{ "Contributors": "MIMIC", "Source": "MIMIC-IV", "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/", "Categories": [ "Summarization" ], "Definition": [ "Summarize the MRI imaging diagnostics' detailed findings for the Abdomen into a concise conclusion." ], "Reasoning": [], "Input_language": [ "English" ], "Output_language": [ "English" ], "Instruction_language": [ "English" ], "Domains": [ "Medicine", "Clinical Reports", "MRI", "Abdomen" ], "Positive Examples": [], "Negative Examples": [], "Instances": [ { "input": "Lower Thorax: Visualized lung bases are clear. There is no pleural effusion. \nHeart size is enlarged.\n\nHepatobiliary: The liver is cirrhotic in morphology. There is intrahepatic\nbiliary ductal dilatation in segment VII, likely secondary to a focal\nobstruction at the level of the TIPS stent, with associated progressive\nenhancement of the surrounding hepatic parenchyma, compatible with fibrosis,\nstable. A 3.0 cm focus of subcapsular progressive enhancement in the left\nhepatic dome (series 1104, image 23) is also compatible with fibrosis, stable.\nThere is no focal lesion meeting OPTN 5 criteria for hepatocellular carcinoma.\nThere are no focal hepatic lesions meeting OPTN 5 criteria for hepatocellular\ncarcinoma.\n\nThere are stones in the gallbladder. There is no extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal lesion or ductal dilatation.\n\nSpleen: The spleen is top-normal in size, measuring 13.0 cm in length, and\nnormal in signal intensity.\n\nAdrenal Glands: Bilateral adrenal glands are normal in contour.\n\nKidneys: The kidneys are normal and symmetric in size. There is no\nhydronephrosis. There are no focal renal lesions.\n\nGastrointestinal Tract: Visualized small and large bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is a patent TIPS extending from the main portal vein to the\nintrahepatic IVC. Main, right and left portal veins are patent. Hepatic\nveins are patent. Hepatic arterial anatomy is conventional. There is a\nrecanalized paraumbilical vein.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nSoft tissue structures of the abdominal wall are unremarkable.", "output": "1. Cirrhotic morphology of the liver. No focal lesions meeting OPTN 5\ncriteria for hepatocellular carcinoma.\n2. Patent TIPS.\n\nRECOMMENDATION(S): 2. Patent TIPS." }, { "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: The liver is homogeneous with a smooth contour. No suspicious lesion\nseen. The portal vein and hepatic veins are patent. No free fluid.\n\nBiliary: The common bile duct measures up to 9 mm, similar to previously. \nThere is minimal opening at one point. No obstructing mass is visualized.\nThis is likely due to sphincter of Oddi dysfunction.\n\nThe gallbladder is unremarkable. T2 feathery, probably duodenum.\n\nPancreas: Normal T1 appearance of the pancreas. No pancreatic duct dilatation.\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: A few small cortical cysts are seen in both kidneys, the largest in\nthe upper pole of the left kidney measuring 2.5 cm in diameter. No\nhydronephrosis.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No size significant lymph nodes.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: Nonspecific enhancing lesion in L1\nvertebral body, too small to characterize, but statistically likely\nhemangioma. This was not seen on the previous examination, possibly due to\ntechnique.", "output": "1.The common bile duct measures up to 9 mm, similar to previously. There is\nminimal opening at one point. No obstructing mass is visualized. This is\nlikely due to sphincter of Oddi dysfunction.\n\n2. Nonspecific enhancing lesion in L1 vertebral body, too small to\ncharacterize, but statistically likely hemangioma. Dedicated lumbar spine MRI\ncan be performed for further characterization if clinically indicated." }, { "input": "Lower Thorax: There is a small right pleural effusion. There is scattered\nlinear subsegmental atelectasis of the bilateral lung bases.\n\nLiver: The liver is enlarged, with the right hepatic lobe measuring 20.5 cm in\nlength, and smooth in contour. There is severe diffuse hepatic steatosis with\ncalculated fat fraction of 36%. There are a few hepatic cysts versus biliary\nhamartomas, measuring 2.3 x 1.9 cm in segment III (series 10, image 29), 1.0 x\n0.9 cm in segment II (series 10, image 18), and subcentimeter in segment VIII\n(series 10, image 20 and 21). No suspicious hepatic lesion is identified. \nThere is mild diffuse periportal edema. There is a small amount of\nperihepatic ascites. Taken together, these findings are concerning for\nhepatitis.\n\nThe portal and hepatic veins are patent.\n\nBiliary: The gallbladder is collapsed and demonstrates mural edema, likely\nreactive to the underlying hepatic process. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is normal in size and low in signal intensity. The signal\nintensity increases on the out-of-phase images, compatible with iron overload.\nThere is a small cystic lesion in the inferior spleen (series 9, image 20).\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size. There is a 1.8 x 1.6 cm cyst in\nthe lower pole of the left kidney with a thin septation (series 3, image 27). \nThere is also a tiny cyst in the lower pole of the left kidney. There is no\nsolid renal mass or hydronephrosis. There is nonspecific bilateral\nperinephric stranding.\n\nGastrointestinal Tract: The stomach is collapsed and grossly unremarkable. \nVisualized upper abdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: Note is made of multiple osseous\nhemangiomas. No suspicious osseous lesion is identified. There are midline\nincisional changes of the lower abdominal wall. There is diffuse subcutaneous\nedema of the abdomen.", "output": "1. Enlarged liver with mild diffuse periportal edema and a small amount of\nperihepatic ascites, concerning for hepatitis. Severe diffuse hepatic\nsteatosis, with calculated fat fraction of 36%.\n\n2. Collapsed gallbladder with mural edema, likely reactive to the underlying\nhepatic process.\n\n3. Findings of iron overload in the spleen.\n\n4. Small right pleural effusion." }, { "input": "Lower Thorax: Minimal dependent left lower lobe atelectasis appear similar\ncompared to prior.\n\nLiver/biliary: The patient is status post orthotopic liver trans plant\ncomplicated by recurrent primary sclerosing cholangitis. Hepaticojejunostomy\nis unremarkable. The previously noted abnormal T2 signal in the anterior\nlower aspect of the liver (series 8, image 55) is improved compared to prior. \nPreviously noted abnormal T2 signal in the posterior aspect of the liver\n(series 8, image 48) is similar to slightly increased compared to prior. \nThere is persistent increased peribiliary signal which may be due to\ninfectious or inflammatory cholangitis. No focal fluid collection.\n\nPancreas: Evaluation of the pancreas is notable for several cystic lesions,\nthe largest measuring up to 19 mm in the pancreatic tail (series 3, image 28).\nThese lesions likely represent side branch IPMNs and unchanged. No main\npancreatic duct dilatation.\n\nSpleen: Splenomegaly appear similar compared to prior.\n\nAdrenal Glands: Unremarkable\n\nKidneys: Simple appearing renal cysts measuring up to 15 mm in the kidneys are\nunchanged.\n\nGastrointestinal Tract: There is no bowel obstruction. Small volume ascites.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Thoracoabdominal aortic dissection is again noted and appears\nfairly similar compared to most recent MR. ___ upper abdominal varices\nand splenorenal shunt in keeping with portal hypertension.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "Overall cholangitis appears fairly similar with abnormal T2 signal in the\nanterior aspect of the liver appearing slightly improved, and in the posterior\naspect of the liver appear similar to slightly worse.\nRecurrent primary sclerosing cholangitis within the transplant liver, with\nunchanged degree of biliary ductal dilatation and stricturing.\nThere is no drainable fluid collection.\n\nSequela of portal hypertension, with splenomegaly, varices and small volume\nascites are unchanged.\n\nProbable side-branch IPMNs measuring up to 19 mm in diameter are unchanged.\n\nUnchanged thoracoabdominal aortic dissection as noted above." }, { "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: The transplanted hepatic parenchyma is homogeneous with a smooth\ncontour. No suspicious lesion seen. The portal vein and hepatic veins are\npatent. No free fluid. A 5 mm cyst is seen in segment 5.\n\nThere are a few very vague small subcentimeter subcapsular arterial enhancing\nfoci of doubtful significance. In the dome of the right lobe, a round 5 mm\nfocus of hyperenhancement arterial phase images shows no correlate on pre\ncontrast imaging sequences or on more delayed contrast-enhanced imaging\nsequences. This is highly nonspecific would probably not significant\nclinically.\n\nThere is an elongated geographic subcapsular lesion in segment 5 of the liver\nmeasuring 4.1 cm x 1.0 cm and demonstrating T1 and T2 isointensity to the\nliver parenchyma. It is very faintly hypointense compared to background liver\non precontrast T1 weighted imaging. It is indistinguishable from background\nliver on T2 weighted images. Post gadolinium injection, the lesion is not\nvisible on the arterial phase. On the portal venous phase, it is\nhypoenhancing. On the later phases, this lesion fills in with contrast and is\nagain indistinguishable from the liver parenchyma. The lesion is not seen on\nthe diffusion weighted imaging. There is no macroscopic fat. This could be\npostoperative in nature.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\nhas been surgically removed.\n\nPancreas: Normal T1 appearance of the pancreas. No pancreatic duct dilatation.\n\nSpleen: The spleen is absent.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: A few subcentimeter cortical cysts are seen bilaterally. No\nhydronephrosis.\n\nGastrointestinal Tract: The partially visualized bowel is unremarkable.\n\nLymph Nodes: No size significant lymph nodes.\n\nVasculature: Patient is status post liver transplant with the piggyback. \nThere is mild celiac stenosis at the origin. A stent is noted along the\nhepatic artery. There is signal dropout along the stent making it difficult\nto assess with this technique, but intra hepatic arterial branches opacify\nappropriately. Portal vein and its major branches appear patent. Hepatic\nvenous branches are also patent.,\n\nOsseous and Soft Tissue Structures: Unremarkable.", "output": "1. Status post liver transplant. Mild celiac stenosis. Stent along the\nhepatic artery, difficult to assess with this technique. Patent distal\narterial branches, however.\n\n2. Geographic peripheral subcapsular hypovascular lesion along segment V of\nthe liver, likely corresponding to the lesion seen by ultrasound. The lesion\nis mainly seen on the portal venous phase, where it is hypoenhancing. Seems\nvery unlikely to represent any type of tumor and seems most likely to\nrepresent postoperative/post ischemic change.\n\n3. Very small nonspecific arterial enhancing focus in the dome of the right\nlobe measuring 5 mm within segment 8. This is very unlikely to be significant\nclinically although follow-up might be considered depending on risk level.\n\nRECOMMENDATION(S): 3 month follow-up with ultrasound could be considered to\nensure stability of the lesion. Also, small arterial enhancing focus in the\nright hepatic dome is doubtful in significance, but if there is any concern\nfor recurrent hepatitis C and/or hepatic fibrosis, it may be appropriate to\nconsider follow-up MR." }, { "input": "Lower Thorax: Minor bibasal atelectasis. No pleural or pericardial effusion. \nBilateral gynecomastia is noted.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are smooth. Multiple\npunctate T2 hyperintense, non-enhancing foci scattered throughout the liver\nparenchyma are most in keeping with biliary hamartomas. No concerning solid\nor cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. There is a stable 2 mm cyst\nin the head of the pancreas. No nodularity or duct abnormality is identified.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. Bilateral subcentimeter cortical cysts\nare noted. The largest cyst arises from the right interpolar region measuring\n15 x 12 mm. There are no concerning solid or cystic lesions. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. No\nabnormal areas of mural thickening.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: Multilevel degenerative change is noted\nthroughout the thoracolumbar spine. The bone marrow demonstrates normal\nsignal characteristics. No concerning osseous lesions.", "output": "2 mm pancreatic cyst statistically most likely represents a side-branch IPMN.\nThere are no concerning features. Follow-up MRCP in ___ years is recommended." }, { "input": "Multiple gallstones are present within the gallbladder, which is not\ndistended. The common bile duct is dilated, measuring 0.9 cm but tapers\nsmoothly to the level of the ampulla without etiology identified. This is\nslightly larger than ___ CT.\n\nPancreatic duct is normal in caliber. 2 mm cystic lesion in the pancreas\n(9:15). Normal signal of the pancreas. Multiple sub centimeter subcortical T2\nbright lesions in the right kidney, likely representing small cysts.\n\nThe adrenal glands are normal in appearance bilaterally. No adrenal mass is\nidentified.", "output": "1. Normal bilateral adrenal glands. Extra-adrenal paraganglioma is not\nexcluded on this study however.\n\n2. Cholelithiasis. Mild common bile duct dilation, suggestive of papillary\nstenosis.\n\n3. 2 mm cystic lesion in the pancreas head, possibly side branch IPMN, for\nwhich follow-up MRCP in ___ year is recommended." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Peripheral reticular enhancement seen on delayed contrast phase is\nconsistent with fibrotic changes. There is hypertrophy of the left hepatic\nlobe and caudate lobe. 7 mm T2 hyperintense biliary cyst or hamartoma in the\nright hepatic lobe (04:18).\n\nBiliary: Cholelithiasis without gallbladder wall thickening. No intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: Tiny 5 mm T2 hyperintense lesion in the body tail junction of the\npancreas (08:12). The pancreatic parenchyma otherwise maintains normal bulk,\nintrinsic hyperintense T1 signal and enhancement pattern. No focal lesion or\nductal abnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: 6.6 x 4.0 x 6.2 cm left perinephric rim enhancing collection (19:26)\nwith intrinsic hyperintensity on T1 weighted images consistent with the known\nchronic abscess/infected hematoma, previously 6.7 x 4.6 x 6.7 cm. There is a\nmoderate amount of left perinephric and ___ stranding. The left\nkidney is partly displaced by this collection and demonstrates overall delayed\nand decreased enhancement. The left proximal ureter is thick walled and\nenhancing with periureteral stranding compatible with inflammatory changes\nfrom ureteral stones and ureteral stent. Large left proximal ureteral stones\nare again identified, unchanged in size and position. Left internal ureteral\nstent is not well visualized on this exam but likely present.\nThere is also a 3.7 x 1.9 x 7.8 cm rim enhancing fluid collection tracking\nalong the lateral aspect of the left psoas muscle and anterior to the left\nquadratus lumborum muscle, previously measuring 3.1 x 2.6 x 8.1 cm, not\nsignificantly changed. Along the track where the drainage catheters were\nremoved, there has been accumulation of a small amount of fluid with a 4.0 x\n1.5 cm small rim enhancing collection in the left posterior flank/body wall.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: Multiple prominent retroperitoneal lymph nodes are likely\nreactive.\n\nVasculature: Moderate atherosclerotic disease of the abdominal aorta.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is normal in\nappearance", "output": "1. No significant change in size of left perinephric collection or of the\nextension of the collection tracking along the posterior para renal space,\ncompared to prior CT given differences in technique. MR cannot further\ncharacterize ___, however we note that this collection is known to be\nheavily loculated and resistant to catheter drainage previously, and continues\nto display internal complexity and hemorrhagic components.\n2. New small (4.0 x 1.5 cm) amount of fluid/abscess collecting along the\ntrack of the removed drainage catheters in the left posterior lateral body\nwall.\n4. Changes in the liver suggestive of early hepatic cirrhosis.\n5. Probable 5 mm side-branch IPMN in the pancreatic body tail junction.\n6. Cholelithiasis.\n\nRECOMMENDATION(S): Follow up MRI one year for probable sidebranch IPMN" }, { "input": "Lower Thorax: The imaged lower thorax is clear. There is no pleural or\npericardial effusion.\n\nLiver: The partially imaged liver demonstrates a nodular contour, in keeping\nwith cirrhosis. As intravenous contrast was not administered, evaluation for\nliver lesions is limited.\n\nBiliary: There is no intra or extrahepatic biliary dilation. The common bile\nduct is normal in caliber. Stones are noted within the the gallbladder, with\nno secondary signs of inflammation.\n\nPancreas: The pancreas is normal in signal intensity with no duct dilation. 5\nmm pancreatic body cystic lesion (5:5), is unchanged from the prior MRI,\nlikely a side-branch IPMN.\n\nSpleen: The spleen is normal in size with a focal T2 hyperintensity at the\nupper pole (6:6), which may represent a splenic cleft.\n\nAdrenal Glands: The adrenal glands are morphologically normal bilaterally.\n\nKidneys: The right kidney is normal in size no hydronephrosis or perinephric\nabnormality.\n\nThere is a complex loculated perinephric collection in the left posterior para\nrenal space, extending posteriorly and inferiorly towards the iliacus muscle. \nThe collection measures 8.9 x 3.4 x 6.9 cm (05:16, 6:18), and has decreased in\nsize since the prior MRI where it measured 9.7 x 4.0 x 7.3 cm. The signal\ncharacteristics of the collection are heterogeneous on T2 weighted imaging\nwith restricted diffusion, as on the prior study. A drain tract extends\nposterolaterally to the skin surface. The margins of the tract have collapsed\nand the previously seen peripherally enhancing fluid collection within the\ntract has resolved.\nTwo stones in the proximal to mid left ureter are again seen, measuring 19 and\n18 mm respectively (06:21).\n\nGastrointestinal Tract: Imaged bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesion is\nappreciated.", "output": "1. Interval slight decrease in size of the heterogeneous, multiloculated left\nposterior pararenal collection, now measuring 8.9 x 3.4 x 6.9 cm, previously\n9.7 x 4.0 x 7.3 cm. No new collection.\n2. Resolution of a fluid collection along the left posterolateral flank drain\ntract.\n3. Unchanged 5 mm pancreatic body cystic lesion, likely a side-branch IPMN.\n4. Unchanged left ureterolithiasis.\n5. Cirrhotic morphology of the liver." }, { "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The entire liver has not been included on this scan. The imaged\nportion of the liver demonstrates normal T2 signal intensity and a 6 mm T2\nhyperintense, likely cyst in segment 6 (5:7).\n\nBiliary: The gallbladder is distended and demonstrates presence of dependent\ncalculi in the region of the neck extending into the cystic duct. There is no\nintrahepatic or extrahepatic biliary ductal dilation.\n\nPancreas: There is significant atrophy of the pancreatic parenchyma without\nmain duct dilation. There are multiple foci of coarse calcification within\nthe pancreatic parenchyma likely related to chronic pancreatitis, better\nevaluated on the CT torso from ___.\n\nSpleen: No splenomegaly or focal splenic lesions.\n\nAdrenal Glands: No right adrenal nodule. Left adrenal nodule measuring 1.6 x\n1.1 cm in size (5:8) is not well visualized on the in and out-of-phase\nsequences and hence cannot be optimally characterized. This nodule was also\nseen on the CT torso dated ___ with ___ approximately 28 of\nthe noncontrast scan, hence not an adenoma. However it remains unchanged in\nsize compared to that prior scan.\n\nKidneys:\nNo right-sided hydronephrosis or discrete solid lesion.\nThe left kidney appears dysmorphic. There is a 1.0 cm homogeneously T2\nhyperintense cyst in the superior pole of the left kidney. No hydronephrosis.\nThere is a left-sided nephroureteral stent in place, better visualized on the\nprior CT torso. The known left perinephric fluid collection located along the\nposterolateral aspect of the left kidney, within the perinephric space\nmeasures approximately 5.0 by 1.7 cm in size (05:21) with a homogeneously T2\nhypointense rim, likely calcification as seen on the prior CT. No significant\ninterval increase in size of this perinephric collection compared to the prior\nCT. There is another smaller collection measuring approximately 2.5 by 2.0 cm\nin size abutting the left quadratus lumborum muscle (05:26) with linear tracts\nextending to the adjacent perinephric collection, slightly smaller than\nbefore.\nA fistulous tract is seen communicating from the left perinephric collection\nup to the skin along the left posterolateral body wall. Compared to the CT\ndated ___ there is no significant increase in size or no new\nramifications from this fistula.\n\n\nGastrointestinal Tract: There is no bowel obstruction. Small hiatus hernia. \nPartially visualized is a right anterior abdominal wall hernia containing\nnonobstructed small bowel loops.\n\nLymph Nodes: No upper abdominal lymphadenopathy.\n\nVasculature: Limited evaluation in the absence of intravenous contrast.\n\nOsseous and Soft Tissue Structures: Visualized bones demonstrate normal signal\nintensity. Mild degenerative changes of the thoracolumbar spine.", "output": "1. The known left perinephric fluid collection demonstrates wall\ncalcification, is slightly smaller in size compared to the CT dated ___ and continues to communicate with another smaller fluid\ncollection located anterior to the left quadratus lumborum muscle. There is a\npatent fistulous tract extending from the left perinephric collection to the\nskin overlying the left posterolateral back which has not changed\nsignificantly compared to the prior CT. No new fluid collections seen in the\nleft perinephric space.\n2. There is a left ureteral stent and known left ureteral calculi -not well\nvisualized on this scan. No hydronephrosis on either side.\n3. Small hiatus hernia, partially imaged right anterior abdominal wall hernia\ncontaining a nonobstructed small bowel loop, cholelithiasis and stones within\nthe cystic duct without intra or extrahepatic biliary ductal dilation are\nadditional incidental findings." }, { "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver: Liver has a cirrhotic morphology with widening of the hilar periportal\nspace and blunting of the left lateral lobe. There are numerous T2\nhyperintense foci without enhancement scattered throughout all of the lobes of\nthe liver. None of these demonstrate any enhancement or restricted diffusion.\nThese are consistent with simple cysts, however correlation with prior imaging\nis recommended. No evidence of hepatic steatosis on the dual-echo GRE images.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nis not well seen.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated. There is 0.6 cm nonenhancing cystic lesion in\nthe uncinate process of the pancreas, likely represents side-branch IPMN,\nstable since CT exam.\n\nSpleen: Top normal size. Normal signal and enhancement.\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement. No solid\nmass.\n\nGastrointestinal Tract: No evidence of obstruction. No mass.