


Instruction: Generate impression based on findings.

Input: Invasive squamous cell carcinoma of the supraciliary ridge treated with chemoradiation. There are stable post-treatment findings in the left supraciliary region, with a small amount of persistent mild patchy, ill-defined enhancement in the left supra-orbital subcutaneous tissues. Otherwise, there is no evidence of gross tumor. The right orbit is unremarkable. There is a small left maxillary sinus retention cyst. There is a right temporomandibular joint effusion. The imaged intracranial structures are grossly unremarkable.

Output: Stable post-treatment findings in the left supraciliary ridge region, without evidence of gross tumor recurrence.


Instruction: Generate impression based on findings.

Input: Left transcortical resection of interventricular mass, likely a meningioma. The images are degraded by patient motion. There are recent postoperative findings related to left transparietal resection of a mass in the trigone of the left lateral ventricle. There is a subcentimeter focus of enhancement in the left lateral ventricle along the posterior margin of the left thalamus. Otherwise, there are blood products within the left material ventricles and along the transcortical surgical approach. There are also small areas of restricted diffusion and high T2 signal in the splenium of the corpus callosum and high T2 signal without restricted diffusion along the margins of the surgical approach. Aside from residual prominence of the left lateral ventricle trigone, the ventricular system is not particularly enlarged. There is fluid and air in the subgaleal space overlying the left parietal craniotomy flap.

Output: Recent postoperative findings related to left transparietal resection of a mass in the trigone of the left lateral ventricle, with what may represent a small amount of residual tumor along the posterior margin of the left thalamus, versus inflamed choroid plexus. Otherwise, a small amount of hemorrhage is present along the surgical approach and small areas of ischemic changes are apparent in the splenium of the corpus callosum.


Instruction: Generate impression based on findings.

Input: 18 years Female (DOB:6/2/1998)Reason: 3T Scanner, QSM/permebaility, CCM Protocol; s/p cavernoma resection in September; 8 week follow up History: s/p cavernoma resection in September; 8 week follow upPROVIDER/ATTENDING NAME: ISSAM A. AWAD ISSAM A. AWAD Since the prior examination the patient is undergone surgery for a right lateral precentral gyrus lesion consistent with cerebral cavernous malformation. The lesion bed is hyperintense on T2 and hypointense on T1. There is associated susceptibility effect surrounding the lesion bed.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.

Output: Since the prior exam patient is undergone right sided surgery for removal of a lesion consistent with cerebral cavernous malformation. There is no convincing evidence for residual cerebral cavernous malformation.


Instruction: Generate impression based on findings.

Input: Male 64 years old Reason: rule out mass, infection, etiology of dementia History: confusion. There is no evidence of intracranial hemorrhage, mass, or acute infarct. Mild global cerebral volume loss, slightly advanced for age, which is nonspecific. There is minimally increased frontal volume loss. There is no disproportionate volume loss involving the hippocampi. No abnormal intracranial enhancement. There is periventricular T2/FLAIR hyperintensity which is nonspecific but likely related to mild chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.No acute intracranial findings. Specifically no evidence of infarct, hemorrhage, or intracranial mass effect.2.Mild chronic small vessel ischemic changes.3.Mild global parenchymal volume loss with slightly increased involvement of the frontal lobes. This finding is nonspecific.


Instruction: Generate impression based on findings.

Input: 50 year-old male please evaluate for edema and acute bleed. There is no evidence of intracranial hemorrhage, mass or edema. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: No intracranial hemorrhage. Small vessel ischemic disease, age indeterminate. If there is clinical concern for acute ischemia, an MRI may be considered.


Instruction: Generate impression based on findings.

Input: 55 years Male (DOB:2/23/1961)Reason: stroke code rule out stroke History: as abovePROVIDER/ATTENDING NAME: JAMES J WALTER JAMES J WALTER MRI of the brainThere is a 12x8 mm axial dimension focus of diffusion restriction along the superior aspect of the right cerebellar hemisphere.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is occlusion of the right SCA at its origin. There is suspicion of thrombus bulging into the basilar artery from the SCA.The anterior communicating artery is identified and is medium size. The right A1 segment is hypoplastic. There is fetal origin of the right PCA with a medium size right p1 segment . The left posterior communicating artery is small. The RVA is hypoplastic.

Output: 1.There is occlusion of the right SCA at its origin. There is suspicion of thrombus bulging into the basilar artery from the SCA.2.There is a 12x8 mm axial dimension acute infarction along the superior aspect of the right cerebellar hemisphere.3.Findings were discussed with Tania Rubeiz MD.


Instruction: Generate impression based on findings.

Input: Complex febrile seizure and dev delay: assess for lesions. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma, including the hippocampi, appears unremarkable. There is no evidence of heterotopia. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: No potential seizure foci are identified.