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Normal branching pattern of the\nceliac axis. Main portal vein is patent and dilated, very blunted at the\nhilum. Right and left portal vein branches are very attenuated, though\nvisible. There is a large recanalized paraumbilical vein. There is a\nsplenorenal shunt. Hepatic veins are patent. There are perigastric and\nparaesophageal varices.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal.", "output": "1. Innumerable hepatic lesions are seen throughout the liver. These\ndemonstrate high signal on T2 weighted images and do not demonstrate any\nenhancement or restricted diffusion to suggest a solid lesion. These are most\nconsistent with innumerable simple cysts based on this single exam. \nCorrelation prior imaging is recommended in the setting of a history of breast\ncancer.\n\n2. Cirrhosis with sequela of portal hypertension including borderline\nsplenomegaly, patent paraumbilical vein, and varices (both paraesophageal and\nperigastric)." }, { "input": "Lower Thorax: The lower thorax is unremarkable. There is no pericardial or\npleural effusion.\n\nLiver: The liver demonstrates a cirrhotic morphology compatible with\ncirrhosis. There is no evidence of signal dropout on out of phase imaging to\nsuggest diffuse hepatic steatosis. T2 hyperintense nonenhancing foci within\nthe liver are compatible with cysts or biliary hamartomas. No suspicious\nhepatic masses are seen.\n\nThe right and left portal veins are attenuated. The main portal vein is\npatent and there is a large patent paraumbilical vein. The SMV and splenic\nvein are patent. Numerous upper abdominal collaterals are seen.\n\nBiliary: The gallbladder is present. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity without pancreatic ductal\ndilatation or peripancreatic fluid.No pancreatic lesions are seen.\n\nSpleen: Spleen is enlarged measuring up to 15.6 cm. The signal intensity is\nnormal. There is no focal lesion seen.\n\nAdrenal Glands: The adrenal glands are normal in shape and size.\n\nKidneys: The kidneys demonstrate normal corticomedullary differentiation and\nare symmetric and normal in size without hydronephrosis.No renal lesions are\nseen.\n\nGastrointestinal Tract: The visualized large and small bowel demonstrate\nnormal thickness and caliber.\n\nLymph Nodes: There is no lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in size.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen.\nThe body wall is within normal limits.", "output": "1. Cirrhotic morphology of the liver with sequela of portal hypertension\nincluding splenomegaly and prominent upper abdominal collateral vessels\nincluding a large patent paraumbilical vein. No suspicious hepatic lesion.\n2. Numerous hepatic cysts are similar from the prior study, none demonstrating\nconcerning features.\n3. Mild splenomegaly is new since ___." }, { "input": "The liver is visualized and is of normal signal\nintensity. No focal liver lesions identified. The spleen is of normal size\nbut multiple subcentimeter areas of low signal intensity are identified on the\nout- of- phase imaging that demonstrate some blooming and reduced signal on\nthe in- phase imaging.\n\nThe adrenals are visualized and are normal. The kidneys are visualized and\nare normal. The gallbladder is normal.\n\nThe pancreas is visualized and is of normal signal intensity. The pancreatic\nduct is normal in caliber. Post-administration of secretin, the pancreatic\nduct fills normally to a maximum at 3 minutes, but does not decompress\ncompletely by 10 minutes. The clinical significance of this delayed emptying\nof the pancreatic duct is unclear. It could represent an element of ampullary\nstenosis. However, no evidence of any irregularity in the duct and no evidence\nof any stenosis within the pancreatic duct.\n\nNo evidence of any intrahepatic or extrahepatic bile duct dilatation.\n\nNo evidence of any significant lymphadenopathy. The bowel where visualized is\nnormal. The osseous structures where visualized are normal. No evidence of\nany free fluid.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series.", "output": "1. Secretin MRCP reveals normal filling of pancreatic duct at 3 minutes, but\nincomplete emptying at 10 minutes, the clinical significance of which is\nclear. However, it could represent an element of ampullary stenosis.\n2. Multiple low signal subcentimeter areas on T1-weighted imaging that\ndemonstrate a drop in signal and blooming on the in-phase imaging. Calcified\ngranulomas are unlikely as no calcification is seen on CT and Gamna- Gandy\nbodies are unlikely because there is no evidence of portal hypertension. Less\ncommon conditions to cause this appearance includes splenic peliosis." }, { "input": "In segment III of the liver are two arterially enhancing foci, the larger\nmeasuring 0.6 cm (1001:38). Slightly more superiorly is an additional 5 mm\narterial-enhancing focus without associated washout (1001:41). A similar\nappearing 0.5 cm focus is present in segment 4 (1001:51). Some of these are\nmore subtle, but present on ___ study. No additional arterially enhancing\nlesions are identified within liver. Post radiofrequency ablation changes in\nsegment 6 of the liver present without enhancement to suggest recurrent tumor.\nPostsurgical changes are noted at the junction of segments VII and VIII. The\nliver surface is nodular, compatible with known cirrhosis. There is an 8 mm\ncyst adjacent to the intrahepatic IVC. Slight drop out of signal in the\nliver, compatible with steatosis.\n\nThere is no ascites. Normal gallbladder. The spleen is normal size. The\npancreas enhances normally. Normal adrenal glands and kidneys. Visualized\nloops of bowel are within normal limits. Normal bone marrow signal. Lung bases\nare clear.", "output": "1. Three tiny arterially enhancing foci in the liver, which may represent\ntransient hepatic intensity differences (THIDs) and do not demonstrate\nwashout. Attention on follow-up is recommended.\n\n2. Post RFA and surgical changes without evidence of recurrence in the liver.\n\n3. Cirrhosis." }, { "input": "MR ABDOMEN: The liver is nodular with left lobe hypertrophy in keeping with\nknown cirrhosis. There is loss of signal on the out of phase images relative\nto the in phase images, compatible with mild fatty deposition. Postsurgical\nchanges are seen at the junction of segment VII/VIII without enhancement to\nsuggest local recurrence. Post RFA changes are seen in segment VI with\nintrinsic T1 hyperintensity due to coagulation necrosis, also without abnormal\nenhancement to suggest local recurrence.\n\n5-mm arterially enhancing foci in segment III without washout (1401:56, 59)\nare unchanged. The previously seen arterially enhancing focus in segment IV is\nless apparent on today's study. Additional peripherally enhancing arterial\nfoci in segment IVb/V adjacent to the gallbladder (1401:61) are unchanged\nsince ___, likely perfusional.\n\nThere is no intra or extrahepatic bile duct dilation. The gallbladder is\nnormal without stones. The spleen is normal in size. The pancreas is normal in\nsignal intensity and enhancement with a normal caliber main pancreatic duct.\nBilateral adrenal glands are normal. The kidneys enhance symmetrically without\nhydronephrosis. Visualized bowel is unremarkable. There is no ascites. No\nenlarged mesenteric or retroperitoneal lymph nodes are seen in the upper\nabdomen. The imaged portions of the abdominal aorta are normal in caliber.\nHepatic arterial anatomy is conventional. The hepatic veins in the main portal\nvein, splenic vein and SMV are patent.\n\nNo bone marrow signal abnormality is identified.", "output": "1. Tiny arterially enhancing foci in segment III are unchanged from ___, likely representing transient hepatic intensity differences. Routine\nfollow up is recommended. The segment IV arterial enhancing focus is less\napparent on this study.\n2. Posttreatment changes without evidence of recurrence.\n3. Cirrhosis." }, { "input": "There are postsurgical changes consistent with provided history of liver\ntransplantation.\n\nPunctate nonenhancing T2 hyperintense foci in the hepatic parenchyma are\nconsistent with cysts versus small biliary hamartomas. There is a 1.7 cm\nsubcapsular wedge-shaped area of hyper enhancement in segment V (14 01:22)\nwhich becomes isointense to surrounding hepatic parenchyma more delayed phase\nimaging. There is no evidence of washout or pseudo capsule formation. There\nis no suspicious hepatic lesion.\n\nThe gallbladder is surgically absent. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nSpleen is not enlarged. There is no evidence of pancreatic mass or pancreatic\nductal dilatation.\n\nAdrenal glands are unremarkable. There is symmetric renal enhancement and\nexcretion of intravenous contrast. There is no evidence of hydronephrosis.\nThere is no suspicious renal lesion in the visualized kidneys.\n\nAbdominal aorta has a normal caliber.", "output": "Post liver transplantation. No concerning hepatic mass. No lymphadenopathy." }, { "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: Evaluation of the liver is somewhat limited due to non breath holding\ntechnique. Given this limitation, the liver is normal in signal intensity\nwithout evidence of focal suspicious mass. The hyperechoic lesion seen on\nultrasound has no imaging correlate on today's study. The portal vein is\npatent.\n\nGallbladder and Biliary System: The gallbladder is normal with no evidence of\nstones. There is no significant intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.The main pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal\nlesion.The adrenal glands are normal bilaterally.\n\nBowel: There is extensive circumferential submucosal edema involving the\ngastric antrum extending into the duodenal bulb with some mucosal\nhyper-enhancement. The visualized bowel loops and mesentery are within normal\nlimits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "1. No suspicious focal liver lesion identified. The hyperechoic mass seen on\nultrasound has no imaging correlate on MRI.\n\n2. Extensive circumferential submucosal edema as well as mucosal\nhyper-enhancement involving the gastric antrum extending into the duodenal\nbulb. These findings may represent gastritis/ duodenitis. Ulcer can not be\nexcluded. Correlation with symptoms and endoscopy is recommended.\n\nNOTIFICATION: Findings discussed with ___ by ___ telephone at\n5:10pm on ___, 10 minutes following review." }, { "input": "Exam is limited by non breath hold technique.\n\nLower thorax: There is a small right pleural effusion.\n\nLiver: The liver demonstrates normal morphology. There is patchy drop in\nsignal on out of phase imaging compared with in phase imaging, compatible with\nsteatosis, with a fat fraction measuring up to 16%. There is increased\ndiffusion signal in the remainder of the hepatic parenchyma which may be due\nto inflammation. No suspicious focal liver lesion identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. There is a\nrecannulized paraumbilical vein.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. There is small ascites.", "output": "1. Exam is limited by non breath hold technique.\n2. Patchy moderate hepatic steatosis.\n3. Increased diffusion signal in the remainder of the hepatic parenchyma, may\nbe due to acute hepatitis.\n4. No focal suspicious hepatic lesions.\n5. Sequela of portal hypertension including a recannulized paraumbilical vein\nand small ascites. No splenomegaly.\n6. Small right pleural effusion." }, { "input": "Lower Thorax: The visualized lung bases are grossly clear. There is no\npleural effusion.\n\nLiver: The transplant liver is normal in contour and signal intensity. There\nis no evidence of hepatic steatosis. No suspicious liver lesions are seen. A\nT2 hyperintense focus in segment VII of the liver is compatible with cyst or\nbiliary hamartoma (series 5, image 20).\n\nBiliary: There is mild central intrahepatic biliary ductal dilatation. There\nis no extrahepatic biliary ductal dilatation. Note is made of an abandoned\nsegment of native proximal extrahepatic duct in the hilum. The gallbladder is\nsurgically absent.\n\nPancreas: The pancreas is atrophic but normal in intrinsic signal intensity. \nThere is no main ductal dilatation. No focal pancreatic lesions are seen.\n\nSpleen: The spleen is mildly enlarged measuring 13.7 cm without focal lesions.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. Multiple T2 hyperintense nonenhancing\nlesions in the bilateral kidneys, the largest measuring 8.7 cm in the\ninterpolar region of the right kidney, are consistent with simple cysts. A\nfew subcentimeter no T1 hyperintense lesions in bilateral kidneys are\ncompatible with hemorrhagic cysts. No suspicious renal lesions are\nidentified. No hydronephrosis. There is no perinephric abnormality.\n\nGI: Visualized intra-abdominal loops of small and large bowel are normal in\ncaliber.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The hepatic arterial, portal and venous anastomoses are patent. \nThe abdominal aorta and its major branches are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions detected.", "output": "No evidence of recurrent hepatocellular carcinoma in the transplant liver." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: An orthotopic liver transplant is again seen. There are a few minute\nstable cysts. There is a minute nonenhancing mildly hyperintense T2 lesion in\nthe right hepatic lobe on series 3, image 12, possibly hemorrhagic cysts,\nstable. No findings of hepatocellular carcinoma. The portal vasculature is\npatent.\n\nBiliary: There is stable minimal of biliary ductal dilatation along the right\ninferior transplant margin.\n\nPancreas: There is a stable 6 mm pancreatic cystic lesion in the uncinate\nprocess. No main ductal dilatation. The pancreas is otherwise unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: Multiple renal cysts are again noted, the largest on the right with\nthin internal nonenhancing septations measuring 8.7 cm. No hydronephrosis.\n\nGastrointestinal Tract: There is no intestinal obstruction or ascites in the\nupper abdomen. There is stable mild nodularity in the omentum, most likely is\npostsurgical.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes.\n\nVasculature: Conventional hepatic branches again seen. The hepatic\nvasculature is patent.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions are seen.", "output": "Post liver transplant. No hepatocellular carcinoma.\n\nStable 6 mm side-branch intraductal papillary mucinous neoplasm. No main\npancreatic ductal dilatation." }, { "input": "Liver: Hepatic contour is nodular with geographic redistribution with areas of\nreticular delayed enhancement compatible with given diagnosis of cirrhosis.\nExophytic 21 mm mass in hepatic segment IV B adjacent to the gallbladder\ndemonstrate areas of an arterial hyper enhancement with delayed washout,\ndiffusion restriction, as well as a pseudo capsule (10:59). Several areas of\nperipheral, non masslike arterial enhancement seen throughout the liver do not\npersist on delayed phases and are compatible with perfusion anomaly.\nGallstones within otherwise unremarkable gallbladder. Portal vein is patent.\n\nBiliary: No intra or extrahepatic biliary dilatation.\n\nPancreas: Mildly atrophied without focal lesion or ductal dilatation.\n\nSpleen: Enlarged measuring up to 16 cm in maximal dimension. Few focal areas\nof signal void on out of phase imaging compatible with Gamna Gandy bodies.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Several large bilateral simple cysts measuring up to 67 mm in the\nright interpolar kidney and 25 mm in the left lower pole kidney. No solid\nrenal mass. No hydronephrosis.\n\nGastrointestinal Tract: Stomach, duodenum and visualized small and large bowel\nloops are normal caliber without evidence of obstruction.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal caliber.", "output": "1. 21 mm exophytic mass in hepatic segment IVb demonstrating arterial\nenhancement with washout, diffusion restriction and pseudocapsule meeting OPTN\ncriteria for HCC, corresponding to the lesion seen on ultrasound.\n2. Cirrhotic liver with sequela of portal hypertension including splenomegaly.\n3. Cholelithiasis.\n4. Several, large bilateral simple renal cysts.\n\nNOTIFICATION: Results were entered into the online critical results\ncommunication dashboard by Dr. ___ at 16:47 ___." }, { "input": "Lower Thorax: Lung bases and lower pleural spaces are clear.\n\nLiver: The liver demonstrates a nodular contour, along with lobar\nredistribution, with enlargement of the caudate lobe and left lateral lobe,\nmorphological features in keeping with hepatic cirrhosis. No evidence of\nhepatic steatosis. The previously seen hepatocellular carcinoma within\nsegment 4B, treated with chemo embolization has significantly decreased in\nsize from the first post chemoembolization hepatic MRI dated ___. \nToday the lesion measures 0.7 x 1.3 cm (series 1002, image 53), and previously\nmeasured approximately 1.5 x 1.6 cm (series 14, image 60). This treated\nlesion remains hypo enhancing on the post gadolinium images. Multiple\narterially enhancing lesions with no associated washout or signal abnormality\non the diffusion-weighted images are identified within the liver, largest\nwithin segment ___ measuring 8 mm (series 1001, image 63), unchanged in size\nand appearance from the comparison study. No new hepatic mass lesions. \nBackground hepatic fibrosis as appreciated on the post contrast images. \nHepatic vasculature remains patent. Trace ascites.\n\nBiliary: No intra or extrahepatic ductal dilatation. The gallbladder contains\nmultiple gallstones, as seen previously, with no evidence of gallbladder wall\nthickening or pericholecystic inflammatory changes.\n\nPancreas: Pancreas enhances homogeneously with no main pancreatic ductal\ndilatation or peripancreatic abnormality.\n\nSpleen: The spleen remains enlarged in size, measuring up to 14 cm in the CC\ndimension. No focal splenic mass.\n\nAdrenal Glands: Adrenal glands are normal in size and appearance with no focal\nmass lesion.\n\nKidneys: No dilatation of the renal collecting system. Multiple renal cysts\nare noted bilaterally, largest in the right kidney measuring up to 8.6 cm,\nunchanged in appearance from the comparison study. 2.3 cm exophytic cyst\narising from the lower pole of the left kidney is again noted containing a\nthin internal septation.\n\nGastrointestinal Tract: Visualized loops of small large bowel are\nunremarkable.\n\nLymph Nodes: No large sized retroperitoneal lymphadenopathy. Small periportal\nlymph nodes are identified, which appear less prominent than on the prior\nstudy.\n\nVasculature: No aneurysmal dilatation of the abdominal aorta. 2 left renal\narteries. Gastric varices.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions are\ndemonstrated.", "output": "Status post chemoembolization of segment 4 hepatocellular carcinoma which has\nsignificantly decreased in size from the comparison study. No evidence of\nresidual or recurrent HCC.\n\nTrace ascites with splenomegaly and gastric varices, in keeping with sequelae\nof portal hypertension. Background hepatic cirrhosis.\n\nCholelithiasis." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: The caudate lobe is enlarged, and the liver has a nodular contour. \nThis is in keeping with the history of cirrhosis. The patient is status post\na TACE to a lesion in segment 4. Due to the location of this previously\ntreated lesion, is somewhat difficult though evaluate, though no residual\nlesion is definitely identified. There is slight heterogeneous enhancement in\nthe area of the treatment zone, suggestive of post-treatment fibrosis. There\nare no foci of arterial hyperenhancement or washout to suggest recurrent or\nresidual tumor.\n\nThere are innumerable regenerative nodules. There are several tiny foci of\narterial hyperenhancement without a correlate on the T2 weighted images or\nevidence of washout. The largest is in segment 5, and measures 8 mm (12, 44).\nThis is unchanged dating back to ___. No lesions meet OPTN-5 criteria\nfor HCC.\n\nThe hepatic arterial anatomy is conventional. The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. Multiple\nstones are identified in the gallbladder, including one which is hyperintense\non the T1 weighted images. There is no MRI evidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is mildly enlarged, measuring 14.8 cm. It previously\nmeasured 14 cm. There are no focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There is a dominant simple renal\ncyst measuring 89 mm in the lower pole of the right kidney (8, 40). A 28 mm\nexophytic cyst arising from the lower pole of the left kidney has a single\nthin septation which is not significantly changed. The other cysts are\nsimple. There are no worrisome renal lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is very trace perihepatic ascites, similar to\nthe prior exam.\n\nLymph Nodes: There are mildly prominent periportal lymph nodes, which are\nlikely reactive to the underlying liver disease. There is no retroperitoneal\nor mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque. There are esophageal and\ngastric varices.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild multilevel degenerative changes are noted throughout the spine. The soft\ntissues are unremarkable.", "output": "1. Posttreatment changes in segment 4 without evidence of residual or\nrecurrent disease.\n2. Several unchanged foci of arterial hyperenhancement which are nonspecific.\nNo lesions meet OPTN-5 criteria for HCC.\n3. Cirrhosis with portal hypertension, including splenomegaly, varices, and\ntrace ascites.\n4. Cholelithiasis." }, { "input": "Lower Thorax: Limited views of the lung bases are clear. There is no pleural\neffusion.\n\nLiver: The liver demonstrates a nodular contour with enlargement of the left\nlateral segment and caudate lobe compatible with cirrhosis. Diffuse fibrosis\nand innumerable regenerative nodules are again identified. Patient is status\npost TACE to an exophytic lesion in segment IV. There is no evidence of\nresidual or recurrent tumor. Heterogeneous enhancement at the area of the\ntreatment zone appears minimally decreased compared to the prior study and\nlikely represents post treatment changes. Scattered sub centimeter arterially\nenhancing lesions without washout on subsequent phases or T2 correlate are\nagain noted. The largest of which measures 8 mm in segment V (10:47). These\nare overall unchanged compared to the prior study. The portal vein is patent.\nHepatic arterial anatomy is conventional. Sliver of perihepatic ascites is\npresent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. \nMultiple gallstones are again identified within a mildly distended\ngallbladder. There is no gallbladder wall thickening or pericholecystic\nfluid.\n\nPancreas: The pancreas demonstrates normal contour and signal intensity. \nThere is no main duct dilatation or peripancreatic abnormality.\n\nSpleen: The spleen remains enlarged and measures 15.4 cm, previously 14.8 cm. \nNo focal splenic lesion is seen.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. Multiple T2 hyperintense\nnon-enhancing lesions are identified compatible with simple cysts with the\nlargest arising from the interpolar region of the right kidney measuring 8.5\ncm. Minimally complex 2.6 cm cyst arising from the lower pole of the left\nkidney is also unchanged since the prior study. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach, small and large bowel are unremarkable\nwithout bowel wall thickening or dilatation. Gastroesophageal varices are\nagain identified.