Instruction: Generate impression based on findings.

Input: Abnormal findings on diagnostic imaging of other parts of musculoskeletal system [R93.7], Reason for Study: ^Reason: Abnormal plain film at the VA with sclerotic appearance of L5 vertebral body concerning for osteoblastic met, though hypertrophic DJD cons For the purpose of this dictation, the lowest visualized intervertebral disc space is labeled L5-S1. There is normal lumbar lordosis. There is minimal anterolisthesis of L4 on L5.The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The conus medullaris terminates at the L1 level. The right renal cyst was seen.Degenerative changes are specified by the intervertebral level as follows: T12-L1: disc dessication, no neuroforaminal narrowing or spinal stenosis. L1-L2: disc dessication, there is diffuse minimal bulging of disc especially toward the left side neuroforamen without significant neuroforaminal narrowing, no evidence of spinal stenosis. L2-L3: disc dessication, no neuroforaminal narrowing or spinal stenosis. L3-L4: disc dessication, diffuse bulging of disc, no neuroforaminal narrowing or spinal stenosis. L4-L5: disc dessication, grade 1 anterolisthesis of L4 on L5, minimal to mild spinal canal stenosis due to bilateral ligamentum flavum thickening, diffuse bulging of disc toward neural foramen bilaterally (left worse than right) results minimal neuroforaminal narrowing. L5-S1: disc dessication, focal broad based disc protrusion central to right lateral which abuts thecal sac. No neuroforaminal narrowing or spinal stenosis.

Output: 1. Degenerative lumbar disc disease.2. Multi-level disc bulges as described above, especially at the level of L45 there is grade anterolisthesis of L4 on L5 with minimal to mild spinal canal stenosis.


Instruction: Generate impression based on findings.

Input: New onset of headache and panic attack. Rule out brain pathologySigns and Symptoms: New onset of headache and psychological symptomspossible sinus thrombosis. Brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRV brain:The dural venous sinuses are patent. Straight sinus, internal cerebral veins and basal veins are identified and appear patent.

Output: MR venogram of the brain is within normal limitsMRI of the brain is within normal limits


Instruction: Generate impression based on findings.

Input: Pain and locking. Check for internal derangement MENISCI: The lateral meniscus is unremarkable other than mild fraying of the inner edge. Otherwise the medial meniscus demonstrates a globular signal within the body extending into the posterior horn without a definite discrete linear component. These changes extend to the superior articular surface posteriorly.CARTILAGE AND BONE: Heterogeneous signal with mild irregularity involving tic the the trochlear groove and with diffuse thinning and cartilaginous loss in both medial and lateral compartments, greater medially. Underlying medial compartment contusion with changes involving the anterior femoral condyles and posterior tibial plateauu. Superimposed moderate osteoarthritic changesLIGAMENTS: Ligaments appear intact, specifically the ACL is well visualized.. EXTENSOR MECHANISM: No significant abnormality noted..ADDITIONAL

Output: 1. Medial meniscal changes, largely degenerative involving the body and posterior horn; see detail provided 2. Bone contusion involving medial compartment with extensive cartilaginous loss and degenerative changes, again greater in the medial aspects3. Small Baker cyst


Instruction: Generate impression based on findings.

Input: Metastatic NSCLC treated with radiation. There are multiple, at least 12, supratentorial and infratentorial enhancing lesions with associated vasogenic edema. For example, a left posterior frontal lobe lesion measures up to 27 mm in diameter, previously 25 mm, and two contiguous right inferior parietal lobe lesions measure up to 40 mm, previously 36 mm, and contains hematocrit levels. Furthermore, many of the lesions have increased in size since 7/1/15. There are chronic lacunar infarcts in the bilateral basal ganglia and corona radiata. There is no evidence of acute infarct. There is mild diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a mildly expansile enhancing lesion in the left frontal bone with slight epidural and subgaleal extension. There is also an enhancing nodule within the right paraspinal muscles that measures up to 18 mm. The orbits are grossly unremarkable. There are secretions and mucosal thickening throughout the left maxillary sinus.

Output: 1. Numerous supratentorial and infratentorial metastases, some of which are hemorrhagic and have increased in size since 7/1/15.2. Left frontal bone metastasis.3. Right paraspinal muscle metastasis.


Instruction: Generate impression based on findings.