\n\nLymph Nodes: Prominent reactive periportal lymph nodes are unchanged. There\nis no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. The major branch vessels are patent.\n\nOsseous and Soft Tissue Structures: No marrow abnormality is identified. The\nsoft tissues are grossly unremarkable.", "output": "1. Post treatment changes in segment IV of the liver without residual or\nrecurrent tumor.\n\n2. Multiple unchanged arterially enhancing hepatic foci, non-specific\nfindings. No lesion meeting OPTN-5 criteria for HCC.\n\n3. Cirrhotic liver with sequelae of portal hypertension including\nsplenomegaly, gastroesophageal varices, and trace ascites.\n\n4. Cholelithiasis band renal cysts." }, { "input": "Lower Thorax: Visualized lung bases and lower mediastinal structures are\nunremarkable.\n\nLiver: The liver has a nodular contour with lobar redistribution, consistent\nwith cirrhosis. The patient is status post TACE treatment in segment 4B from\n___ which demonstrates heterogeneous enhancement. No evidence of\nrecurrent tumor.\n\nPreviously demonstrated arterial hypervascular lesions are not seen, likely\nrelated to timing of the contrast bolus. However, on portal venous and\ndelayed phases, there are multiple transient hepatic intensity differences.\n\nNo lesions concerning for hepatocellular carcinoma.\n\nTrace perihepatic ascites.\n\nBiliary: Cholelithiasis. No intrahepatic or extrahepatic biliary duct\ndilatation.\n\nPancreas: Pancreas is normal. No focal pancreatic lesion. No pancreatic duct\ndilatation.\n\nSpleen: Splenomegaly is demonstrated, measuring 15.7 cm, previously 14.8 cm.\n\nAdrenal Glands: Adrenal glands are normal.\n\nKidneys: Kidneys are normal size and are symmetric. Numerous cysts are\ndemonstrated, largest lobulated cyst in the interpolar region of the right\nkidney measuring 8.1 cm. Largest in the left kidney is noted in the lower\npole with a single septation.\n\nGastrointestinal Tract: Visualized small and large bowel are unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Conventional hepatic arterial anatomy. Gastroesophageal varices.\nAbdominal aorta is unremarkable.\n\nOsseous and Soft Tissue Structures: Multilevel degenerative changes of the\nvisualized thoracic and lumbar spine.No soft tissue lesions.", "output": "1. Cirrhosis with evidence of portal hypertension. Splenomegaly has mildly\nprogressed compared to the prior exam.\n2. Stable TACE treatment site in segment 4B. No concerning lesions for\nhepatocellular carcinoma.\n3. Stable renal cysts." }, { "input": "Lower Thorax: The lung bases are grossly clear. No pleural or pericardial\neffusion.\n\nLiver: The liver has a markedly nodular contour with reticular enhancement,\ncompatible with cirrhosis and fibrosis. Patient is status-post TACE treatment\nto segment 4B, where there is heterogeneous signal and enhancement. No\nevidence of recurrent tumor.\n\nThere are numerous foci of arterial enhancement without T2, precontrast or\ndelayed phase correlate (for example 1401:32, 44, 48, 61, 69). Some of these\nlesions are new, and some were previously seen, however, none meet OPTN 5\ncriteria for HCC. These are most consistent with transient hepatic intensity\ndifferences.\n\nSeveral punctate T2 hyperintense nonenhancing foci are seen within the liver\nas well, consistent with cysts or biliary hamartomas. No concerning hepatic\nlesions are identified. No ascites.\n\nBiliary: Multiple gallstones are seen within the gallbladder, without evidence\nof wall thickening or pericholecystic fluid. No intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: Pancreas is normal in signal intensity and bulk. No evidence of\npancreatic ductal dilatation or enhancing pancreatic lesions.\n\nSpleen: Spleen is enlarged, measuring 16.4 cm, previously 15.8 cm. Multiple\nGamna Gandy bodies are seen within the spleen.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Kidneys are normal in size, and demonstrate symmetric enhancement\nafter the administration of contrast. Multiple T2 hyperintense nonenhancing\ncortical and parapelvic cysts are present. The largest of which is located in\nthe interpolar region of the right kidney, and measures 8.4 x 7.2 cm.\n\nGastrointestinal Tract: The stomach is under distended, but grossly normal. \nImaged loops of small and large bowel are normal in course and caliber.\n\nLymph Nodes: Enlarged lymph nodes measured 1.2 x 1.1 cm in the porta hepatis,\nand 1.2 x 1.1 cm in the region of the gastroduodenal artery are likely\nreactive. Several other scattered prominent retroperitoneal and mesenteric\nlymph nodes are present.\n\nVasculature: Abdominal aorta is normal in caliber. Note is made of\nparaesophageal and gastric varices.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions.", "output": "1. Cirrhosis with sequela of portal hypertension, including splenomegaly and\nvarices. No ascites.\n2. Status post TACE to a lesion in segment 4B, without evidence of residual or\nrecurrent disease.\n3. Multiple transient hepatic intensity differences within the liver.\n4. No concerning liver lesions meeting OPTN 5 criteria for HCC.\n5. Cholelithiasis." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion\n\nLiver: Liver demonstrates nodular contours compatible with liver cirrhosis. \nThere is no significant drop of signal on the out of phase images as compared\nto the in-phase images to suggest hepatic steatosis. There is diffuse\nreticular lace-like enhancement on the more delayed phases suggestive of\nfibrosis.\n\nPatient is status post transarterial chemoembolization of segment IVB. No\nevidence for tumor recurrence. Multiple peripheral nodular areas of arterial\nenhancement that do not persist on the more delayed phases, or without washout\nmost likely suggestive of transient hepatic intensity differences. No\nworrisome enhancing hepatic mass lesions meeting OPTN Class 5 criteria for\nHCC.\n\nBiliary: Gallbladder is present containing multiple gallstones. No\ngallbladder wall thickening or pericholecystic fluid. There is no\nintrahepatic or extrahepatic biliary duct dilatation. The common bile duct\ntapers normally towards the ampulla without obstructing filling defects or\ncholedocholithiasis.\n\nPancreas: Pancreas demonstrates normal signal intensity on the T1 weighted\nimages and enhances homogeneously. No suspicious solid or cystic mass lesion.\nThe main pancreatic duct is not dilated. No peripancreatic inflammatory\nchanges or fluid collections.\n\nSpleen: Spleen is enlarged measuring 15 cm in maximal diameter. It otherwise\nenhances homogeneously without focal mass lesion.\n\nAdrenal Glands: The adrenal glands are normal bilaterally without focal\nnodules.\n\nKidneys: The kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There is adequate excretion of contrast on\nthe more delayed phases. Multiple stable simple renal cortical cysts, the\nlargest at the interpolar region of the right kidney measuring 7.7 x 8.9 cm. \nNo suspicious renal masses or hydronephrosis.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon the\nupper abdomen are within normal limits. No ascites.\n\nLymph Nodes: Multiple prominent periportal, peripancreatic and gastrohepatic\nlymph nodes, stable from prior and not pathological by size criteria, likely\nreactive to underlying chronic liver disease. No suspicious mesenteric or\nretroperitoneal lymphadenopathy by size criteria. There are 2 new nonenlarged\nprominent lymph nodes along the anterior left chest wall (series 16, image\n40).\n\nVasculature: Abdominal aorta is normal in caliber its major branches are\npatent. Hepatic arterial anatomy is conventional. The splenic vein, SMV,\nportal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions. Small nonspecific foci of enhancement within the costochondral\njunctions bilaterally, unchanged from prior, of questionable etiology.", "output": "1. Status post TACE. No evidence of residual or recurrent tumor.\n2. Cirrhotic morphology of the liver with extensive fibrosis. No worrisome\nenhancing hepatic mass lesions meeting OPTN Class 5 criteria for HCC. Trace\nperihepatic free fluid.\n3. Cholelithiasis." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology. No suspicious focal liver\nlesion identified. Iron level: ___ Micromol/g with a standard deviation of\n30, consistent with light to moderate iron overload.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is borderline enlarged, measuring 12.5 cm, stable.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. Hepatic arterial\nanatomy is conventional.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "Light to moderate hepatic iron overload." }, { "input": "The visualized lung bases are clear. There is no pleural effusion.\n\nThe liver again demonstrates diffusely decreased signal intensity on T2\nweighted imaging, as well as signal dropout on in-phase compared to out of\nphase imaging, consistent with hemosiderosis. A previously characterized\nhemangioma in the left lobe is unchanged. There is no intra or extrahepatic\nbiliary duct dilation. There is adenomyosis of the gallbladder fundus. The\nspleen is normal in size, again with decreased T2 signal intensity consistent\nwith hemosiderosis. The pancreas is within normal limits, without focal\nlesion, peripancreatic fluid collection, iron deposition, or ductal dilation.\nThe adrenal glands and kidneys are normal bilaterally, with multiple bilateral\nsimple renal cysts unchanged. The visualized loops of small and large bowel\nare unremarkable. Intra-abdominal vascular flow voids are preserved. There is\nno retroperitoneal or mesenteric lymphadenopathy. No focus of abnormal\nenhancement with contrast administration is identified. The osseous structures\nare unremarkable.", "output": "1. Redemonstration of hemosiderosis. Liver iron content using the\n___ calculator is estimated to be 200 (+/-50) umol iron/g dry\nweight liver(normal < 36 \u00b5mol/g) using the PD sequence. This corresponds to\nmoderate iron overload. Given the significant iron deposition within the\nliver, we are unable to concurrently assess for coexisting fatty liver.\n2. Unchanged left hepatic lobe hemangioma.\n3. Bilateral simple renal cysts." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear other\nthan minimal atelectasis. There is no pleural effusion. The base of the\nheart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is mild iron deposition in the liver, compatible\nwith hemosiderosis. The liver iron concentration estimated the T2++ sequence\nis 45 (+/-20) umol/g. Normal is less than 36 umol/g. In comparison the prior\nexam, the liver iron content has decreased. It previously was 200 (+/-50)\numol/g. No significant hepatic steatosis is identified, though a small amount\ncould be obscured by the presence of iron within the liver.\n\nIn the left lobe of the liver, there is a lobulated 21 mm T2 hyperintense\nlesion which demonstrates peripheral nodular arterial enhancement that fills\nin on the delayed phases. This is compatible with a hemangioma. There is a\nsmall perfusion abnormality surrounding this lesion. It is unchanged from\nprior exams. No other liver lesions are identified. The hepatic arterial\nanatomy is conventional. The portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is collapsed, which somewhat limits evaluation. Within the\nlimitations, there is no MRI evidence of cholecystitis. A small gallstone is\nnoted in the gallbladder fundus.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 9.2 cm. There is very mild\ndrop in signal on the in phase images in comparison to the out of phase\nimages, suggesting mild iron deposition within the spleen. This is in keeping\nwith hemosiderosis.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. Multiple subcentimeter renal cysts\nare noted bilaterally. There are no worrisome renal lesions, hydronephrosis,\nor perinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There are few mildly prominent periportal lymph nodes. None meet\nsize criteria for pathologic enlargement. There is no retroperitoneal or\nmesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nIn a mid thoracic vertebral body, there is a 10 mm T2 hyperintense lesion,\nwhich is unchanged from the prior exam, and most compatible with a hemangioma.\nThe soft tissues are unremarkable.", "output": "1. Mild hemosiderosis. The liver iron concentration has decreased notably\nfrom the prior exam, as detailed above.\n2. Unchanged left hepatic hemangioma.\n3. Cholelithiasis." }, { "input": "Lower Thorax: The heart is normal in size. There is no pleural or pericardial\neffusion.\n\nLiver: The liver is normal in size and smooth in contour. There is no hepatic\nsteatosis. There is a 0.7 x 0.5 cm cyst or biliary hamartoma in segment VII. \nThere are a few scattered arterially enhancing lesions without T2 correlate,\nincluding a 0.5 cm lesion in segment VIII (series 1001, image 34), a 1.0 cm\nlesion at the border of segments VI and VII (series 1001, image 44), 0.8 cm\nlesion in segment VI (series 1001, image 100), likely representing transient\nhepatic intensity differences. There is no correlate for the echogenic right\nhepatic lobe lesion described on abdominal ultrasound from ___. \nNo suspicious hepatic lesion is detected.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. No focal\nlesion is detected.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size. There is a 3.2 x 1.5 cm simple\ncyst in the upper pole of the left kidney, and a another tiny cyst in the\ninterpolar region.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. The abdominal wall is within normal limits.", "output": "No correlate for the right hepatic lesion described on abdominal ultrasound\nfrom ___. Subcentimeter cyst or biliary hamartoma in segment\nVII, and a few scattered transient hepatic intensity differences. No\nsuspicious hepatic lesion." }, { "input": "The liver is shrunken and nodular, consistent with known cirrhosis. There is a\n4.8 x 3.9 cm area of hypoenhancement in segment VI, representing the site of\nchemoembolization. Hypoenhancement on all phases in a wedge-shaped area\nextending to the inferior margin of the liver likely tissue necrosis\n(1402:115). There is an 8 mm arterially enhancing focus in the peripheral\nright lobe with no definite washout in segment VII/VIII (1401:43).\n\nAccessory left hepatic artery is better appreciated on prior CTA (___:65).\nThe hepatic and portal veins are patent. There is a 4.1 cm long seroma along\nthe posterior margin of the right lobe, unchanged from multiple priors\n(12:58). The spleen is not enlarged. Evaluation of the pancreas on T2 weighted\nsequences is severely limited by dielectric defect. The adrenal and kidneys\nare unremarkable. There is large volume ascites. Bone marrow signal is\nnormal.", "output": "1. Post treatment changes in segment VI after chemoembolization including\ntissue necrosis. No evidence of residual tumor. Patent hepatic vasculature.\n2. 8 mm arterially enhancing focus in segment VII/VIII without definite\nwashout. Attention at followup is recommended.\n3. Accessory left hepatic artery.\n4. Large volume ascites." }, { "input": "The morphologic appearance of the liver is unchanged, with contour nodularity\nand segmental size variation in keeping with the known underlying cirrhosis.\nPosttreatment change within segments V and VI is also unchanged. There\ncontinues to be a 5.0 x 5.9 x 9.6 cm region of nonenhancing liver parenchyma,\nconsistent with tissue necrosis (17:87). This is somewhat wedge-shaped in\ncontour extending to the inferior margin of the liver. More superiorly there\nis peripheral bile duct obstruction (16:77). The contents of this area of\nnecrosis are heterogeneous on T2 weighted imaging, as well as T1 weighted\nimaging, but without enhancement.\n\nOn arterial phase of imaging there are numerous foci of punctate arterial\nhyperenhancement including at the margin of segments VII and VIII, as was seen\npreviously. The largest in segment VII/VIII has a diameter of 8-mm, unchanged\nfrom prior (10:34). None demonstrate associated subsequent washout. A tiny T2\nhyperintense, nonenhancing focus is noted within segment 4B (16:52),\nconsistent with a biliary hamartoma.\n\nThere is evidence of chronic portal hypertension on the basis of a\nrecannulized paraumbilical vein and innumerable portosystemic collateral\nvessels (16:104). The spleen is borderline enlarged, measuring up to 13 cm\ncaudocranially. Large volume of ascites is again noted with mild thickening\nand hyperenhancement of the peritoneal surface, likely related to recent\nparacentesis. Splenic vein, superior mesenteric vein and portal venous system\nare patent and contrast opacified.\n\nLobulated area of T1 hyperintensity and T2 hypointensity without enhancement\nis noted posterior to the right lobe of the liver (07:39). This may reflect a\nloculated collection of chronic blood products or proteinaceous seroma,\nunchanged from multiple priors and measures 4.5 x 1 cm. Other smaller similar\nappearing foci are noted adjacent to this dominant collection.\n\nThe pancreas, adrenal glands and right kidney are normal in appearance. There\nis a tiny cyst within the superior pole of the left kidney.\n\nLymph nodes within the porta hepatis and gastrohepatic ligament are unchanged\nand nonspecific in etiology. Note is made of an accessory left hepatic artery.\nOtherwise arterial vascular anatomy is conventional. There is mild\natherosclerotic plaque involving the infrarenal abdominal aorta. Osseous\nstructures are unremarkable. The lung bases are clear.", "output": "1. Cirrhosis with sequela of portal hypertension including large volume\nascites.\n2. Stable post treatment appearance within segments V and VI without evidence\nof residual or recurrent tumor.\n3. Multiple sub-cm foci of arterial hyperenhancement without washout or\nT2-correlate, similar compared to the prior study and are non-specific,\npossibly perfusional abnormalilties. Continued attention on follow up to\nthese regions are recommended." }, { "input": "The bases of the lungs are grossly clear. There is no pleural or pericardial\neffusion.\n\nThe liver has a nodular contour, compatible with known cirrhosis. A previously\ndescribed treated lesion in hepatic segment VI is again noted, measuring\napproximately 7.5 by 7.3 x 8.4 cm (01:15, 04:32). This area is\nwell-circumscribed, and contains heterogeneous contents with a predominant\nportion of T2 hyperintense, T1 hypointense central liquefaction, with a\nsmaller amount of necrotic tissue contained within. Along the posterolateral\nmargin of the lesion are 2 hypointense projections extending to the hepatic\ncapsular surface (1004:104), with no evidence of enhancement, likely\nretractile tissue/fibrosis, also related to posttreatment change. Wedge-shaped\nT2 hyperintense signal within the inferior-most tip of the right hepatic lobe\nin segment VI (04:40) is likely related to a small area of infarcted hepatic\nparenchyma.\n\nNo new concerning hepatic lesions with washout are identified. A patent\nindwelling TIPS stent. Extending from the right hepatic vein to the right\nportal vein is unchanged in position compared to prior studies. A small\nlobulated focus of T1 hyperintensity and T2 hypointensity with no enhancement\nis again noted posterior to the right hepatic lobe (5a:21, 04:28, 1004:54),\nunchanged, compatible with loculated collection of chronic blood products.\n\nThe pancreas, bilateral adrenal glands, and right kidney are unremarkable. A\nnonenhancing tiny left upper pole renal cyst is unchanged (1004:76). There is\nno pathologic enlargement of mesenteric or retroperitoneal lymph nodes, and\nslightly prominent porta hepatic lymph nodes are unchanged, measuring up to 7\nmm in short axis diameter (1004:78). There is no portal venous or hepatic\nvenous thrombosis identified. Incidental note is made of an accessory left\nhepatic artery arising from the left gastric artery (1001:56). \nAtherosclerotic plaque within the abdominal aorta is again noted, with\npersistent mild infrarenal ectasia, with no aneurysmal formation. No focal\nbone marrow signal abnormalities are detected.", "output": "1. Continued evolution of post treatment changes predominantly in hepatic\nsegment VI, with no evidence of residual or recurrent tumor.\n2. Small wedge-shaped parenchymal infarct in the inferior most tip of hepatic\nsegment VI.\n3. Cirrhotic liver with patent TIPS shunt." }, { "input": "Lower Thorax: Please see the chest CT obtained immediately prior to this exam\nfor complete intrathoracic details.\n\nLiver: The liver is shrunken and nodular, compatible with the history of\ncirrhosis. There is no hepatic steatosis. There is a well-circumscribed 7.4\nx 7.3 x 8.6 cm cystic lesion with internal blood products, compatible with the\npreviously treated hepatocellular carcinoma. Allowing for changes in\nmeasurement technique, the appearance of this lesion is not significantly\nchanged. There is no abnormal enhancement around this lesion to suggest local\nrecurrence.\n\nIn the periphery adjacent to this lesion, there is T2 hyperintense material\nwhich is nonenhancing and likely related to post treatment changes or an old\ninfarct. There is some mild biliary duct dilation in this region. This is\nstable in appearance.\n\nIn segment VIII, there is an 8 mm focus of arterial hyperenhancement (901,\n50). There is no definite washout or a correlate on the T2 weighted images. \nThis is new from the prior exam. No other foci of arterial hyperenhancement\nare noted.\n\nThere are few punctate T2 hyperintense lesions, compatible with cysts or\nbiliary hamartomas.\n\nThe patient is status post TIPSS. The TIPSS is patent. There is minimal\nbiliary duct dilation in the parenchyma peripheral to the TIPSS, which is also\nunchanged. The remainder the portal veins are also patent. The hepatic veins\nare attenuated, though patent.\n\nAlong the posterior aspect of the right lobe of the liver, there is an\nunchanged non-enhancing T1 hyperintense crescent-shaped fluid collection\nmeasuring 38 x 13 mm, which is compatible with a benign cystic lesion. Given\nthe lack of a perceptible wall, it is unlikely to be a hematoma.\n\nBiliary: There is no central intrahepatic or extrahepatic biliary duct\ndilation. The gallbladder is collapsed, which limits evaluation. No stones\nor cholecystitis is identified.\n\nPancreas: The pancreas is normal in signal and enhances homogeneously. There\nis no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 12.6 cm. There no focal\nlesions. A 7 mm accessory spleen is noted in the left upper quadrant (4, 16).\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are no focal lesions,\nhydronephrosis, or perinephric abnormalities. The kidneys enhance\nsymmetrically.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: An enlarged portocaval lymph node is unchanged. There is no\nretroperitoneal or mesenteric lymphadenopathy. Two prominent epiphrenic lymph\nnodes along the diaphragm (903, 45 and 52), do meet criteria for pathologic\nenlargement, and are unchanged from the prior exam.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is mild atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe soft tissues are unremarkable.", "output": "1. Posttreatment changes in the right hepatic lobe, unchanged from the prior\nexam, as described above. No evidence of local recurrence.\n2. No lesions meet OPTN-5 criteria for HCC. There is an 8 mm focus of\narterial enhancement in segment VIII without washout or a T2 correlate, which\nbears watching on follow-up exams.\n3. Patent TIPSS." }, { "input": "Liver: There are no imaging features of advanced cirrhosis. Minute foci of\narterially hyper enhancement throughout the liver (1101:32, 40, 53, 66, 70),\nthe largest in hepatic segment VII (1101:41) that have no correlate on other\nsequences, most consistent with transient hepatic intensity differences. \nOtherwise, no lesion characteristic of hepatocellular carcinoma is seen.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is within normal limits without evidence of cholelithiasis.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: Unremarkable\n\nAdrenal Glands: Unremarkable\n\nKidneys: The kidneys are unremarkable aside for small cysts\n\nGastrointestinal Tract: There is no evidence of bowel obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. The major abdominal\nvasculature are patent. Hepatic arterial anatomy is conventional.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion.", "output": "No HCC." }, { "input": "Lower thorax: The lung bases are grossly clear. Please refer to separate\nreport of CT chest performed on the same day for description of the thoracic\nfindings.\n\nLiver: The liver demonstrates normal morphology and signal intensity. No\nsuspicious focal liver lesion identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis. There no discrete lesion, but an equivocal 5 mm\nresidual hypodensity in the posterior right upper pole, not seen on all\nsequences, the region of a previously seen hyperdensity which measured\napproximately 1.3 cm in ___ (17:56).\n\nBowel: The stomach is unremarkable. The small and large bowel are\nunremarkable. There is no wall thickening, adjacent inflammatory change, or\nabnormal enhancement. There is no evidence of stricture or obstruction.\n\nPelvis: The bladder and distal ureters are unremarkable. The prostate and\nseminal vesicles are unremarkable. No free fluid in the pelvis.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. Incidental note is\nmade of a retroaortic left renal vein.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nOsseous/Soft Tissue: There are stable sclerotic changes along the endplates of\nthe T11 and T12 vertebral bodies, likely Schmorl's nodes. No concerning\nosseous lesions. No free fluid.", "output": "1. Equivocal residual 5 mm remaining signal abnormality in the posterior right\nupper pole, in the region of a 1.3 cm exophytic lesion seen on CT in ___, may be due to collapse of a hemorrhagic cyst or a treated metastasis. \nOtherwise no concerning renal lesions.\n2. No additional evidence of metastatic disease in the abdomen or pelvis.\n3. Please refer to separate report of CT chest performed on the same day for\ndescription of the thoracic findings." }, { "input": "Lower Thorax: Atelectasis is seen dependently at the lung bases, otherwise, no\ngross abnormalities.\n\nLiver: The liver demonstrates normal signal intensity. There is no suspicious\nhepatic lesion.\n\nBiliary: No intra- or extrahepatic biliary dilation. Gallbladder is\nunremarkable without gallstones.\n\nPancreas: Pancreas has a normal appearance without ductal dilation.\n\nSpleen: Spleen is normal in appearance and size.\n\nAdrenal Glands: Adrenal glands are thin without nodularity.\n\nKidneys: Several small subcentimeter T2-hyperintense foci seen within the\nkidneys, consistent with renal cysts. No hydronephrosis or other focal\nabnormality.\n\nGastrointestinal Tract: Stomach is grossly unremarkable. Visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal adenopathy.\n\nVasculature: Visualized abdominal vasculature is grossly unremarkable.\n\nOsseous and Soft Tissue Structures: There are no gross abnormalities.", "output": "No focal abnormality on MRI corresponding to the area of increased FDG\nactivity along the superior edge of the gallbladder fossa at the posterior\nedge of segment four/eight. No dedicated follow-up is required based on the\ncurrent findings." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion. \nGynecomastia is present.\n\nLiver: Scattered mildly T1 bright regenerative nodules are present. There is\nno chemical shift on the in or out of phase sequences to suggest the presence\nof hepatic steatosis or iron deposition. The liver contours are smooth. No\nsolid or cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: There is abnormally low heterogenous signal intensity on\nT1-weighted images and heterogenous enhancement of the left aspect of the\npancreatic body and most of the pancreatic tail with an expanded parenchyma\nand irregular spiculated defined contour. There are small side branches\nidentified in the abnormal pancreas but no significant ductal dilation. The\nremainder of the pancreas maintains normal bulk, intrinsic hyperintense T1\nsignal and enhancement pattern. No focal lesion or ductal abnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: Scattered bilateral renal cortical cysts, largest in the lower pole\nthe right kidney measuring 1.3 cm (02:31).\n\nGastrointestinal Tract: There is a small ___ duodenal\ndiverticulum. The GI tract is of normal caliber throughout.\n\nLymph Nodes: There are enlarged porta hepatis and peripancreatic lymph nodes\nmeasuring up to 12 mm with (04:20), likely secondary to underlying liver\ndisease.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "There are scattered mildly T1 bright regenerative nodules, one of which may\ncorrespond to abnormality seen on ultrasound. No concerning liver lesions\nidentified.\n\nAbnormal appearance of the left pancreatic body and most of the pancreatic\ntail as detailed above, likely secondary to prior or resolving pancreatitis. \nClinical correlation is recommended and consideration for EUS should be given.\n\nRECOMMENDATION(S): Follow up ultrasound routine screening." }, { "input": "Lower Thorax: Within normal limits.\n\nLiver: There are scattered T1 hyperintense regenerative nodules. No\nsuspicious enhancing lesions. Background liver appears normal.\n\nBiliary: No intra extrahepatic biliary ductal dilatation. Gallbladder is\nabsent.\n\nPancreas: Diffuse signal heterogeneity of the body and tail of pancreas is\nagain seen however the pancreas appears less swollen since the prior MR\nexamination from ___. There is no peripancreatic fluid or edema. \nThe main pancreatic duct is not dilated.\n\nSpleen: The spleen size is normal. There is no focal splenic mass.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: There is 1.3 cm simple cyst in lower pole of the right kidney. \nPunctate hemorrhagic cyst noted in the mid polar region of the left kidney. \nKidneys are otherwise unremarkable.\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal mass.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries are\npatent and normal in caliber. There is a tiny accessory left renal artery\n(series 1201, image 84). Conventional hepatic arterial anatomy is\ndemonstrated. The portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. Regenerative nodules throughout the liver. No concerning hepatic mass.\n2. The pancreas again demonstrates heterogeneous abnormal signal intensity,\nbut appears less wall and in comparison to the ___ examination. \nThere is no pancreatic duct dilation or focal mass. The findings likely\nrepresent resolving pancreatitis. A follow-up MRCP is recommended in 6 months\nto assess for continued improvement." }, { "input": "Liver: Again seen is cirrhotic liver morphology. No steatosis demonstrated. \nThe hepatic vasculature is patent. No hepatic mass demonstrated.\n\nBiliary: Post cholecystectomy. No biliary ductal dilatation.\n\nPancreas: The pancreas is unremarkable\n\nSpleen: The spleen is unremarkable\n\nAdrenal Glands: The adrenal glands are unremarkable\n\nKidneys: The kidneys remain unremarkable aside for a few diminutive cysts some\nof which are hemorrhagic. There is no hydronephrosis.\n\nGastrointestinal Tract: Small periampullary duodenal diverticulum is again\nseen. There is no intestinal obstruction or ascites in the upper abdomen.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions are seen.", "output": "Cirrhotic liver. No HCC." }, { "input": "Lower thorax: No pleural effusions.\n\nLiver: At least three T2 hyperintense lesions (slightly decreased signal\nintensity compared to fluid), the largest in segment 7 of the liver measures\n25 mm in diameter. These lesions most likely correspond to the hyperechoic\nlesions seen on ultrasound and most likely represent hemangiomas.\n\nBiliary: No intra or extrahepatic bile duct dilatation. The gallbladder\nappears normal.\n\nPancreas: No pancreatic abnormality.\n\nSpleen: No splenic abnormality.\n\nAdrenal Glands: Appear normal.\n\nKidneys: No hydronephrosis.\n\nGastrointestinal Tract: No features of small or large bowel obstruction. The\nappendix is not clearly visualized, but there are no secondary features of\nappendicitis.\n\nPelvis: ___ intrauterine pregnancy.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Major vasculature are patent.\n\nOsseous and Soft Tissue Structures: No suspicious bony lesions.", "output": "1. The appendix is not identified, but there is no secondary features of\nappendicitis.\n\n2. No acute intraabdominal pathology identified.\n\n3. Three T2 hyperintense lesions most likely correspond to the hyperechoic\nlesion seen on ultrasound and most likely represent hemangiomas." }, { "input": "Lower thorax: Partially imaged lung bases are clear.\n\nSolid organs: The solid organs including the liver, gallbladder, spleen,\npancreas, adrenals and kidneys are within normal limits. There is no\nhydronephrosis. No evidence of intra or extrahepatic biliary dilatation.\n\nGastrointestinal Tract: The visualized small and large bowel loops are normal\nin caliber. The appendix is normal in caliber measuring approximately 3-4 mm\nin maximum diameter. There is no evidence of appendiceal wall thickening or\nperiappendiceal inflammatory changes.\n\nPelvis: Uterus shows a fetus in a cephalic position with a posterior placenta.\nThe cervix measures 4.6 cm. No adnexal abnormality seen on the given images. \nThe urinary bladder is normally distended with normal wall thickness.\n\nLymph Nodes: No significant lymphadenopathy.\n\nVascular: Time-of-flight imaging shows patent pelvic vasculature. The\nbilateral gonadal veins are enlarged however patent.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal. No soft tissue\nabnormality.", "output": "No acute process in the abdomen or pelvis to explain patient's symptoms." }, { "input": "The study was terminated prematurely by the patient due pain. Only localizer\nand axial and coronal SSFSE sequences were obtained.\n\nLower thorax: Limited visualization of the lower thorax demonstrates no large\npleural effusion.\n\nHepatobiliary: Partially visualized liver with no intra or extrahepatic ductal\ndilatation. No cholelithiasis. No gallbladder wall thickening.\n\nPancreas: No pancreatic ductal dilatation. No peripancreatic stranding.\n\nSpleen: No splenomegaly.\n\nAdrenal Glands: Symmetric bilaterally.\n\nKidneys: No hydronephrosis.\n\nGastrointestinal Tract: No abnormally dilated loops of bowel. Normal caliber\nappendix. No periappendiceal inflammation.\n\nPelvis: Intrauterine fetus in cephalic position with posterior placenta. No\nlarge adnexal lesions given the limitations of technique.\n\nLymph Nodes: No significant lymphadenopathy, given limitation of technique.\n\nVasculature: Normal caliber abdominal aorta. Limited evaluation without\nTime-of-flight imaging.\n\nOsseous and Soft Tissue Structures: No destructive osseous lesions.", "output": "The study was terminated prematurely by the patient due pain, however there is\nno evidence of acute appendicitis." }, { "input": "Lower Thorax: The lung bases are clear. Heart size is normal.\n\nLiver: The liver is normal in morphology and signal intensity. There is a 1.3\nx 1.3 cm simple cyst in segment ___ of the liver. No additional focal hepatic\nlesions are seen. There is no ascites.\n\nBiliary: The gallbladder is unremarkable without stones. There is no intra or\nextrahepatic biliary duct dilation.\n\nPancreas: The pancreas in morphology and signal intensity. There is no\nevidence of pancreas divisum. There is no focal pancreatic lesion.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right adrenal gland is unremarkable. There is a 1.4 x 1.7\ncm left adrenal nodule with diffuse drop of signal on out-of-phase imaging,\nconsistent with an adenoma.\n\nKidneys: The kidneys are symmetric in size. There are scattered simple in the\nbilateral kidneys. In addition to simple cysts, there is a 2.1 x 1.5 x 1.9 cm\nT2 intermediate intensity exophytic lesion arising from the anterior right\nlower pole with internal hyperenhancement similar to that of background kidney\n(series 3, image 43). There is intra voxel but no for bulk fat seen within\nthis lesion. The left, right, and main renal veins are unremarkable. There\nis 1 renal artery bilaterally.\n\nGastrointestinal Tract: There is no hiatal hernia. Postsurgical changes from\nRoux-en-Y gastric bypass are present.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. There\nis no superficial soft tissue abnormality.", "output": "2.1 cm right lower pole renal mass containing intra voxel, but no identifiable\nbulk fat. Findings are concerning for clear cell renal cell carcinoma with\nalternative differential of a fat poor AML. No renal vein invasion." }, { "input": "Lower Thorax: Unremarkable.\n\nLiver: The portions visualized of the liver is unremarkable. There is no\nsteatosis. There is a simple 1.3 cm left hepatic cyst.\n\nBiliary: No dilatation of the intra or extrahepatic biliary duct. The portion\nvisualized of the gallbladder is unremarkable.\n\nPancreas: No pancreatic lesion. No dilatation of the main duct.\n\nSpleen: unremarkable.\n\nAdrenal Glands: 16 mm left adrenal nodule showing drop of signal suggesting an\nadrenal adenoma.\n\nKidneys: The kidneys are symmetric in size. There is scattered simple cysts\nin bilateral kidneys. We again see a 2.1 x 1.5 x 2 cm intermediate to\nhyperintense T2 lesion that is exophytic at the anterolateral right lower lobe\nwith internal enhancement. This mass is unchanged since the previous exam.\n\nGastrointestinal Tract: Gastric bypass. No signs of bowel obstruction. The\nprior colitis has improved.\n\nLymph Nodes: No adenopathy.\n\nVasculature: The renal veins are patent. There is a duplicated IVC with the\nleft IVC draining via the left renal vein.\n\nOsseous and Soft Tissue Structures: No aggressive looking bone lesion.", "output": "Stable solid right renal mass suggestive of a clear cell RCC. No metastasic\ndisease." }, { "input": "Lower thorax: Lung bases, visualized pleural spaces, and lower mediastinal\nstructures are unremarkable.\n\nLiver: Liver is normal in signal and contour. No liver steatosis. No\nmorphologic features of cirrhosis. A partially visualized small septated cyst\nis noted in segment ___ of the liver. This is incompletely assessed on\ntoday's study, but was seen on multiple prior studies dating back to ___.\n\nBiliary: Normal gallbladder and biliary tree. No intrahepatic or extrahepatic\nbile duct dilatation.\n\nPancreas: Pancreas maintains normal bulk. The main pancreatic duct is normal.\n\nSpleen: The spleen is not enlarged (10 cm).\n\nAdrenals: Stable left adrenal adenoma which measures up to 16 mm in diameter\n(stable from ___. Right adrenal gland unremarkable.\n\nKidneys: Again re-demonstrated are scattered millimetric renal cortical cysts.\nKnown T2 hyperintense lesion at the lower pole of the right kidney, without T1\nhyperintense components, and with nodular internal enhancement, measures\napproximately 1.7 x 2.1 x 1.8 cm in AP, transverse, and craniocaudal\n___, unchanged from prior. It is unchanged in size and morphology from\nthe MR performed ___. No additional solid renal lesions identified.\n\nBowel: Patient is status post Roux-en-Y gastric bypass surgery. Visualized\nloops of large and small bowel otherwise normal in appearance. No mural\nthickening. No luminal distention.\n\nVasculature: Abdominal aorta is normal in caliber. Major branch vessels are\npatent. Portal and hepatic veins are patent.\n\nLymph nodes: No lymphadenopathy\n\nOsseous/Soft Tissue: No acute or focal destructive osseous lesions. Spinal\nhardware lower lumbar spine. Additional susceptibility artifact within the\nparaspinal subcutaneous soft tissues, again post-surgical in nature. On the\npost-gadolinium sequences, note is made of patchy enhancement along the\nposterior elements of the lower lumbar spine and extending into the paraspinal\nfascia and the paraspinal subcutaneous fat (series 21, images 85-112). \nCranial to the hardware, symmetric enhancement is noted in the facet joints. \nAdditionally, there is a thin slip of fluid within the subcutaneous paraspinal\nfat (series 2, image 29). Upon review of patient's electronic records, we\nnote that patient was treated for wound dehiscence. Recent surgical note\nstates interval healing of the wound. Thin fluid collection may reflect\npostsurgical seroma. Similarly, the enhancement described above is likely-in\nnature. No drainable fluid collection is identified.", "output": "1. Stable size and morphology of T2 hyperintense enhancing mass at the lower\npole of the right kidney, with imaging features suggestive of renal cell\ncarcinoma, likely clear cell type.\n2. Stable left adrenal adenoma.\n3. Soft tissue in hands meant the subcutaneous soft tissues of the lumbar\nspine, related to spine surgery and subsequent wound related care. No\nevidence of drainable fluid collection." }, { "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The liver demonstrates normal morphology. No steatosis. There is a\n1.4 cm hyperintense lesion in segment IV a on T2 weighted images with thin\nseptation without enhancement on postcontrast images, consistent with a\nseptated cyst, unchanged. Scattered punctate hyperintense lesion on T2\nweighted images without enhancement are consistent with cysts or biliary\nhamartomas. No suspicious hepatic lesion.\n\nBiliary: The gallbladder is within normal limits. No biliary ductal\ndilatation.\n\nPancreas: The pancreas demonstrate normal signal intensity without focal\nlesion or pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: The right adrenal gland is unremarkable. 2.0 x 1.5 cm left\nadrenal nodule demonstrates drop in signal intensity on out of phase images,\nconsistent with an adenoma, unchanged compared to ___ allowing for\ntechnique differences.\n\nKidneys: The kidneys demonstrate normal nephrogram bilaterally.\n\nAgain seen is a 1.9 x 1.6 cm right lower renal pole exophytic lesion (series\n5, image 30 and series 3, image 9), hyperintense on T2 weighted images and\nisointense to renal parenchyma on precontrast T1 weighted images, overall\nunchanged compared to ___ allowing for technique differences. On\npostcontrast images, this lesion demonstrate progressive avid enhancement. \nConstellation of finding is most consistent with a clear cell renal cell\ncarcinoma. When compared to MRI from ___, the mass unchanged.\n\nNo new suspicious renal lesion. Bilateral punctate cortical simple cysts are\nnoted. No hydronephrosis.\n\nGastrointestinal Tract: The patient is status post gastric bypass. Otherwise\nthe visualized upper abdominal bowel loops are within normal limits.\n\nLymph Nodes: No enlarged abdominal lymph nodes.\n\nVasculature: No abdominal aortic aneurysm. Single renal artery bilaterally. \nThe celiac artery, SMA, and renal arteries are patent. The portal venous\nsystem is patent.\n\nOsseous and Soft Tissue Structures: The patient is status post L4-5 posterior\nfusion and laminectomy. There are post surgical changes in the midline lower\nback subcutaneous tissue. There is a 3.2 x 2.1 cm lesion in the right lower\nback, mildly hyperintense on both T2 and precontrast T1 weighted images with\nrim enhancement, which could represent a hematoma.", "output": "1. Unchanged 1.9 x 1.6 cm right lower renal pole exophytic mass compared to\nrenal MRI from ___ with imaging features most consistent with a clear\ncell renal cell carcinoma. No new suspicious renal mass.\n2. 3.2 x 2.1 cm lesion in the right lower back with imaging features probably\nrepresenting a hematoma. Correlation with any history of recent trauma is\nrecommended." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver is normal in morphology and signal intensity. There is no\nhepatic steatosis. No suspicious focal liver lesion identified. A previously\nseen arterially enhancing lesion in segment 2 of the liver is not imaged on\nthis study.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. There is\ncholelithiasis, with no evidence of gallbladder wall thickening or\npericholecystic fluid (4:15).\n\nPancreas: Again seen is a 6 mm cystic lesion in the body of the pancreas, not\nsignificantly changed from prior, and likely representing a side branch IPMN\n(4:13). Pancreas otherwise demonstrates normal signal intensity on T1\nweighted images and enhances homogeneously. Pancreatic duct is normal in\ncaliber.\n\nSpleen: The spleen is normal in size, measuring 12.1 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: Compared with MRI abdomen on ___, there is increase in size\nof a predominantly T2 hyperintense complex solid and cystic lesion with\nnumerous thin septations in the interpolar region of the left kidney,\nmeasuring 2.2 x 2.0 cm compared with 2.0 x 1.8 cm previously, with interval\nincrease in the enhancing solid component along the medial edge, measuring 1.4\nx 1.1 cm, compared with 1.4 x 0.7 cm previously (5:13, 18:49, 1501:31). There\nare multiple additional T2 hyperintense, T1 hypointense, nonenhancing lesions\nin the bilateral kidneys, the largest arising from the upper pole of the right\nkidney and measuring 1.3 cm, consistent with simple cysts (5:20). A 1.0 cm T2\nhyperintense, T1 isointense, nonenhancing lesion in the midpole of the right\nkidney is consistent with a cyst (5:22, 13:40). The kidneys otherwise enhance\nand excrete symmetrically without hydronephrosis.\n\nBowel: There is colonic diverticulosis. Partially imaged loops of small and\nlarge bowel are otherwise unremarkable.\n\nPelvis: A partially imaged ovarian cystic lesion is unchanged (5:10).\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Interval increase in size of a 2.2 x 2.0 cm complex solid and cystic mass\nin the interpolar region of the left kidney, with interval increase in size of\nthe enhancing solid component, suspicious for renal cell carcinoma.\n2. Stable 6 mm pancreatic cystic lesion, likely represents represents a\nside-branch IPMN, for which no additional follow-up is required given\npatient's age and size of lesion.\n3. Cholelithiasis with no evidence of acute cholecystitis.\n4. Colonic diverticulosis.\n5. A partially imaged simple ovarian cystic lesion is grossly unchanged." }, { "input": "Lower Thorax: The lower lungs are clear. No pericardial or pleural effusion.\n\nLiver: The hepatic parenchyma is normal in contour, without evidence of\nsteatosis. No focal lesions are identified.\n\nBiliary: There is no evidence of intrahepatic or extrahepatic biliary\ndilation. The gallbladder contains numerous gallstones without evidence of\nwall thickening and pericholecystic stranding.\n\nPancreas: The pancreas is atrophic. There is no evidence solid masses or\nductal dilation. In the body of the pancreas, a 4 mm focus of hyperintense\nsignal on T2 weighted imaging is unchanged or slightly smaller than in ___\n(06:17).\n\nSpleen: Normal in size and appearance without focal lesions.\n\nAdrenal Glands: Normal in size and appearance.\n\nKidneys: Kidneys are symmetric in size with normal cortical medullary\ndifferentiation. There is no hydronephrosis or perinephric abnormality. \nSeveral bilateral cortical nonenhancing foci demonstrate hyperintense signal\non T2 weighted sequences and hypointense signal on T1, measuring maximally 1.1\ncm in the upper pole of the right kidney, consistent with simple cysts.\n\nIn the midpole of the right kidney, a well-defined oval lesion with\nintermediate signal on T2 weighted imaging and iso to hyperintense signal on\nT1 weighted imaging with a tiny adjacent vessel peripherally and no internal\nenhancement, measuring 0.9 x 1.0 cm, unchanged from ___ (9:36, 11:36),\nlikely a proteinaceous cyst. No restriction on diffusion-weighted imaging.