Input: 3-year-old male with a history of cerebral palsy and left hemiplegia. There is a large right extra-axial fluid collection within the right frontotemporal region, which communicates with the ventricular system via the lateral aspect of the lateral right lateral ventricle. The communication is lined by gray matter compatible with schizencephaly. There is mass effect on the adjacent right sided brain parenchyma as well as the right lateral ventricle from the fluid collection, 3 mm of midline shift, as well subtle osseous remodeling with slight enlargement of the right middle cranial fossa and hemicranium overall. There is no associated susceptibility or diffusion-weighted abnormality. The absence of traversing vessels coursing through the fluid collection indicate that much of this fluid collection is likely within the subdural space although likely communicating with the subarachnoid space. For reference, the diameter of the fluid component in the right middle cranial fossa measures 42 mm and and the diameter in the right frontal region is 30 mm.There is also some probable remodeling along the anterior floor of the right anterior cranial fossa with the right gyrus rectus located slightly more caudally compared to the contralateral side, again likely secondary to the chronic fluid collection and resultant mass effect. The right frontal and temporal lobes and somewhat dysmorphic and hypoplastic secondary to the chronic mass effect. There are areas of gyral thickening and possible micronodular appearance along the cleft within the right inferior frontal lobe that are suggestive of polymicrogyria. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.

Output: 1.Findings compatible with a right frontotemporal open lipped schizencephaly in communication with the right lateral ventricle. Suspected polymicrogyria along the cleft, which could be better evaluated with 3-D T1 imaging.2.Large chronic right lateral extra-axial frontotemporal fluid collection possibly from a ball and valve mechanism between the subarachnoid and subdural spaces which results in significant mass effect on the adjacent brain parenchyma as well as chronic remodeling of the right hemicranium.


Instruction: Generate impression based on findings.

Input: Seizures, but normal EEG on 12/29/14. PMH significant for hypertension, diabetes, rheumatoid arthritis, chronic migraines, neuropathy. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. In particular, the hippocampi are intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is a small amount of fluid within the left sphenoid sinus.

Output: No evidence of potential seizure foci.


Instruction: Generate impression based on findings.

Input: Altered mental status. There is no evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy high signal intensities on bilateral periventricular white matter on FLAIR images indicate nonspecific small vessel ischemic disease.There is a linear encephalomalacia seen on the right basal ganglia indicating prior ischemic infarct. In addition, cortical and subcortical encephalocele on the left parietal lobe which also suggest prior ischemic infarct.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, or restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.

Output: No evidence of acute ischemic or hemorrhagic lesion.Moderate to severe degree non specific small vessel ischemic disease.Multifocal chronic ischemic stroke lesions including right basal ganglia and left parietal lobe as described above.


Instruction: Generate impression based on findings.

Input: Thyroid cancer with metastatic brain lesions: three-month follow-up. There are postsurgical findings related to left parietal metastasectomy. There is adjacent dural thickening and blood products, but no evidence of enhancing tumor in the resection cavity. There is a 2 mm diameter enhancing lesion with susceptibility effect in the left superior parietal lobule, previously 3 mm. There is also a 2 mm focus of enhancement in the right middle frontal gyrus and right medial orbitofrontal gyrus, previously 3 mm. There is am unchanged non-enhancing subcentimeter nodular focus of susceptibility effect along the ependymal surface of the right caudate head. There is no evidence of new intracranial lesions, intracranial hemorrhage, or acute infarct. The pituitary gland appears unremarkable. Multiple foci of T2 hyperintensity in the bilateral cerebral white matter are nonspecific, but compatible with chronic small vessel ischemic disease. The ventricles and basal cisterns are unchanged in size. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild mucosal thickening involving the anterior ethmoid air cells and bilateral mucous retention cysts of the maxillary sinuses, right greater than left. The orbits are grossly unremarkable.

Output: 1. Subcentimeter left parietal lobe and right frontal lobe lesions appear to have slightly decreased in size. 2. The non-enhancing subcentimeter nodular lesion along the ependymal surface of the right caudate head is unchanged.3. No evidence of acute infarct.


Instruction: Generate impression based on findings.

Input: 85 year-old female with right frontal bony expansile mass seen on MRI. Focal lesion in the right frontal bone adjacent to the frontal sinus demonstrates internal groundglass opacity and is associated with mass effect but no significant edema on the underlying frontal lobe. These findings are consistent with a focus of fibrous dysplasia. No additional lesions are seen within the calvarium.Mild scattered hypodensities within the subcortical white matter consistent with small vessel ischemic disease, unchanged since prior MRI. There is no evidence of intracranial hemorrhage, mass or edema. The ventricles and basal cisterns are normal in size and configuration.The visualized paranasal sinuses and mastoid air cells are normally pneumatized.

Output: Focal fibrous dysplasia in the right frontal bone. Otherwise, stable small vessel ischemic changes.


Instruction: Generate impression based on findings.