\n\nIn the midpole of the left kidney is oval well-circumscribed lesion measuring\n2.0 x 2.0 x 2.0 cm, unchanged from ___. It is predominantly cystic as\ndemonstrated by hyperintense signal on T2 weighted imaging and hypointense\nsignal on T1 weighted imaging precontrast. An internal nodular\navidly-enhancing component along the medial aspect measuring 1.4 x 1.2 cm is\nstable since the ___ study (2:14, 6:21, 11:22).\n\nGastrointestinal Tract: The stomach and visualized small intestine are\nnormal. Diverticulosis is noted in colon.\n\nLymph Nodes: A left periaortic retroperitoneal lymph node measures 9 mm in\nshort axis, unchanged from ___. No retroperitoneal, mesenteric, or porta\nhepatis lymphadenopathy is present by size criteria.\n\nVasculature: The visualized aorta proximal mesenteric vasculature are patent.\n\nPelvis: In the right adnexa, a 1.6 x 1.4 cm lesion demonstrating hyperintense\nsignal on T2 weighted imaging, unchanged from ___ (2:9).\n\nOsseous and Soft Tissue Structures: Moderate compression deformity of the T9\nvertebral body is new since the prior MR in ___ and more prominent than on\nchest CT from ___ (02:16). Previously described rib fractures ___\nare not included within the study. No concerning lesions suspicious for\nneoplasm are identified.", "output": "1. Overall stable size and appearance of complex left renal lesion since\n___, remaining concerning for renal cell carcinoma, likely clear cell type.\n2. Moderate compression deformity of the T9 vertebral body has slightly\nworsened since ___, and is new since the ___ study.\n3. 4 mm cystic lesion within the pancreatic body is unchanged, statistically\ndelete likely an IPMN. No dedicated followup required.\n4. Cholelithiasis.\n5. Unchanged 1.6 cm benign-appearing right adnexal cyst. This could be\nfollowed with a yearly pelvic ultrasound.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:25 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. Cardiomegaly is\nincidentally noted.\n\nLiver: Enlargement of caudate lobe and widening of periportal hilar space is\nconsistent with known cirrhosis. Within segment II is a T2 hyperintense, T1\nhypointense, nonenhancing 7 mm focus consistent with a cyst or biliary\nhamartoma. There is a 8 mm mildly T2 hyperintense, heterogeneously\nhypoenhancing focus with intravoxel fat in segment IVb just superior to the\ngallbladder fossa (3:24, 16:46 and 6:17), most compatible with focal fat\ndeposition, which could correspond to one of the previously identified\nechogenic foci on ultrasound, although it measures smaller today. No other\nMRI correlates are identified. There is no suspicious hepatic lesion. No\nascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. \nCholedocholithiasis is agsin seen. The gallbladder is unremarkable.\n\nPancreas: Stable subcentimeter cystic lesions in the pancreatic body and tail,\nlikely side-branch IPMNs, measuring up to 4 mm. Pancreas is otherwise\nhomogeneous in signal intensity without suspicious mass. No pancreatic duct\ndilatation. No peripancreatic fat stranding.\n\nSpleen: Spleen is homogeneous in signal intensity and normal in size. No\nsuspicious lesion.\n\nAdrenal Glands: Unremarkable\n\nKidneys: Kidneys demonstrate normal signal intensities and are symmetric in\nsize. There are multiple bilateral T2 hyperintense nonenhancing simple renal\ncysts. There also two hemorrhagic cysts in the right kidney, the larger\nmeasuring 1.1 cm in the interpolar region (02:36 and 16:51). Again noted\nwithin the interpolar region of the left kidney is a 2 cm round complex cystic\nand solid mass demonstrating avid hyperenhancement of the solid component\n(03:32, 02:30), concerning for a clear cell renal cell carcinoma. There is no\ninterval so fat within this mass. This mass has remained stable in size and\nappearance since studies dating back to ___. No hydronephrosis.\n\nGastrointestinal Tract: No hiatal hernia. The stomach is unremarkable. The\nvisualized small and large bowel are notable for colonic diverticulosis. No\nobstruction. The T2 bright simple-appearing 1.8 cm simple cyst within the\nright adnexa remains unchanged since ___ (02:27); this can be followed\nwith yearly pelvic ultrasound.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are not pathologically\nenlarged.\n\nVasculature: There is conventional hepatic arterial anatomy. The portal and\nhepatic veins are patent. The aorta is normal in caliber. The major\nintra-abdominal aortic branches are normal in caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. T9\nvertebral body compression deformity is again seen. Soft tissues are\nunremarkable.", "output": "1. 8 mm focal fat in liver segment IVb may correspond to one of the echogenic\nlesions seen on US although it measures smaller today; otherwise no other MRI\ncorrelates are identified. Therefore, short interval ultrasound follow-up of\nthe liver in 6 months is recommended.\n2. Stable size and appearance of the known 2 cm complex cystic and solid left\nrenal mass, with signal enhancement characteristics concerning for a clear\ncell renal cell carcinoma, compared to ___ MRI.\n3. Multiple bilateral simple renal cysts and right hemorrhagic cysts.\n4. Cholelithiasis.\n5. Stable 1.8 cm simple right adnexal cyst, unchanged since ___, can be\nfollowed with yearly pelvic ultrasound.\n6. Stable pancreatic cystic lesions measuring up to 4 mm likely represent\nsidebranch IPMNs. No specific follow-up is indicated due to small size and\npatient's age.\n\nRECOMMENDATION(S): Short interval ultrasound follow-up of the liver in 6\nmonths to re-evaluate multiple echogenic foci.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:41 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Lower Thorax: No pleural effusion. Subsegmental atelectasis at the lung\nbases.\n\nLiver: The liver is again noted to be cirrhotic. A 6 cm mass is seen at the\ndome of the liver in segment ___. This mass demonstrates central necrosis and\nperipheral arterial hyperenhancement with washout consistent with HCC, OPTN\n5X. In retrospect, this is difficult to see prior CTs, however previously\nmeasured 5.5 cm. There are additional subcentimeter hypoenhancing satellite\nserpiginous lesions and nodules distal to the mass, in segment 7, either\nsatellite tumor or intravascular tumor.\n\nBiliary: There is moderate intra and extrahepatic biliary ductal dilatation up\nto the ampulla. No choledocholithiasis is demonstrated.. Cholecystectomy\nchanges are redemonstrated.\n\nPancreas: The pancreas is difficult to evaluate due to motion.\n\nSpleen: Moderate splenomegaly is again seen\n\nAdrenal Glands: The adrenal glands appear unremarkable.\n\nKidneys: Bilateral renal cysts are present.\n\nGastrointestinal Tract: Distal esophageal dilatation with reflux is again\nnoted a laparoscopic gastric band is redemonstrated. There is no bowel\nobstruction in the upper abdomen. Changes of colectomy and ileostomy are\nagain noted. There is trace perihepatic ascites.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes visualized.\n\nVasculature: A TIPS is again noted from the right portal to the right hepatic\nvein. The remaining portal vasculature appears patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are seen. \nModerate diffuse subcutaneous soft tissue edema may be due to third spacing.", "output": "1. Cirrhotic liver with 6 cm mass at the right hepatic dome in segment ___\nconcerning for hepatocellular carcinoma, OPTN 5 X and subcentimeter satellite\nlesions or intravascular thrombus in segment 7.\n2. Moderate biliary ductal dilatation up to the ampulla. No\ncholedocholithiasis.\n3. Sequela of portal hypertension including portosystemic shunts, splenomegaly\nand trace ascites.\n4. Additional findings as above." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion. \nTiny enhancing nodule in the right lower lobe is unchanged compared to prior\nCT and likely represents scarring.\n\nLiver:\n\nCirrhotic hepatic parenchyma, nodular in contour and demonstrating peripheral\nreticular areas of progressive enhancement with capsular retraction indicating\nfibrotic changes. Numerous siderotic/regenerative nodules are identified.\n\nThere are 2 radiofrequency ablation cavities in segment III of the liver. \nThese cavities demonstrate areas of increased T1 signal consistent with blood\nproducts, which is expected. Adjacent to the more inferior 3.2 x 2.7 cm\n(1004:86) ablation zone along the falciform ligament there are some ill\ndefined areas of discontinuous arterial hyperenhancement predominantly\ninferiorly and anteriorly, most concerning of which is seen on series 1001\nimage 93. Adjacent to the more superior 4.1 x 2.4 cm (1004:59) ablation zone\nthere are areas of peripheral hyperenhancement likely representing normal\npost-ablation changes.\n\nThere is a 0.9 cm arterial enhancing lesion in segment 2 of the liver\n(1001:44) which demonstrates possible central washout. By size criteria alone\nthis does not meet OPTN criteria.\n\nMultiple other small sub centimeter arterial enhancing lesions, without\ndefinitive washout, some of which are more conspicuous today but do not need\nto meet OPTN criteria but are suspicious for ___. Multiple small foci of\nwashout on delayed phase imaging, may represent changes from fibrosis and\nregenerative nodularity but cannot exclude multifocal HCC.\n\nNonspecific simple cystic structure in between the superior pole the right\nkidney and the inferior edge of the liver.\n\nTrace ascites.\n\nBiliary: Small gallstones identified. No intra or extrahepatic biliary\ndilatation. No gallbladder wall thickening or mass.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: Multiple scattered small bilateral well-defined T2 hyperintense\nlesions, compatible with simple renal cysts and not significantly changed. No\nhydronephrosis. No concerning renal lesion.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Early recannulized umbilical vein noted. Gastric varices are\nnoted. Conventional hepatic arterial anatomy. Normal caliber aorta and\nbranches.\n\nOsseous and Soft Tissue Structures: Partially visualized small fat containing\nmidline ventral hernia noted.", "output": "1. Two post radiofrequency ablation sites in hepatic segment III. The more\ninferior treatment zone along the falciform ligament demonstrates some nodular\nenhancement at the inferior anterior aspect, potentially suspicious though not\nmeeting OPTN criteria for ___. Close attention on followup is suggested.\n2. There are multiple hepatic subcentimeter arterial enhancing lesions\nwithout clear washout. These are suspicious for ___ although none of which\nmeet CT criteria by size criteria alone. There are also multiple small sub cm\nfoci on washout phase without clear correlate on other phases, which may\nrepresent changes from fibrosis and regenerative nodules.\n\nRECOMMENDATION(S): Close interval follow-up of multiple\narterial-hyperenhancing foci to exclude multifocal HCC." }, { "input": "Motion artifact substantially limits study.\n\nLower thorax: The lung bases are grossly clear.\n\nLiver: The liver is heterogeneous and nodular in appearance, consistent with\ncirrhosis. There are innumerable nodules, some of which are spontaneously\nbright, similar to prior. There is no hepatic steatosis. Patient is status\npost RFA to two segment III lesions in ___, both decreased in size\nand measuring 3.1 x 2.1 cm and 3.0 x 2.3 cm, compared with 4.1 x 2.4 cm and\n3.3 x 2.5 cm previously (1504:56, 81). Again seen is intrinsic T1\nhyperintensity of the RFA sites, consistent with coagulation necrosis, with no\npersistent hyper enhancement to suggest recurrent disease. Peripheral\nhyperenhancement adjacent to the more superior ablation zone is similar to\nprior, and is likely perfusional in nature (1501:37). Previously seen areas\nof arterial hyperenhancement adjacent to the more inferior ablation zone is no\nlonger visualized.\nAgain seen is a 0.9 cm T1 hyperdense lesion in segment 2 of the liver,\nunchanged (13:25). Numerous scattered foci of washout on delayed phase\nimaging without correlate on other sequences are similar to prior, and may\nrepresent fibrotic changes. There is trace ascites.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. There are\nsmall gallstones (4:15, 7:35). There is no gallbladder wall thickening or\npericholecystic fluid.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is normal in size, measuring 10 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: Again seen is a 1.5 cm cystic lesion between the upper pole of the\nright kidney and the liver (4:35). There are multiple additional\nsubcentimeter T2 hyperintense, T1 hypointense, non enhancing lesions at the\nbilateral kidneys, consistent with simple renal cysts. There is a hemorrhagic\ncyst in the right kidney. The kidneys otherwise enhance and excrete\nsymmetrically without suspicious lesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. Hepatic arterial\nanatomy is conventional. There is a recannulized umbilical vein. There is an\naccessory left renal artery.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.", "output": "1. Study is substantially limited by motion. Within this limitation, there is\nno evidence of residual tumor at prior segment III RFA sites. No new hepatic\nlesions meeting OPTN criteria for HCC.\n2. Cirrhosis with trace ascites.\n3. Cholelithiasis with no evidence of acute cholecystitis." }, { "input": "Motion artifact degrades the quality of the study.\n\nLower Thorax: The lung bases are clear. No pleural or pericardial effusion. \nBilateral gynecomastia is noted.\n\nLiver: The liver is nodular in keeping with the known history of cirrhosis. \nMultiple nodules demonstrate intrinsic high signal on the T1 weighted images. \nThe RFA sites in segment 3 measure 17 x 23 mm and 28 x 20 mm and demonstrate\nhigh signal on the T1 weighted images in keeping with coagulation necrosis\n(___). No central enhancement to suggest recurrent/residual\ndisease. Although the study is limited by motion artifact, no definite new\nlesions meeting OPTN 5A criteria for ___. Scattered foci of arterial\nhyperenhancement without washout or T2 correlate are most in keeping with\ntransient hepatic intensity differences. There is a small amount of ascites.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. There is cholelithiasis. Pericholecystic fluid is\nlikely related to chronic liver disease.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. There is a 2 mm cyst in the\ntail (10:21) which was difficult to see on the prior exam due to motion\nartifact. Statistically, this lesion is most in keeping with a side-branch\nIPMN. No nodularity or ductal abnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. Bilateral millimetric cysts are again\nnoted. 6 and 7 mm hemorrhagic cysts in the right kidney are unchanged\ncompared to the prior exam. There are no concerning solid or cystic lesions. \nNo hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. No\nmural thickening or abnormal enhancement.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: No definite esophageal varices. The visualized abdominal aorta\nand proximal mesenteric vessels appear patent without any significant areas of\nnarrowing or dilatation. Conventional hepatic arterial anatomy. The portal\nand hepatic veins are patent. An accessory left renal artery is noted.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions. Posterior to the upper pole\nof the right kidney, there is a well-defined cystic lesion measuring 11 x 12\nmm which may represent a duplication cyst.", "output": "1. Limited study due to motion artifact. No evidence of recurrent/residual\ndisease at the prior segment 3 RFA sites. No new lesions meeting OPTN 5\ncriteria for ___.\n2. Cirrhosis with trace ascites.\n3. Cholelithiasis\n4. There is a 2 mm cyst in the tail (10:21) which was difficult to see on the\nprior exam due to motion artifact. Statistically, this lesion is most in\nkeeping with a side-branch IPMN. No concerning features. This lesion can be\nassessed at the time of further follow-up imaging for the liver." }, { "input": "Lower Thorax: The lower lungs are clear without pleural or pericardial\neffusion.\n\nLiver: A moderate amount of perihepatic ascites is increased from ___.\nHepatic contour is nodular in keeping with history of cirrhosis. Reticular\npattern of enhancement suggests mild fibrosis accentuated by motion. There is\nno significant hepatic steatosis (fat fraction less than 2%). Numerous nodules\ndemonstrate hyperintense signal on T1 weighted imaging consistent with iron\ndeposition. No new focal lesions meeting OPTN criteria for HCC.\n\nRFA treatment sites in hepatic segment III measure 2.7 x 2.0 cm, stable from\n___, and 2.4 x 1.3 cm near the porta hepatis, slightly smaller than in ___\nwhen it measured 2.3 x 1.7 cm (1302:73, 1302:53). Both areas demonstrate\nhyperintense signal on T1 weighted imaging consistent with coagulation\nnecrosis and no abnormal hyperenhancement to suggest recurrent disease.\n\nBiliary: The gallbladder contains stones. No intraductal stones are seen. \nTop normal common hepatic and common bile ducts measure 6 and 8 mm,\nrespectively, stable from ___. Trace pericholecystic fluid is stable from\n___, likely due to underlying liver disease.\n\nPancreas: Parenchyma is normal in signal without focal lesions ductal\ndilation.\n\nSpleen: A small amount perisplenic ascites is increased from ___. The\nspleen measures 10.8 cm, normal in size and appearance without focal lesions.\n\nAdrenal Glands: Normal in size and appearance.\n\nKidneys: Subcentimeter foci demonstrate hyperintense signal on T1 weighted\nimaging in the right renal cortex consistent with hemorrhagic or proteinaceous\ncysts (11:110, 11:88). A 3 mm focus demonstrating hyperintense signal on T2\nweighted imaging in the cortex of the left kidney is consistent with a simple\ncyst. No solid masses, hydronephrosis, or perinephric abnormality.\n\nGastrointestinal Tract: The stomach is normal. Visualized loops of small and\nlarge intestine demonstrates normal caliber and wall thickness.\n\nLymph Nodes: No retroperitoneal, mesenteric, or porta hepatis lymphadenopathy\nby size criteria.\n\nVasculature: The visualized aorta is normal in caliber. Hepatic arterial\nvasculature is conventional. The celiac axis, SMA, portal vein, and hepatic\nveins are patent. No evidence of varices.\n\nOsseous and Soft Tissue Structures: Cyst in Morison's pouch measures 1.4 x 1.2\ncm, stable from ___ (7:20). No concerning lesion for neoplasm.", "output": "1. Cirrhotic liver with fibrosis and multiple siderotic nodules. No lesions\nmeeting OPTN-5 criteria for HCC.\n2. Post hepatic segment III RFA x 2 without evidence of residual or recurrent\ndisease.\n3. Moderate ascites increased from ___. No splenomegaly.\n4. Patent vasculature.\n5. Cholelithiasis." }, { "input": "Lower Thorax: There is a right lower lobe opacity that is better characterized\non the recent CT of the chest. This is compatible with pneumonia. Within the\nlimitations of MRI, the lung bases are otherwise clear. There is no pleural\neffusion. The base of the heart is normal in size. There is no pericardial\neffusion.\n\nLiver: The liver has a nodular contour, compatible with cirrhosis. There is\nno background hepatic steatosis. In segment ___, there is a rim enhancing 28\nx 25 x 21 mm lesion which corresponds to the abnormality seen on CT. The\ndominant rim in the lesion is slightly hyperintense on the T2 weighted images.\nIt demonstrates arterial hyperenhancement that persists on the delayed phases.\nWithin the lateral aspect of the rim, there is a 8 mm more nodular focus of\narterial hyperenhancement that appears to washout on the delayed phases (1401,\n26 and 1403, 36). The central portion of the lesion is nonenhancing. There\nis no restricted diffusion. The signal on the T2 weighted images centrally is\nintermediate to hypointense. The entire lesion is hypointense on the\npre-contrast T1-weighted images.\n\nThere are two sub-5 mm foci of arterial hyperenhancement in the periphery of\nthe liver in segment 4A (1401, 29) and in segment 7 (1401, 27). They have no\ncorrelate on other sequences. These are most likely are transient hepatic\nintensity differences. No other liver lesions are identified.\n\nThe hepatic arterial anatomy is conventional. The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. In the body\nof the gallbladder, there is a 3 mm enhancing focus, most compatible with a\npolyp (8, 27). A polyp of this size requires no specific follow up. No\nstones are identified.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 12.3 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are multiple simple cysts\nbilaterally, measuring up to 21 mm. There are no worrisome renal lesions,\nhydronephrosis, or perinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There are no concerning osseous lesions. Mild-to-moderate\nmultilevel degenerative changes are noted throughout the spine. The soft\ntissues are unremarkable.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque. Incidentally noted is a\ncircumaortic left renal vein.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild-to-moderate degenerative changes are noted throughout the spine. The\nsoft tissues are unremarkable.", "output": "1. Indeterminate liver lesion in segment ___, as described above. There are\nno classic features for either hepatocellular carcinoma or infection. The\narea of washout in the rim and the lack of diffusion weighted images argues\nagainst infection. The nonenhancing portion of the lesion may represent\nhemorrhage. Alternately, it could be a partially treated abscess/phlegmon. \nBiopsy is recommended.\n2. Cirrhotic liver. No evidence of portal hypertension.\n3. Tiny gallbladder polyp, which requires no specific follow-up.\n4. Right lower lobe pneumonia, which as better characterized on the recent CT\nthe chest.\n\nRECOMMENDATION(S): Biopsy of the indeterminate liver lesion, as above.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:48 AM, 5 minutes after\ndiscovery of the findings." }, { "input": "Lower thorax: Included lower thorax demonstrates no abnormal masses aside for\nlinear atelectasis at the lung bases. No pericardial or pleural effusion.\n\nLiver: The liver demonstrates homogeneous signal intensity. No suspicious\nliver masses. A subcentimeter simple hepatic cyst is noted.\n\nBiliary: Gallbladder is normal in appearance. No intrahepatic or extrahepatic\nbiliary dilation.\n\nPancreas: Pancreas demonstrates normal T1 signal intensity. No focal masses. \nMain pancreatic duct is normal in caliber.\n\nSpleen: Normal spleen size without focal masses.\n\nAdrenal Glands: Right adrenal gland is normal in appearance. Re-demonstrated\nwithin the left adrenal gland is a circumscribed 2.5 x 2.3 x 2.1 cm nodule\ndemonstrating intralesional foci of signal dropout on out of phase imaging\ncompatible with an adrenal myelolipoma (04:24, 06:53).\n\nKidneys: The kidneys are normal and symmetric in size. No hydronephrosis. No\nabnormal renal masses.\n\nGastrointestinal Tract: Bowel loops are normal in caliber. No bowel\nobstruction.\n\nPelvis: Included portion of the upper pelvis demonstrates no acute\nabnormalities.\n\nLymph Nodes: No retroperitoneal or abdominal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No abnormal body wall soft tissue masses\nor aggressive osseous lesions.", "output": "1. 2.5 cm left adrenal myelolipoma. Of note the lesion is stable in size and\nFDG avidity dating back to ___.\n2. No abdominal lymphadenopathy." }, { "input": "Liver: The patient is status post liver transplant. There is a segment V 1.1\ncm focus of arterial hyperintensity without correlate on subsequent sequences,\npossibly perfusion (___). There are two unchanged, 3 mm hypoenhancing\nlesions without T2 correlate on the right (___) and on the left (___). No\nhepatic steatosis. No fluid collection, abnormal enhancement or edema.\n\nBiliary: No biliary ductal dilatation. The gallbladder is surgically absent.\n\nPancreas: There are multiple T2 hyperintense, well-circumscribed lesions\nthroughout the pancreas, likely representing side branch IPMNs. No main\nductal dilatation.\n\nSpleen: Splenomegaly, measuring 21.0 cm.\n\nAdrenal Glands: The bilateral adrenal glands are unremarkable.\n\nKidneys: Unremarkable aside for multiple cysts.\n\nGastrointestinal Tract: No ascites or obstruction.\n\nLymph Nodes: No upper abdominal lymphadenopathy.\n\nVasculature: Again seen is mild varicose dilatation of the central right and\nleft portal veins. The portal veins are patent. Stable narrowing of the\narterial vasculature at the anastomosis (___). The hepatic arterial and\nvenous vasculature is otherwise patent. Stable multiple perisplenic and\nperigastric varices. Stable collateral vessels along the chest wall.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. The patient is status post liver transplant. No biliary obstruction, fluid\ncollection, abnormal enhancement or edema.\n2. Multiple pancreatic cystic lesions, likely representing side-branch\nintraductal papillary mucinous neoplasms, as on prior. Recommend attention on\npresumed interval follow-up imaging or follow-up MRI in ___ year." }, { "input": "Linear atelectasis are seen in the lung bases. There is no pleural or\npericardial effusion.\n\nThe transplant liver demonstrates homogeneous signal intensity on T1 and T2\nweighted images, and on DWI. There is somewhat heterogeneous arterial\nenhancement of the hepatic parenchyma, which normalizes on later phases. \nThere is no evidence of hepatic necrosis. The hepatic artery appears kinked\njust below the caudate lobe (10:44), with normal distal filling, an appearance\nunchanged from prior imaging. Portal and hepatic veins are patent.\n\nThe spleen is enlarged, measuring 19 cm in craniocaudal dimension.\n\nCortical renal cysts present.\nThe pancreas is not in size signal, without ductal dilatation. 1.6 cm cluster\nof cystic pancreatic lesion (07:26) is similar compared to ___.\n\nThere is trace amount of perihepatic free fluid.\nNo concerning retroperitoneal or mesenteric lymphadenopathy is seen.\nThe bone marrow signal is normal.", "output": "1. Transplant liver, with splenomegaly; no evidence of liver necrosis.\n2. Unchanged kinking morphology of the hepatic artery, with normal distal\nfilling.\n3. Clustered pancreatic cystic lesions, similar compared to ___,\nlikely side branch IPMNs.\n\nRECOMMENDATION(S): Followup of pancreatic cystic lesions by MRCP in one year." }, { "input": "Lower thorax: Partially imaged lung bases are clear.\n\nSolid organs: There are bilateral renal cysts measuring up to 2.3 cm in the\nright kidney. The spleen measures 8 cm and is low in T2 signal, compatible\nwith history sickle cell. The solid organs including the liver, gallbladder, \npancreas, and adrenals are within normal limits. No hydronephrosis. No\nevidence of intra or extrahepatic biliary dilatation.\n\nGastrointestinal Tract: The visualized small and large bowel loops are normal\nin caliber. The appendix is not definitively visualized, however there is a\ncandidate for the appendix seen medial to the pedunculated fibroid which is\nnormal in appearance however cannot be followed completely to confirm it is\nblind ending (5:48).\n\nPelvis: There is a fibroid uterus, the largest fibroid a 7.9 x 7.8 x 8.3 cm\nright pedunculated fibroid (5:50; 4:14). The uterus is gravid with the fetus\nin cephalic position with a posterior placenta. The cervix measures 6.5 cm in\nlength. The internal os measures 2.5 cm and has a funneled appearance,\nconcerning for cervical incompetence (6:38). The bilateral ovaries are\nnormal. Just superior to the right ovary and inferior to the pedunculated\nfibroid in the right anterior lower quadrant, there is a small amount of\nstranding and trace edema which can be seen in relation to the ovary in\npregnancy (5:60; 7:60). There is no edema in the ovary itself to indicate\ntorsion or any other acute abnormality. The urinary bladder is normally\ndistended with normal wall thickness.\n\nVasculature: The vasculature including the gonadal veins demonstrates normal\nsignal on time-of-flight.\n\nLymph Nodes: No significant lymphadenopathy.\n\nOsseous and Soft Tissue Structures: Status post bilateral hip arthroplasty,\nwith hardware slightly limiting evaluation of the low pelvis. There is drop\nin signal on inphase imaging compared out of phase imaging in the bone marrow\nsuggestive iron disposition and compatible with history sickle cell anemia. \nNo concerning osseous lesions.", "output": "1. No acute process in the abdomen or pelvis.\n2. The appendix is not definitively visualized, however a likely candidate for\nthe appendix is identified and is normal in appearance.\n3. Appearance of the cervix suggestive of cervical incompetence.\n4. Fibroid uterus including a 8.3 cm right pedunculated fibroid, a potential\nsource of right-sided pain.\n5. Findings compatible with history of sickle cell anemia.\n\nNOTIFICATION: The additional findings of cervical incompetence which was not\nincluded in the wet read was discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 8:42 am, 1 minutes after discovery of the findings." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size\n\nLiver: The patient is status post a trisegmentectomy of the liver. Along the\nupper aspect of the surgical margin, there is a 22 x 14 mm nonenhancing focus,\nwhich is heterogeneous signal on the T2 weighted images and slightly high\nsignal on the precontrast T1 weighted images. This likely represents a\nresolving hematoma. The known fiducial at the margin is not well seen by MRI.\nThere is trace ill-defined fluid in the fat of the right upper quadrant, which\nis likely reactive.\n\nIrregularity along the resection margin is noted, and of uncertain etiology. \nIt is most likely post-surgical changes, so tumor recurrence cannot be\ncompletely excluded.\n\nIn segment 3, there is a 29 x 20 mm lobulated lesion (14, 43) which is\nslightly high signal on the T2 weighted images, contains no fat or hemorrhage,\nand demonstrates rim enhancement. There is also enhancement within the\ncentral aspect of the lesion that increases on the delayed phases. There is\nrestricted diffusion. This is most consistent with a cholangiocarcinoma\nmetastasis. This is increased in size since the prior exam from ___. Just inferior and left of this lesion is a similar 18 x 16 mm lesion\n(4, 48), which is also most compatible with a metastasis. This is new from\nthe prior exam from ___. Finally, along the right border of\nsegment 3, there is a 17 x 12 mm lesion (14, 55), which is also suspicious.\n\nNo other lesions are identified. The portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is surgically absent.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 11.8 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. Several subcentimeter cysts are\nnoted bilaterally. There are no worrisome renal lesions, hydronephrosis, or\nperinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal other than scattered diverticula. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nPostsurgical changes are noted in the anterior abdominal wall. There is no\nfluid collection or hernia. The soft tissues are otherwise unremarkable.", "output": "1. Three discrete lesions in the left hepatic lobe are highly suspicious for\ncholangiocarcinoma metastases, as described above.\n2. Irregularity along the surgical margin is most likely post-surgical,\nthough peritoneal tumor recurrence at the surgical site cannot be completely\nexcluded. Continued attention on follow-up exams is recommended." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. The\nbase of the heart is normal in size. There is no pericardial effusion.\n\nLiver: The patient is status post a trisegmentectomy. There is compensatory\nhypertrophy of the left lobe. There is no background hepatic steatosis. \nOverall, the configuration of the liver is not significantly changed from the\nprior exam. The previously identified resolving hematoma along the resection\nbed is similar in size, measuring 14 mm (8, 24). There is minimal linear\nenhancement along the resection margin, which likely represents postsurgical\nchanges.\n\nThe previously identified metastases have decreased in size. In segment 3,\nthere is a 17 x 15 mm rim enhancing lesion (11, 42), which previously measured\n29 x 20 mm. Just lateral to this lesion is a 18 x 14 mm lesion, which is also\ndecreased in size. It previously measured 18 x 16 mm. Finally, along the\nright border of segment 3, there is a 7 x 6 mm lesion (10, 52), which\npreviously measured 17 x 12 mm. No new lesions are identified.\n\nThe portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is surgically absent.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen size is at the upper limits of normal, measuring 13 cm. \nThere are no focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are few subcentimeter simple\ncysts. There are no worrisome renal lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: A few scattered subcentimeter perihepatic and retroperitoneal\nlymph nodes are noted, though none meet size criteria for pathologic\nenlargement or have worrisome morphologies. There is no mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nA 10 mm T2 hyperintense lesion in the sacrum is most compatible with a\nhemangioma. Postsurgical changes are noted in the anterior abdominal wall. \nThere is no fluid collection or hernia. The soft tissues are otherwise\nunremarkable.", "output": "Interval decrease in size of the three hepatic metastases, as described above.\nNo new metastases are identified. No evidence of other metastatic disease in\nthe upper abdomen." }, { "input": "Lower Thorax: The heart is normal in size. There are no pleural or\npericardial effusions.\n\nLiver: There are postsurgical changes of trisegmentectomy of the right hepatic\nlobe, with compensatory hypertrophy of the left hepatic lobe. There is no\nevidence of hepatic steatosis. The patient is status post radiofrequency\nablation of two metastatic lesions in segment III of the left hepatic lobe on\n___. An irregularly marginated, confluent area of nonenhancement in\nthe lateral aspect of segment III is in keeping with coagulative necrosis, and\nthere is no suspicious enhancement in this area. An approximately 0.8 x 0.4\ncm rim enhancing lesion at the medial aspect of the left hepatic lobe adjacent\nto the resection margin (series 10, image 65), is about the same in size\n(previously 0.7 x 0.6 cm), and is again most compatible with a small\nmetastasis. The main portal, left portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is within normal limits. There is no pancreatic ductal\ndilatation.\n\nSpleen: The spleen is within normal limits.\n\nAdrenal Glands: The adrenal glands are within normal limits. No focal nodules\nare seen.\n\nKidneys: There are tiny cortical cysts in the bilateral kidneys.\n\nGastrointestinal Tract: There are no dilated bowel loops within the\nvisualized upper abdomen.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and mesenteric branch vessels are normal in\ncaliber and patent.\n\nOsseous and Soft Tissue Structures: The bone marrow signal is normal. There\nare incisional changes of the anterior abdominal wall.", "output": "1. Interval radiofrequency ablation of two segment III metastases without\nevidence of residual viable tumor.\n2. 0.8 x 0.4 cm suspected metastasis at the right edge of the remnant liver,\nadjacent to the resection margin, is unchanged in size since the ___\nstudy.\n3. No new hepatic lesion." }, { "input": "Lower Thorax: Lung bases are within normal limits. No pleural or pericardial\neffusion.\n\nLiver: Postsurgical changes are seen status post trisegmentectomy and multiple\nradiofrequency ablations. At the inferior margin of hepatic segment III,\nthere are several new progressively peripherally enhancing lesions, most\nlikely representing cholangiocarcinoma metastases. These are all in close\nproximity to each other, with the largest measuring approximately 2 cm. Some\nof these were present on prior CT from ___, measuring up to 0.8 cm. \nAdditional is smaller metastases are seen on image images 47 and 40 of series\n16. Hepatic vasculature is patent.\n\nBiliary: No biliary ductal dilatation.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable aside for a stable small left renal\ncyst.\n\nGastrointestinal Tract: No bowel obstruction or ascites. Previous fluid\ncollections subjacent to the stomach is no longer seen.\n\nLymph Nodes: No upper abdominal adenopathy.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions. Extensive\npostsurgical changes are seen along the anterior abdominal wall.", "output": "Interval progression of disease manifested as several new and enlarging\nhepatic metastases as above." }, { "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The patient is status post right trisegmentectomy. Three hypovascular\nablation beds in segment 3 (series 100, image 78, 90) do not demonstrate\nsuspicious internal enhancement.\n\nThere has been interval decrease in tumor burden at the site of prior disease\nseen at the inferior aspect of segment 3.\n\nThere are several new or significantly increased T2 hyperintense, hypovascular\nmasses scattered throughout the remaining liver, concerning for metastatic\ncholangiocarcinoma. For example, a 10 mm enhancing mass in segment 3 (series\n200, image 77) is new from prior examination. A 4.0 x 3.5 cm hypovascular\nmass with internal enhancement in segment 2 (series 200, image 67) previously\nmeasured 0.4 cm. Numerous additional hypovascular masses measuring up to 3.3\ncm (series 200, image 28, 41, 58, 82) are also concerning for metastatic\ndisease.\n\nThere is extensive confluent fibrosis in the periphery of segment 3.\n\nBiliary: There is new mild multifocal intrahepatic biliary ductal dilatation\nlikely secondary to the intrahepatic masses described above. The gallbladder\nis surgically absent.\n\nPancreas: The pancreas is normal in size and signal intensity. There is no\nmain pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: Adrenal glands are unremarkable, bilaterally.\n\nKidneys: There is no suspicious renal mass or hydronephrosis.\n\nGastrointestinal Tract: The stomach and visualized loops of small and large\nbowel are unremarkable.\n\nLymph Nodes: Prominent retroperitoneal lymph nodes do not meet CT size\ncriteria for lymphadenopathy.\n\nVasculature: The patient is status post right portal vein embolization.\n\nOsseous and Soft Tissue Structures: There is no evidence of osseous malignancy\nor infection.", "output": "1. Evidence of treatment response at the site of Y-90.\n2. Numerous new large hepatic lesions concerning for metastatic\ncholangiocarcinoma.\n3. Mild new intrahepatic biliary ductal dilatation due to obstructing central\nmasses." }, { "input": "Cervix and nondistended vagina: There is a 5.9 x 5.3 x 7.1 cm heterogeneously\nenhancing mildly T2 hyperintense mass originating from the cervix with\nsuperior component extending into the lower and mid uterine body and inferior\ncomponent extending into the upper third of the anterior vaginal wall. No\ninvolvement of the mid or lower third of the vagina. There is parametrial\nextension of the tumor along its posterior and bilateral lateral borders (8 mm\non left and 10 mm on right) (10:15). The tumor abuts the distal right ureter\n(10:15) without right-sided hydroureter or hydronephrosis or direct\ninvolvement. Adhesions are noted extending from the posterior aspect of the\ncervix to the anterior rectal wall without tumor extension (___). There is\nthickening of the left round ligament (10:9) without definite tumor\ninvolvement.\n\nThe uterus is anteverted and measures 4.2 x 10.5 x 4.4 cm. A 0.8 cm T2\nhypointense lesion along the right posterolateral uterine body is consistent\nwith a uterine fibroid. (05:16). The residual endometrium is normal in\nthickness for age and measures 5.The residual junctional zone is not\nthickened.\n\nThe right ovary is visualized and appears within normal limits with\nphysiologic follicular cysts.\nThe left ovary is visualized with a subtle 1.7 x 1.1 cm T2 hypointense\nheterogeneously enhancing area which may (series 1202, image ___ which may\nrepresent an ovarian primary, or implant, however given location differential\nincludes distal fallopian tube (10:9). This represents the general area of\nFDG avidity on the radioscintigraphy examination from ___.\n\nTrace pelvic free fluid is within physiologic limits.\n\nLYMPH NODES: There are abnormally enlarged bilateral external iliac lymph\nnodes measuring 1.5 cm on the right and 1.3 cm on the left. (10:12, 9). \nAdditionally, there is an abnormal left internal iliac lymph nodes which\nmeasures 0.6 cm in short axis and although does not meet size criteria for\nenlargement demonstrates heterogeneous enhancement worrisome for disease\ninvolvement. (10:7).\n\nBLADDER AND DISTAL URETERS: Bladder and distal ureters are unremarkable.\n\nRECTUM AND INTRAPELVIC BOWEL: Rectum is notable for adhesions extending from\nthe posterior cervix to the anterior rectal wall without tumor extension. \nSigmoid diverticulosis noted without evidence of acute diverticulitis. \nVisualized small and large bowel are otherwise unremarkable.\n\nVASCULATURE: Patent vasculature. No aneurysmal dilatation.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: No suspicious osseous lesions. Again\nnoted is disc protrusion at L4-L5 which is partially imaged. Soft tissues are\nunremarkable.", "output": "1. 7.1 cm cervical mass with parametrial, lower/mid uterine, and anterior\nvaginal wall extension with bilateral external iliac lymphadenopathy and\nsuspicious left internal iliac lymph node. Tumor abuts the right ureter\nwithout hydroureter or hydronephrosis. FIGO stage at least T2b.\n2. 1.7 cm left ovarian lesion may represent an ovarian primary or tumor\nimplant, however given its location the distal fallopian tube abutting the\novary could be similar in appearance." }, { "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: Redemonstration of diffusely decreased T2 signal intensity throughout\nthe liver.\n\nIron level: 215 Micromol/g (severe overload), ___ Micromol/g in ___.\n\nNo focal concerning lesions. The portal veins and hepatic veins appear patent.\nHepatic arterial anatomy is conventional.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is normal.\n\nPANCREAS: The pancreas normal in signal intensity and enhancement. No focal\nconcerning lesions or pancreatic duct dilatation. No evidence of\nperipancreatic inflammation.\n\nSPLEEN: The spleen is normal size. No focal concerning lesions. Diffuse\nsiderosis is again noted.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nThere are a few subcentimeter simple cyst in the right kidney. No concerning\nlesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.\n\nBONES: No concerning osseous lesion. Diffusely decreased T2 signal intensity\nthroughout imaged osseous structures is again noted, compatible with\nsiderosis.\n\nSOFT TISSUES: No concerning soft tissue lesions.", "output": "Siderosis involving the liver, spleen and bones with interval increase of\nsevere liver iron overload." }, { "input": "Lower Thorax: The lung bases are clear. There is no pericardial pleural\neffusion. The heart size is normal.\n\nLiver: The hepatic parenchyma demonstrates normal signal intensity on T1 and\nT2 weighted sequences. There is a large blooming artifact from a metallic CBD\nstent, obscuring the central liver. Within this limitation. No focal hepatic\nlesion is detected. Specifically, a subcentimeter hypodensity along the\nperiphery of the right hepatic lobe seen on the CT examination from ___ does not demonstrate an MRI correlate. No focus of restricted diffusion\nis identified.\n\nBiliary: There is no intra or extrahepatic bile duct dilation. The\ngallbladder is decompressed, and appears normal.\n\nPancreas: There is moderate dilation of the main pancreatic duct, which\nmeasures up to 9 mm (series 5, image 23), unchanged since the CT from ___. A known pancreatic head mass is not well evaluated on MR due to\nthe blooming artifact from the adjacent CBD stent.\n\nSpleen: The spleen size is within normal limits. There are no focal splenic\nlesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. A well-circumscribed 7 mm cyst is seen arising from the upper\npole of the right kidney (series 5, image 22, series 1102 image 64). No\nconcerning renal lesion is identified.\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal lesion.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy, and no\nascites.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries are\npatent and normal in caliber. The visualized portions of the portal and\nhepatic veins are patent. The portal SMV confluence is not evaluated due to\nsusceptibility artifacts from the adjacent CBD stent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. No abdominal metastasis or lymphadenopathy.\n2. No MRI correlate seen for the subcentimeter focal hypodensity on the right\nhepatic lobe from the ___ CT.\n3. Known pancreatic head mass is not visualized due to susceptibility artifact\nfrom adjacent metallic CBD stent. Moderate dilation of the main pancreatic\nduct, to 9 mm, is unchanged." }, { "input": "The liver is visualized and is irregular and nodular in\noutline, consistent with patient's known diagnosis of hepatitis C cirrhosis.\nPost-administration of contrast, an arterially enhancing lesion is identified\nmeasuring 7 mm (series 8, image 28). This was not seen on the previous MRI.\n\nA second lesion is seen in segment III and measures 7 mm in maximum diameter.\nThis demonstrates enhancement on the arterial phase. It is best seen on\nseries 8, image 56. This lesion was identified on the previous MR and is\nunchanged. There are multiple other tiny less focal areas that demonstrate\nenhancement on the arterial phase.\n\nThe spleen is enlarged at 15.6 cm. The gallbladder is visualized and is\nnormal. No evidence of intra- or extra-hepatic bile duct dilatation. The\nadrenals are normal.\n\nSome subcentimeter cysts are seen in the kidneys bilaterally.\n\nThe pancreas is visualized and is normal.\n\nMultiple enlarged lymph nodes are identified in the region of the porta\nhepatis and the peripancreatic area. The largest of these measures 2.9 cm and\nis best seen on series 9, image 48.\n\nNo evidence of any free fluid. The bowel where visualized is normal. The\nosseous structures visualized are normal.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series.", "output": "1. Two discrete subcentimeter and arterially enhancing lesions in the liver,\none of which is seen in segment III (series 8, image 56), measures 7 mm and is\nunchanged, the second lesion which is new measures 7 mm (series 8, image 28)\nand is in segment VIII. Continue follow up imaging with MR is recommended.\n2. Cirrhotic liver. Splenomegaly.\n3. Retroperitoneal lymph nodes, which are unchanged.\n4. Renal cysts." }, { "input": "Lower thorax: There are small bilateral pleural effusions, left greater than\nright, and adjacent atelectasis at the lung bases, as seen on recent CTA\nchest.\n\nLiver: The liver is nodular in contour and has a mottled appearance with\nhypertrophy of the caudate lobe. There is patchy severe fatty deposition in\nthe liver with a fat fraction measuring up to 44 % in the caudate lobe where\nit is most severe. There is heterogeneous enhancement of the liver\nperipherally. No suspicious focal liver lesion identified. There is large\nvolume ascites.