Input: Clinical question: Mass? Intracranial hemorrhage? Signs and symptoms: Central vertigo x 1 month history of metastatic melanoma to brain and with status post RT Non-enhanced head CT:A there is no evidence of intracranial hemorrhage, edema, mass-effect or midline shift or hydrocephalus.The cortical sulci, ventricular system, CSF cisterns are essentially minimal for patient's stated age of 74.Diffuse patchy areas of subcortical and periventricular low-attenuation are nonspecific however they are suspected for small vessel ischemic disease of indeterminate age. Similar findings were present on prior MRI examination from 12 -- 13 -- 2010.Calvarium is intact. Limited view of paranasal sinuses and mastoid air cells as well as middle ear cavities are unremarkable.Limited images through the orbit demonstrate ptosis bulbi of the right globe as was noted on multiple prior studies.

Output: 1.No evidence of any acute new findings in particular no evidence of hemorrhage or acute cortical stroke.2.Findings of small vessel ischemic disease of indeterminate age.3.Ptosis bulbi of right globe.4.Unremarkable calvarium, paranasal sinuses and mastoid air cells.


Instruction: Generate impression based on findings.

Input: 4-year-old male with lethargy and altered mental status. There is a well-defined focus of hypodensity in the right centrum semiovale, which was seen on 2010 MRI of brain; this is consistent with a prominent perivascular space. There is no evidence of intracranial hemorrhage, mass, edema, hydrocephalus, or midline shift. The ventricles and basal cisterns are normal in size and configuration.The calvaria and skull base are radiographically normal. Sphenoid sinuses and ethmoid air cells are opacified. The mastoid air cells are normal in appearance.

Output: 1.No acute intracranial abnormality. 2.Sinus opacification.


Instruction: Generate impression based on findings.

Input: No evidence of a bleed, mass effect, or edema. There is normal gray-white matter differentiation. The ventricular size is normal. There is no midline shift. No abnormal T2/FLAIR signal. No abnormal enhancement is seen.The major intracranial vascular flow voids are present. There are no restricted diffusion abnormalities. No susceptibility abnormalities.

Output: Unremarkable contrast-enhanced MRI brain.


Instruction: Generate impression based on findings.

Input: 9-year-old male with history of CGD colitis and perianal abscess. Repeat exam to evaluate for resolution. Perirectal pain, swelling and drainage. BONE MARROW: No significant abnormality noted.SOFT TISSUES: The previously seen superficial left perineal soft tissue fluid collection has decreased in size (901/96) to approximately 7 mm. There continues to be peripheral enhancement of the thick abscess wall, with corresponding internal high T2 signal and low T1 signal. A smaller, more anterior low T1/high T2 focus is seen within this left anterior perineal area of inflammation, which may be a smaller adjacent loculated collection versus an anterior extension of the above-described abscess (901/100).Significant adjacent inflammation extends anteriorly to the base of the scrotum, and minimally involves the right perineum. No additional fluid collections are seen.JOINTS: No significant abnormality noted.ADDITIONAL

Output: Small, thick walled, left medial perineal abscess and associated inflammation as above.


Instruction: Generate impression based on findings.

Input: Asymptomatic 59 year old woman presents for routine screening mammography. Personal history of benign right breast biopsy in December 2011. Family history of breast cancer in mother, two sisters, maternal cousin, and four paternal cousins. There is heterogeneous amount of fibroglandular tissue in both breasts.Mild parenchymal enhancement is noted bilaterally. Multiple small enhancing foci seen in both breast not of them are uniquely enhancing. Previously described lobulated 5 mm mass in the right breast 9:00 position is unchanged, consistent with a benign lesion.No abnormal enhancement is seen in either breast. No abnormal lymph nodes are identified in either axillary region.

Output: No MRI evidence for malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Routine Screening Mammogram.


Instruction: Generate impression based on findings.

Input: Recurrent epistaxis, etiology presumed to be from right polypoid nasal mass. There is packing material in the right nasal cavity with low T2 and intermediate T1 signal suggestive of imbibed blood products from epistaxis. There is markedly swollen mucosa within the right maxillary sinus that communicates with a polypoid lesion within the posterior right nasal cavity and nasopharynx via an accessory ostium. The airway is otherwise intubated. There is diffuse mucosal thickening within the bilateral and sphenoid sinuses, right more than left. The orbits and imaged intracranial structures are unremarkable.

Output: RIght antrochoanal polyp in the setting of diffuse sinonasal inflammatory mucosal disease and right nasal packing.


Instruction: Generate impression based on findings.

Input: Shoulder pain. Decreased range of motion. ROTATOR CUFF: No evidence of rotator cuff tears. There is mild tendinopathy in the supraspinatusSUPRASPINATUS OUTLET: No significant abnormality noted.GLENOHUMERAL JOINT AND GLENOID LABRUM: No significant abnormality noted.BICEPS TENDON: No significant abnormality noted. ADDITIONAL

Output: No rotator cuff tears. Mild tendinopathy in the supraspinatus