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is distended without wall thickening or cholelithiasis.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel: There are edematous loops of bowel, similar to recent CT and likely due\nto third spacing. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. Hepatic arterial anatomy is conventional. The portal vein, splenic\nvein and SMV are patent. The hepatic veins are compressed and narrowed,\nhowever remain patent. There is a circumaortic left renal vein.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. There is diffuse anasarca.", "output": "1. Cirrhotic appearance of the liver with patchy areas of severe steatosis and\nperipheral enhancement which may represent confluent fibrosis, of uncertain\netiology, however parenchymal storage diseases are in the differential given\npatient's young age and severe hepatic fat deposition.\n2. The hepatic veins are narrowed however remain patent, with no evidence of\nBudd Chiari.\n3. Large volume ascites, bilateral pleural effusions, and diffuse anasarca." }, { "input": "The liver is shrunken and irregular in outline\nconsistent with patient's known cirrhosis. Note is made of ascites. The\nspleen is enlarged at 16 cm. Note is made of paraesophageal varices. No gross\nliver lesions identified. However, non-gadolinium study is not optimal for\nevaluating focal liver lesions.\n\nThe adrenals are normal. The right kidney is unremarkable. A large cyst is\nseen protruding from the lower pole of the left kidney and measures 6.4 cm.\nThe pancreas is unremarkable. No evidence of any significant lymphadenopathy.\nNote is made of a filter in the IVC.\n\nTime-of-flight imaging and phase-contrast was performed to evaluate\nthe patency of the SMV. The SMV is patent throughout its length. Note is\nalso made of a non-patent portal vein. There is noted to be chronic occlusion\nof the portal vein when compared with previous imaging and perhaps slight\nnonocclusive filling defect at the confluence of the splenic and superior\nmesenteric veins (unchanged since prior CTs).\n\n2D and 3D reformations provided multiple perspectives for the series.", "output": "1. Patent SMV and chronically occluded/obliterated portal vein in patient\nwith cirrhosis, ascites, and splenomegaly.\n2. Limited evaluation of the liver reveals no focal lesion." }, { "input": "Development of large layering right pleural effusion.\n\nStable heterogeneous liver compatible with known cirrhosis. No focal liver\nabnormalities identified. Patchy areas of signal dropout on out-of-phase\nimaging indicate hepatic steatosis, a new finding from prior exam. The liver\nis markedly displaced to the midline, due to massive ascites. No intrahepatic\nor extrahepatic biliary ductal dilatation. Stable splenomegaly measuring 16\ncm. Stable hyperenhancement at the posterosuperior subcapsular spleen, likely\nvarix.\nMultiple perisplenic, retroperitoneal, and paraesophageal varices are noted. \n\nMain portal vein occlusion/obliteration is chronic. Stable cavernous\ntransformation. There is non-occlusive clot in a branch of the left portal\nvein. No involvement of the SMV or splenic vein. Common hepatic artery has\nconventional branching from the celiac axis. The abdominal aorta is normal in\ncaliber. Small subcentimeter paraaortic lymph nodes are seen, increased in\nnumber from prior exam. \n\nSusceptibility gallbladder fossa consistent with cholecystectomy. The adrenal\nglands and pancreas remain unremarkable. A stable simple cyst is seen at the\nlower pole of the left kidney measuring up to 3.1 cm. Smaller T2\nhyperintensities are seen in both renal cortices, likely cysts. No\nhydronephrosis or hydroureter. Preserved corticomedullary differentiation. \nRenal arteries and veins are patent.\n\nThe stomach and duodenum appear within normal limits. There is suggestion of\nmild wall thickening of the jejunum, nonspecific in the setting of ascites and\nmight represent third spacing. No significant mesenteric adenopathy by size\ncriteria. Colon is collapsed containing a moderate amount of stool.\n\nMild thickening and apparent enhancement of the peritoneum, slightly more\nexaggerated in comparison to older studies.", "output": "1. Cirrhotic liver without focal abnormality.\n\n2. Worsening massive ascites and development of a layering right pleural\neffusion.\n\n3. Stable splenomegaly and paraesophageal/splenic/retroperitoneal varices.\n\n4. Chronic obliteration of the main portal vein at the porta hepatis with\ncavernous transformation. No new clot or extension is identified within the\nproximal SMV or splenic vein. The dynamic images are degraded by motion\nartifact.\n\n5. New hepatic steatosis.\n\n6. Mild thickening and enhancement of the peritoneum, slightly more\nexaggerated in comparison to prior exams, of uncertain significance." }, { "input": "Lower Thorax: Lungs are clear. There is no pleural effusion. Heart size is\nwithin normal limits.\n\nLiver: The liver has a nodular contour with an enlarged caudate lobe\nconsistent with cirrhosis. There are a few scattered subcentimeter biliary\nhamartomas.\n\nThere are post ablation changes from ablation of the HCC lesion in hepatic\nsegment VI and hepatic segment VII. Also seen are post embolization changes\nof the lesion at the right hepatic dome. There is uniform enhancement\nsurrounding the TACE site. There is no significant internal enhancement to\nsuggest residual tumor at either site.\nThere is a 1.0 cm nodular arterially enhancing mass at the junction of hepatic\nsegment 7 and the caudate (series 1101, image 63). The lesion has washout and\na pseudo capsule, consistent with HCC.\n\nThere are multiple scattered foci of nodular arterial enhancement without\nwashout or pseudo capsule .\nFor example in the right lobe: 8 mm (series 1101, image 128), 7 mm (series\n1101, image 110), 6 mm (series 1101, image 102) and 7 mm (series 1101, image\n64).\nFor example in the left lobe: 6 mm (series 1101, image 54) and 6 mm (series\n1101, image 50).\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is nondistended. Focal enhancement could represent\nadenomyomatosis.\n\nPancreas: The pancreas has normal morphology. There is no pancreatic ductal\ndilatation.\n\nSpleen: The spleen is homogeneous without focal masses or lesions.\n\nAdrenal Glands: The adrenal glands are symmetric and within normal limits.\n\nKidneys: The kidneys are normal size and symmetric. There are a few simple\ncysts within the left kidney.\n\nGastrointestinal Tract: The visualized bowel is nonobstructed.\n\nLymph Nodes: There are a few prominent mesenteric lymph nodes in the celiac\ndistribution. The largest measures 1.4 cm in diameter and is unchanged from\n___.\n\nVasculature: There is no visualized abdominal aortic aneurysm. There is a\nduplicated left renal artery.\n\nOsseous and Soft Tissue Structures: The visualized soft tissues and osseous\nstructures appear within normal limits. There are no suspicious enhancing\nmasses or lesions.", "output": "1. 1.0 cm nodular arterial enhancing lesion in hepatic segment VII/caudate\nlobe with washout and rim enhancement concerning for HCC.\n2. Multiple subcentimeter arterial enhancing foci within the right and left\nhepatic lobes as detailed above, none of which meet OPTN criteria for HCC.\nClose attention on follow up recommended.\n3. Posttreatment changes from ablation at hepatic segment VI and VII as well\nas embolization of an HCC lesion near the dome of the liver. No suspicious\nenhancement to suggest residual disease." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver is cirrhotic in morphology. Compared with MRI liver ___, patient has undergone interval chemoembolization to segments IV and VIII\nfor recurrence around a prior TACE site. There has been interval decrease in\nextent of arterial enhancement with washout and pseudo capsule surrounding the\ntreatment cavity, however there remains a significant amount remains, most\nprominent along the medial and superior aspect of the treatment cavity,\ndifficult to measure, however measures greater than 5 cm (10:19; 16: 18). \nMore medially along the treatment site in segment IV, there is a 1.3 cm focus\nof arterial enhancement with washout and pseudo capsule which appears slightly\nincreased in size compared with prior, previously measuring 10 mm, meeting\nOPTN 5A criteria for HCC (10:30; 16:29).\n\nIn the caudate lobe, there is a 1.4 cm focus of arterial enhancement which is\nincreased in size from prior, previously measuring 10 mm, and now displays\nwashout with pseudo capsule, meeting OPTN 5A criteria for HCC (10:36; 16:35).\n\nIn segment II, there is a 1.2 cm focus of arterial enhancement which is\nincreased in size from prior, previously measuring 8 mm, and now displays\nwashout with pseudo capsule, meeting OPTN 5A criteria for HCC (10:30; 16:30).\n\nIn segment VI, laterally to a prior treatment cavity, there is new nodular\narterial enhancement which displays washout and pseudo capsule on delayed\nphases, overall spanning up least 1.8 cm, meeting OPTN 5A criteria for HCC\n(10:65; 14:51).\n\nThere are additional treatment cavities in segments VII and at the borders of\nsegments VII/VIII which do not have evidence of significant residual or\nrecurrent tumor.\n\nThere are numerous additional arterially enhancing foci which do not currently\nmeet OPTN criteria for ___ including a 7 mm subcapsular focus of arterial\nenhancement which displays washout in segment VI (10:64).\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is collapsed and likely contains a small amount of sludge.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is enlarged up to 15 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis. There are bilateral renal cysts measuring up to\n2.2 cm in the left mid kidney.\n\nBowel: Partially imaged loops of small bowel are unremarkable. There are\ncolonic diverticula without evidence of acute diverticulitis. There is no\nwall thickening, adjacent inflammatory change, or abnormal enhancement. \nThere is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: Periportal and pericaval lymph nodes are not significantly\nchanged. There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Compared with ___, patient has undergone interval repeat\nchemoembolization for recurrent tumor around a prior TACE cavity. There is\ninterval decrease in extent of tumor surrounding the TACE cavity, however a\nsignificant amount of tumor remains, difficult to measure, however spanning\nmore than 5 cm.\n2. Interval slight increase in size of a 1.3 cm arteria" }, { "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: The liver is nodular consistent with cirrhosis. Patient appears\nstatus-post multiple lesions and trans arterial chemo embolizations, including\ninterval microwave ablation of four separate lesions in segments II, IV, VI,\nand I.\n\nA large, heterogeneous, arterially enhancing lesion with washout surrounding a\nprior segment ___ ablation cavity has increased in size since the prior\nexamination, measuring up to approximately 9.5 x 6.7 cm, previously 8.6 x 6.3\ncm (series 1201, image 36). Mass growth is most impressive inferior to the\nlevel of the ablation cavity, with much more washing out soft tissue in\nsegment IVB compared to the prior examination.\n\nDespite no definite residual tumor at any of the recent ablation sites, there\nare innumerable new and enlarging arterially enhancing lesions with washout\nand pseudo capsule scattered throughout the liver. Lesions now meeting OPTN\ncriteria for hepatocellular carcinoma and include, but are not limited to, the\nfollowing:\n\n1. 1.2 cm segment VIII (series 1201, image 26)\n2. 1.3 cm segment VII (series 1201, image 50)\n3. 1.5 cm segment VII (series 1201, image 60)\n4. 1.7 cm segment V/VIII (series 1201, image 74)\n5. 1.3 cm segment V (series 1201, image 86)\n6. 1.3 cm segment VI (series 1201, image 92)\n7. 1.7 cm segment VI (series 1201, image 41)\n\n The portal veins and hepatic veins appear patent. Hepatic arterial anatomy\nis conventional.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation. There\nis cholelithiasis without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is normal in signal intensity. No concerning lesions.\nNo main pancreatic duct dilatation. No evidence of peripancreatic\ninflammation.\n\nSPLEEN: The spleen is enlarged measures 15.0 cm. There is a small accessory\nspleen.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and nephrogram. There are multiple\nsimple appearing renal cysts. No concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: A heterogeneous retrocaval lymph node is increased in size since\nthe prior examination measures 1.4 cm, previously 1.0 cm (series 1201, image\n118). Allowing for differences in measurement technique, a preaortic lymph\nnode measuring 1.3 cm is unchanged (series 1201, image 127).\n\nVASCULAR: No abdominal aortic aneurysm. There are bilateral accessory renal\narteries.\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: No concerning soft tissue lesions.", "output": "1. A large recurrent hepatocellular carcinoma centered in segment IV has\nsignificantly increased in size since the prior examination.\n2. There are innumerable new and enlarging hepatic lesions, many of which now\nmeet OPTN criteria for hepatocellular carcinoma.\n3. A 1.4 cm retrocaval lymph node has enlarged and is concerning for\nmetastasis.\n4. Cirrhosis with evidence of portal hypertension including splenomegaly." }, { "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: Patient appears status-post multiple ablations involving segments II,\nIV, VI, and I. A large, heterogeneous, arterially enhancing lesion with\nwashout surrounding a prior segment ___ ablation cavity has decreased in size\nsince the prior MRI now status-post repeat trans arterial chemoembolization. \nMeasured in a similar plane as the prior examination's maximum axial\n___, the lesion measures up to approximately 9.3 x 5.5 cm, previously\n9.5 x 6.7 cm. More inferiorly, the lesion measures approximately 7.4 x 4.5\ncm, previously 7.9 x 7.3 cm.\n\nScattered arterially enhancing lesions throughout the right hepatic lobe are\nsignificantly decreased in number and size since the prior examination.\nPreviously seen OPTN 5 lesions in the right hepatic lobe have decreased in\nsize and demonstrate predominantly non enhancement compatible with treatment\nresponse (series 1002, images 30, 55, 73 84, 139). A previously seen OPTN 5\nlesion in the posterior aspect of segment VI has decreased in size and\nmeasures 1.2 cm, previously 1.5 cm, and demonstrates central non enhancement\nand minimal residual peripheral enhancement (series 1001, image 58).\n\nScattered arterially enhancing lesions in the left hepatic lobe appear similar\nin number, but increased in size, some now meeting OPTN criteria for\nhepatocellular carcinoma. Representative lesions include:\n\n1. 1.3 cm segment II, previously 0.9 cm, with washout and pseudo capsule\n(series 1001, image 50; series 1002, image 54).\n2. 1.0 cm segment II, previously 0.9 cm, with washout and pseudo capsule\n(series 1001, image 48; series 1002, image 52).\n3. 1.1 cm segment III, previously 0.9 cm, with washout and pseudo capsule\n(series 1001, image 74; series 1002, image 74).\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation. There\nis cholelithiasis without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is normal in signal intensity. No concerning lesions.\nNo main pancreatic duct dilatation. No evidence of peripancreatic\ninflammation.\n\nSPLEEN: The spleen is enlarged and measures 15.5 cm. No focal concerning\nlesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and nephrogram. There are multiple\nsimple appearing renal cysts. No concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: A 1.6 cm avidly enhancing retrocaval lymph node measuring 1.6 cm\nhas slightly increased in size since the prior examination measures 16 mm,\npreviously 14 mm (series 1001, image 106). A 1.3 cm preaortic lymph node is\nunchanged.\n\nVASCULAR: No abdominal aortic aneurysm. There are bilateral accessory renal\narteries.\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: No concerning soft tissue lesions.", "output": "1. A large recurrent hepatocellular carcinoma centered in segment IV has\ndecreased in size since the prior examination.\n2. Right hepatic lobe lesions, including previously characterized OPTN 5\nlesions demonstrate evidence of treatment response, most decreased in size\nwith non enhancement. A segment VI lesion has decreased in size and\ndemonstrates minimal residual peripheral enhancement. Recommend attention on\nfollow-up imaging.\n3. Segment II and III left hepatic lobe lesions are similar in number, but\nincreased in size since the prior examination. Three lesions now demonstrate\nOPTN criteria for hepatocellular carcinoma.\n4. A 1.6 cm retrocaval lymph node has increased in size and conspicuity, very\nconcer" }, { "input": "Lower Thorax: Visualized lower lungs are unremarkable. No pericardial or\npleural effusion. Heart is normal in size.\n\nLiver: Patient is status post multiple ablation cavities scattered throughout\nboth hepatic lobes.\n\nStatus post chemoembolization of the right hepatic lobe in ___. Though\nthe largest heterogeneous mass in segment 4A surrounding a prior ablation\ncavity is unchanged in size measuring 7.2 x 5.0 cm (1301:58) it shows\nsignificant decrease in overall arterial enhancement compared to prior study. \nThere are 2 residual arterially enhancing nodules with washout in the anterior\naspect of this mass (1301:37) measuring 1.1 and 1.4 cm. Previously mentioned\narterially enhancing lesions that were scattered throughout the right hepatic\nlobe have continued to decrease in size with central nonenhancement and\nminimal residual peripheral enhancement (1302:22, 45, 64, 77, 128).\n\nThere are least 3 new arterially enhancing nodules with washout in segment 6\n(1301:73, 67) the largest of which measures 1.0 cm meeting OPTN criteria and\nthe 2 smaller subcentimeter however showing washout and pseudocapsule\nformation.\n\nStatus post chemoembolization of the left hepatic lobe in ___. \nPreviously mentioned lesions in segments 2 and 3 with washout and\npseudocapsule formation now show central nonenhancement and minimal peripheral\nenhancement (1301:50, 53, 77) all decreased in size since prior.\n\nBiliary: Cholelithiasis with no surrounding wall thickening or edema. No\nintra or extrahepatic biliary dilation. No choledocholithiasis.\n\nPancreas: The pancreas is mildly atrophic but otherwise with normal signal and\nenhancement throughout. No pancreatic duct dilation or focal lesions.\n\nSpleen: The spleen is again noted to be enlarged measuring 15.3 cm in\ncraniocaudal dimension, stable. Signal and enhancement are homogeneous with\nno focal lesions.\n\nAdrenal Glands: Both adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal and symmetric size, shape, nephrogram and\ncontrast excretion. No hydronephrosis. Bilateral simple cysts are again\nnoted measuring up to 2.2 cm (5:41). No worrisome solid lesions.\n\nGastrointestinal Tract: The lower esophagus, stomach, duodenum and visualized\nsegments of small and large bowel are unremarkable and undistended.\n\nLymph Nodes: There are multiple periportal and retroperitoneal lymph nodes\nwhich have grown in size compared to prior study, the largest in the\nretrocaval station measuring 1.7 cm (1301:102), previously 1.4 cm. Other\nexamples are an aortocaval lymph node measuring 1.5 cm (1301:110), and\nepiphrenic lymph node measuring 0.9 cm (1301:32) and the periportal lymph node\nmeasuring 1.1 cm (1301:95).\n\nVasculature: Major vessels of the upper abdomen are patent and normal in\ncaliber. Normal conventional vascular anatomy is again noted.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions or acute\nfractures. Unremarkable appearance of the superficial soft tissues of the\nupper abdominal wall.", "output": "Overall marked decreased tumor burden noted in the liver with residual tumor\nin the anterior aspect of the heterogeneous mass in segment ___.\n\nNew nodules with arterial hyperenhancement and washout in segment VII/VI\nmeasuring up to 1.0 cm, at least one of which meets size criteria for OPTN 5A.\n\nSlight increase in size of the retroperitoneal and periportal lymphadenopathy\nmeasuring up to 1.7 cm consistent with progression of disease.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:02 into th" }, { "input": "Lower Thorax: Visualized lower thorax is grossly unremarkable.\n\nLiver: The liver is nodular and cirrhotic. Redemonstration multifocal hepatic\npost ablation changes with heterogeneous peripheral hepatic enhancement on the\narterial phase.\n- At the level of the large segment ___ ablation cavity there is\nsurrounding heterogeneous nodular arterial enhancement with 2 foci\ndemonstrating associated washout and pseudo capsule which measure 2.2 x 1.1 cm\nand 2.4 x 1.5 cm (1601:40-41, 1603:40-41 and 1601:37, 1603:37). The overall\nappearance of this lesion is stable compared to the MRI of ___.\n- There is a new 0.6 cm focus of arterial hyperenhancement with washout and\npseudo capsule in segment V of the liver (1601: 96, 1603: 96), this is\nsuspicious for ___, however, it does not meet OPTN criteria.\n- Stable arterially hyperenhancing lesions with washout pseudo capsule noted\nat the posterior aspect of segments VI/VII with one lesion measuring 1 cm and\nmeeting OPTN 5A criteria for HCC (1601:75-79).\n-Additional punctate areas of arterial enhancement with millimetric foci of\nwashout within segment 4 are highly suspicious for additional foci of HCC\n(series 1601 image 8, series 1603, image 80).\n- Stable small focus of arterial hyperenhancement without significant washout\nmeasuring 7 mm in segment V of the liver (1601:73). The previously described\nsmall foci of arterial hyperenhancement on MRI of ___, that decreased\nin size on the prior exam of ___, have either further decreased in\nsize or are no longer visualized. There are few new punctate foci of arterial\nhyperenhancement without correlate on other sequences or washout, seen in\nsegments V and III of the liver (1601:79, 1601:65 and 61), these measure up to\n5 mm.\n\nBiliary: No intra- or extrahepatic biliary dilation. There is cholelithiasis\nwithout cholecystitis.\n\nPancreas: The pancreas is mildly atrophic without focal suspicious pancreatic\nlesions. No significant pancreatic duct dilatation.\n\nSpleen: The spleen is enlarged measuring 15.7 cm.\n\nAdrenal Glands: Adrenal glands are thin without nodularity.\n\nKidneys: There are bilateral renal cortical simple cysts measuring up to 2.2 x\n1.8 cm on the left side. No focal concerning renal lesions. No\nhydronephrosis.\n\nGastrointestinal Tract: Stomach is grossly unremarkable. Visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: Stable mildly enlarged periportal lymph nodes measuring up to 1.3\ncm in short axis (1601:86). Stable mildly enlarged retroperitoneal lymph\nnodes measuring up to 1.6 cm in short axis (1601:105, 115). Relatively stable\nepiphrenic lymph nodes measuring up to 1 cm in short axis (1601:30 ___.\n\nVasculature: Visualized abdominal vasculature is grossly unremarkable.\n\nOsseous and Soft Tissue Structures: There are no gross abnormalities.", "output": "1. Cirrhotic liver with multiple prior ablations and stable appearance of the\nablation cavities. There is relatively unchanged appearance of the\nheterogeneous arterial enhancement with 2 foci of washout along the segment IV\na ablation cavity as described above (measuring up to 2.4 cm).\n2. Stable arterially hyperenhancing lesions with washout noted at the\nposterior aspect of segments VI/VII with one stable lesion measuring 1 cm and\nmeeting OPTN 5A criteria for ___. Additional adjacent arterially enhancing\nmillimetric foci with washout, highly concerning for ___.\n3. There is a new 7 mm arterially hyperenhancing segment V liver lesion with\nwashout that is concerning for ___ but does not meet the OPTN 5A criteria\ngiven its size.\n4. Few new foci of arterial hyperenhancement without washout of correlate on\nothe" }, { "input": "Liver/Biliary: No change in progressively enhancing 3.6 x 2.5 cm hepatic\nsegment 3 and 4B mass when compared to CT from ___ however this lesion\nhas decreased in size since ___ MR where it measured 4.2 x 2.7 cm. \n(17:39) Mass is again noted to extend into the porta hepatis with persistent\ninvasion of the left portal vein in a similar distribution to prior MRI. There\nis mild decrease in left-sided intrahepatic biliary duct dilatation with\npersistent left hepatic lobe atrophy (17:36). Moderate hepatic steatosis\npredominately involving the right hepatic lobe with relative sparing of left\nhepatic lobe again noted. (Fat fraction 19.2%). No ascites. Gallbladder is\nsurgically absent.\n\nPancreas: Few subcentimeter pancreatic cystic lesions are unchanged, largest\nmeasuring 0.3 cm in pancreatic tail, likely IPMNs (07:27). Unchanged 1.3 x\n2.3 cm cystic extra pancreatic lesion anterior to the pancreas is likely\nrelated to lymphatics (07:25). No pancreatic duct dilatation.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: 1.4 cm left renal cysts noted. Otherwise unremarkable without\nhydronephrosis.\n\nGastrointestinal Tract: No obstruction. Small duodenal diverticulum again\nnoted.\n\nLymph Nodes: The retroperitoneal adenopathy is unchanged. Representative\nnodes are as follows: portacaval node measures 1.3 cm (12: 47), 0.9 cm para\naortic node (07:39), and 1.3 cm centrally necrotic mesenteric lymph node are\nunchanged (10:44).\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and accessory right renal artery are patent. Hepatic anatomy is\nnotable for accessory left hepatic artery arising off left gastric artery. \nHepatic veins, right portal vein, main portal vein, SMV, and splenic vein are\npatent.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions.", "output": "1. Unchanged 3.6 cm left hepatic lobe mass with left intrahepatic biliary\nduct dilation and similar left portal vein invasion when compared to ___ CT, however, findings are overall improved from ___ MR.\n2. Stable retroperitoneal adenopathy." }, { "input": "There is no abnormality identified in the roots, trunks, divisions or cords of\nthe brachial plexus bilaterally. There is no evidence of edema or enlargement\nof the nerves. There is no intrinsic or extrinsic mass identified. No evidence\nof muscular atrophy or edema. No axillary or supraclavicular lymphadenopathy. \nThe great vessels are normal in caliber and patent. The heart is normal in\nsize.\n\nIncreased signal intensity in the right lung consistent with fibrosis. Small\nleft pleural effusion.", "output": "No brachial plexus abnormality bilaterally.\n\nFibrotic changes in the both lungs. Small left pleural effusion." }, { "input": "The exam is limited. Only T2 weighted images and diffusion weighted images\nwere obtained, as the exam was terminated early due to patient discomfort. \nMotion artifact is also present throughout the exam.\n\nLower Thorax: There are small bilateral pleural effusions, greater on the\nright than the left. The bases of the lungs are otherwise clear. The base of\nthe heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is diffusely enlarged in comparison to the prior exam from\n___. The parenchyma is replaced by innumerable nodules which are mildly\nhyperintense on the T2 weighted images. The nodules are small, measuring\nbetween 1 and 2 cm, though they appear to coalesce in many regions of the\nliver. They demonstrate restricted diffusion. This is most compatible with\ndiffuse metastatic disease. These appear to be new from ___. The\nhepatic vasculature is not well characterized on this noncontrast exam.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is not distended, which limits evaluation. Apparent wall\nthickening and pericholecystic fluid is likely due to the liver disease.\n\nPancreas: The pancreatic parenchyma is normal in signal. There is no duct\ndilation or mass.\n\nSpleen: The spleen is normal in size, measuring 9.8 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands appear slightly thickened in\ncomparison the prior exam, though no discrete nodule is identified.\n\nKidneys: The kidneys are normal in size. There are no worrisome lesions,\nhydronephrosis, or pyelonephritis. There is a probable punctate cysts in the\nright kidney (3, 39).\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is a small amount of ascites.\n\nLymph Nodes: There is lymphadenopathy in the porta hepatis. It is poorly\ncharacterized on this limited exam. There is no retroperitoneal or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. Evaluation of the vasculature is limited on this noncontrast exam.\n\nOsseous and Soft Tissue Structures: There are many osseous metastases, best\nseen on the diffusion-weighted images. They are seen in almost all the\nvertebral bodies in the lower thoracic and upper lumbar spine. Within the\nlimitation of this exam, the spinal canal appears within normal limits without\nfocal narrowing from the metastatic disease. There is diffuse anasarca. The\nsoft tissues are otherwise normal.", "output": "1. Innumerable nodules replacing the entire hepatic parenchyma is most\ncompatible with diffuse metastatic disease, new from ___.\n2. Lymphadenopathy in the porta hepatis.\n3. Diffuse osseous metastases.\n4. Small amount of ascites.\n5. Small bilateral pleural effusions, greater on the right than the left.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 8:52 AM, 5 minutes after discovery of the findings." }, { "input": "The liver is nodular, consistent with cirrhosis. The gallbladder contains\nseveral stones, without wall thickening or pericholecystic fluid to suggest\nacute cholecystitis. The spleen is enlarged, measuring 14.1 cm. The pancreas\nis without focal lesion, ductal dilation, or peripancreatic stranding or fluid\ncollection. The adrenal glands are normal in size and configuration. The\nkidneys are symmetric and normal in size. There is no hydronephrosis or focal\nmass. There is a right lower quadrant ileostomy. Bowel loops are normal in\ncaliber, without wall thickening or evidence of obstruction. The patient is\nstatus post stenting of an intra-abdominal aortic aneurysm. The stent and\nvessels are patent, though the left renal artery is focally stenotic at its\norigin. There is no retroperitoneal or mesenteric lymph node enlargement.\n\nThere is asymmetric thickening of the right aspect of the bladder wall with\nlayering debris within the bladder lumen. The prostate is enlarged, measuring\n5.3 x 6.0 x 4.3 cm with a calculated volume of 71 cc. There is no concerning\nfocal mass or fluid collection. There is no pelvic sidewall or inguinal lymph\nnode enlargement. No pelvic free fluid is seen.\n\nNo focal osseous lesion concerning for infection or neoplasm is identified.", "output": "1. No abscess or other evidence of infection.\n2. Asymmetric thickening of the right aspect of the bladder wall, with\nbladder debris. If not explained by the patient's history or previously\nevaluated, direct visualization with cystoscopy is recommended.\n3. Cholelithiasis without evidence of acute cholecystitis.\n4. Cirrhotic liver and splenomegaly.\n5. Prostate hypertrophy." }, { "input": "Lower Thorax: A moderate right pleural effusion with relaxation atelectasis\nhave increased since ___.\n\nLiver: Cirrhotic-appearing liver again seen with a few diminutive cysts. \nHepatic lesions are as follows:\n\n-An 1.6-cm arterially enhancing lesion in segment III with washout is overall\nunchanged, highly suspicious for ___ but not meeting OPTN 5 criteria.\n\n-A stable 6-mm arterially enhancing lesion with washout in segment V is more\nconspicuous on current exam and also highly suspicious for ___ but does not\nmeet OPTN criteria (1301,49).\n\nTrace ascites, similar to the prior exam. Retroperitoneal edema is mild, not\nsignificantly changed.\n\nBiliary: Cholelithiasis. No intrahepatic or extrahepatic biliary ductal\ndilation.\n\nPancreas: Normal bulk and signal intensity. No evidence of mass or ductal\ndilation.\n\nSpleen: Moderate splenomegaly, unchanged.\n\nAdrenal Glands: Normal configuration and size.\n\nKidneys: Symmetric size without a suspicious mass. A small left upper renal\npole cyst is unchanged.\n\nGastrointestinal Tract: Mild esophageal wall thickening and increased\nenhancement with surrounding edema suggests esophagitis. No bowel obstruction.\n\nLymph Nodes: No enlarged abdominal lymph nodes.\n\nVasculature: Patent hepatic vasculature. Hepatic artery anatomy is\nconventional. Multiple gastric and esophageal varices are compatible with\nsequelae of portal hypertension. Normal caliber abdominal aorta.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion.", "output": "1. Cirrhotic liver with sequelae of portal hypertension. Stable enhancing\nlesions with washout lesions are highly suspicious for ___ but do not meet\nOPTN criteria: 1.6 cm in segment III and 6-mm in segment V.\n\n3. Possible esophagitis.\n\n4. Moderate right pleural effusion, increased from prior." }, { "input": "Lower Thorax: There is a large right pleural effusion with right lower lobe\ncollapse. Small left pleural effusion.\n\nLiver: Morphologic features of cirrhosis. Arterially enhancing lesion within\nsegment 3 with washout now measures 20 mm (axial series 18, image 15),\npreviously 16 mm. No definite pseudo capsule. Arterially enhancing lesion\nwithin segment 5 with mild washout now measures 13 mm, previously 6 mm. No\ndefinite pseudocapsule. There are several additional T2 hyperintense\nsubcentimeter nonenhancing lesions which may represent small cysts or\nhamartomas. Small volume ascites.\n\nBiliary: Uncomplicated cholelithiasis. No biliary ductal dilatation.\n\nPancreas: Unremarkable.\n\nSpleen: Marked splenomegaly, measuring 18.3 cm.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Unremarkable.\n\nGastrointestinal Tract: Imaged portions of the stomach and small bowel are\nunremarkable. Mural thickening of the ascending colon, likely related to\nportal colopathy.\n\nLymph Nodes: Unremarkable.\n\nVasculature: No abdominal aortic aneurysm. The portal venous and hepatic\nvenous systems appear patent. However, there are multiple portosystemic\nshunts with multiple prominent collateral vessels along the left anterior\nabdomen.\n\nOsseous and Soft Tissue Structures: Lower abdominal ventral wall hernia\npartially imaged on wide field of view T2 weighted coronal images.", "output": "1. Interval growth of arterially enhancing lesions within segments 3 and 5. \nGiven size and washout, segment 3 lesion would meet OPTN 5B criteria for HCC,\nalthough these criteria cannot be strictly applied to the current examination\ngiven non-breath hold technique. Segment 5 lesion does not meet OPTN 5\ncriteria for HCC, but remains suspicious.\n2. Morphologic features of cirrhosis with findings of portal hypertension.\n3. Uncomplicated cholelithiasis.\n4. Lower abdominal ventral wall hernia, partially imaged." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are notable for persistent\nlarge right pleural effusion with severe right lower lobe atelectasis. No\nleft pleural effusion.\n\nLiver: The liver is shrunken and nodular in contour with hypertrophy of the\nleft lateral segment consistent with cirrhosis. No significant signal drop on\nout of phase imaging to suggest hepatic steatosis. No ascites.\n\nA 2 x 2.3 cm segment 3 ablation cavity is noted with intrinsic T1 hyperintense\nsignal consistent with coagulation necrosis. No abnormal or nodular\nenhancement to suggest residual or recurrent disease. (1501:69).\n\nWithin segment 5 there is a T1 hyperintense 1 x 0.9 cm arterially\nhyperenhancing lesion without definite washout on delayed phases which is\nunchanged since ___ (1501:57) and remains nonspecific. No pseudo\ncapsule.\n\nThere is a mildly T2 hyperintense nonenhancing band like area along segment 5\nwith subtle capsular retraction which may represent an evolving hepatic\ninfarct given occlusion of the hepatic vein and portal vein branch at this\nlevel (6:22).\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. No\ncholedocholithiasis. Large gallstone noted. Gallbladder is nondistended. \nMild gallbladder wall edema is likely related to underlying liver dysfunction.\n\nPancreas: Pancreas is homogeneous in signal intensity without suspicious mass.\nNo pancreatic duct dilatation or peripancreatic fat stranding. No pancreatic\ndivisum.\n\nSpleen: Spleen is enlarged measuring 18.3 cm, previously 21 cm. No suspicious\nmass.\n\nAdrenal Glands: Adrenal glands are symmetric in size and normal in morphology\nwithout suspicious mass.\n\nKidneys: Homogeneous in signal intensity without suspicious mass. No\nhydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction. Paraesophageal varices noted.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and ___ are patent. Hepatic anatomy is conventional. Left and\nmiddle hepatic veins are patent. A TIPS catheter shunt is seen extending from\nthe supra hepatic aorta to the right main portal vein with small amount of\nintraluminal contrast. Anterior right portal vein, SMV, and splenic vein are\npatent. There is nonenhancing thrombus involving the distal left portal vein\nand distal aspect of right posterior portal vein consistent with thrombus. \nThrombus within the middle hepatic vein noted.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Mild\ndependent anasarca noted. Soft tissues are otherwise unremarkable.", "output": "1. Nonspecific 0.9 cm segment 5 hepatic lesion is without washout or pseudo\ncapsule, unchanged since ___.\n2. No suspicious hepatic lesions meeting OPTN 5 criteria for HCC.\n3. Post ablation of hepatic segment 3 lesion with expected coagulation\nnecrosis. No evidence of residual or recurrent disease.\n4. Cirrhosis with splenomegaly. No ascites.\n5. TIPS catheter with new thrombus involving distal left portal and distal\naspect of right posterior portal veins.\n6. Cholelithiasis without evidence of acute cholecystitis.\n7. Unchanged large right pleural with severe right lower lobe collapse.\n\nRECOMMENDATION(S): Recommend follow-up MR liver in 3 months to assess for\ninterval change." }, { "input": "Lower Thorax: Visualized lung bases are grossly clear. No pleural or\npericardial effusion.\n\nLiver: The liver is normal in morphology. There is no evidence of hepatic\nsteatosis. There is a large heterogeneous mass is seen in segments ___\nmeasuring approximately 10.2 x 6.9 cm. This lesion demonstrates intrinsically\nT1 hyperintense, irregular enhancing solid components. There also\nnonenhancing components which demonstrate blooming artifact on the T1 weighted\nimages, compatible with blood products.\n\nAdditionally there is a mildly heterogeneous lesion in segments ___ (1003:93)\nmeasuring approximately 4.9 x 3.5 cm, which demonstrates subtle\nhyperenhancement relative to background hepatic parenchyma on the delayed\npost-contrast phases, as well as suggestion of a central scar. There is\nassociated perfusion alteration throughout the right hepatic lobe surrounding\nthis lesion on the arterial phase postcontrast images, normalizing to\nbackground liver on the later phases. A smaller 1.8 cm lesion with similar\nsignal and enhancement characteristics is seen in segment VII (1001:71).\n\nBiliary: The gallbladder is within normal limits. No intra or extrahepatic\nbiliary dilation.\n\nPancreas: The pancreas is normal in size and shape. There is an 10 mm focus\nof interdigitating fat in the downstream pancreatic body (4:28 and 3:18). \nThere is a 10 mm cystic lesion in the upstream pancreatic body (4:26 and\n3:22), likely a side-branch IPMN. There is no main ductal dilatation.\n\nSpleen: The spleen is normal in size with no focal lesions.\n\nAdrenal Glands: The left adrenal gland is unremarkable. The right adrenal\ngland is not visualized.\n\nKidneys: The kidneys are normal and symmetric in size. Multiple bilateral\nsimple cysts, including a dominant cyst in the upper pole of the left kidney\n(3:26) measuring up to 3 cm, and others of which are subcentimeter in size. \nThere is also a 4 mm hemorrhagic cyst in the upper pole of the right kidney\n(8:99).\n\nGastrointestinal Tract: The stomach, duodenum and visualized segments of\nsmall and large bowel are unremarkable.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. Major branch vessels\nare patent. Portal vasculature is patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions or acute\nfractures.", "output": "1. Large heterogeneous mass in segment ___ with enhancing components and\ninternal hemorrhage, possibly an underlying adenoma though imaging features\nare nonspecific. Malignancy is not excluded. Biopsy is recommended.\n2. Two other lesions in the right hepatic lobe measuring up to 4.9 cm and 1.8\ncm could represent atypical FNH or atypical adenoma. Recommend follow-up\ncontrast enhanced MRI of the abdomen 3 months with Eovist.\n3. 10 mm cystic lesion in the pancreatic body, likely a side-branch IPMN. See\nbelow for recommendations.\n\n\nRECOMMENDATION(S): For management of pancreatic cyst(s) between 6-15 mm in\npatients less than ___ years at presentation, recommend annual non-contrast\nMRCP follow-up for ___ years, then every other year up to a total of ___ years.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Lower Thorax: Minimally imaged lung bases are grossly unremarkable. There is\nno pleural effusion.\n\nLiver: The liver is smooth in contour. There is no signal loss on\nout-of-phase imaging to suggest hepatic steatosis. There are no suspicious\nfocal lesions in the partially imaged liver. There is incompletely imaged 0.7\ncm nonenhancing lesion the hepatic dome(13; 12), similar to prior CT.\n\nBiliary: There is a small duodenal diverticulum containing the ampulla (3; 4).\nThere is no intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis not visualized.\n\nPancreas: The pancreas is normal, without focal lesion or main ductal\ndilatation.\n\nSpleen: The spleen is normal in signal intensity and size without focal\nlesion.\n\nAdrenal Glands: The adrenal glands appear unremarkable bilaterally.\n\nKidneys: Bilateral kidneys are symmetric in size and demonstrate normal\nnephrogram. There is no hydronephrosis. In the right upper pole, there is a\n0.4 cm lesion which demonstrates signal loss on out-of-phase imaging, likely\nan angiomyolipoma (6; 8), (11; 45). In the right lower pole, there is a 0.9 x\n1.0 cm exophytic, T2 isointense and T1 hypointense lesion with avid\nenhancement, concerning for a small renal cell carcinoma. There is no\nevidence of bulk or intravoxel fat within this lesion.\n\nGastrointestinal Tract: There is a small hiatal hernia. Scattered diverticula\nnoted throughout the colon. The visualized small and large bowel appear\nnormal in caliber without evidence of obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal or pelvic sidewall lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. There are single left\nand two right renal arteries. Bilateral renal veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified.", "output": "1. 1 cm avidly enhancing lesion in the lower pole of the right kidney,\ncorresponding to the CT finding, is concerning for a small renal cell\ncarcinoma.\n2. 0.4 cm fat-containing lesion in the right upper pole is likely an\nangiomyolipoma." }, { "input": "Lower Thorax: No focal consolidation. No pleural pericardial effusion.\n\nLiver: The liver demonstrate normal morphology without steatosis. 0.8 cm\nlesion in the hepatic dome likely representing a cyst or biliary hamartoma is\nunchanged. No suspicious hepatic lesion.\n\nBiliary: No biliary ductal dilatation. The gallbladder is surgically absent.\n\nPancreas: The pancreas demonstrate normal signal intensity and enhancement\nwithout focal lesion. No pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal in size with normal nephrogram. Again seen is\na 1.2 x 1.0 x 0.9 cm exophytic predominantly isointense lesion on T1 and T2\nweighted images, compared to the renal parenchyma arising from the posterior\nright lower renal pole with avid enhancement. When compared to MRI from ___, the lesion has minimally increased in size, at which time it\nmeasured 0.9 x 0.7 x 0.8 cm when measured in similar fashion.\n\nThere is a 4 mm right upper renal pole hyperintense lesion on T2 weighted\nimages (series 6, image 10) with loss of signal intensity on out of phase\nimages, unchanged, consistent with an angiomyolipoma. No new suspicious renal\nmass. No hydronephrosis.\n\nGastrointestinal Tract: There is a small hiatal hernia. There is a 1.9 cm\nduodenal diverticulum. Otherwise the stomach is within normal limits. The\nvisualized upper abdominal bowel loops are within normal limits.\n\nLymph Nodes: The abdominal lymph nodes are not enlarged.\n\nVasculature: The abdominal aorta is normal in caliber. The major tributaries\nof the abdominal aorta are patent. The portal venous system is patent. There\nare 2 right renal arteries. Single left renal artery.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.Small fat containing ventral hernia.", "output": "1. Minimal increase in size of an exophytic posterior right renal lower pole\n1.2 x 1.0 x 0.9 cm mass compared to ___, at which time the mass\nmeasured 0.9 x 0.7 x 0.8 cm. Imaging features are concerning for renal cell\ncarcinoma.\n2. Unchanged 0.9 cm right upper renal pole angiomyolipoma.\n3. No new solid enhancing renal masses; upper abdominal lymphadenopathy or\nsuspicious hepatic/osseous lesions." }, { "input": "Lower Thorax: Visualized lung bases are normal. No pleural or pericardial\neffusion.\n\nLiver: Liver demonstrates normal contour. Diffuse drop in signal intensity on\nout of phase imaging is consistent with hepatic steatosis. Fat fraction\nmeasures 20%, previously 14%.\n\nBiliary: The gallbladder is normal. No intrahepatic or extrahepatic biliary\nduct dilatation.\n\nPancreas: Pancreas is signal intensity and bulk. No focal pancreatic lesion. \nNo pancreatic duct dilatation.\n\nSpleen: Spleen is normal. Accessory splenic tissue. No focal splenic lesion.\n\nAdrenal Glands: Left adrenal gland is normal. Multiloculated cystic lesion\ninterposed between the limbs of the right adrenal gland and adjacent to the\nperiphery of segment 7 of the liver is again noted measuring 4.9 x 1.9 cm. No\ninternal enhancing component. The T1 hyperintense areas are not seen on\ntoday's examination.\n\nKidneys: Kidneys are normal size and symmetric. A 5 mm cyst is noted in the\ninterpolar region of the right kidney.\n\nGastrointestinal Tract: Visualized small large bowel loops are unremarkable.\n\nLymph Nodes: No enlarged lymph nodes.\n\nVasculature: Major abdominal vasculature is normal.\n\nOsseous and Soft Tissue Structures: Mild levoconvex curve of the lumbar spine.\nNo focal osseous lesion.", "output": "1. Multiloculated cystic lesion located between the right adrenal gland and\nsegment 7 of the liver is unchanged in size and appearance. No suspicious\nenhancement or other concerning features. Differential considerations would\ninclude retroperitoneal lymphangioma or complex adrenal cyst.\n2. Hepatic steatosis with fat fraction measuring 20%, previously 14%." }, { "input": "Lower thorax: Partially imaged lung bases are clear.\n\nLiver: Liver demonstrates normal parenchymal morphology. There is no hepatic\nsteatosis. No focal lesions on this unenhanced study.\n\nBiliary: The gallbladder is normally distended. No intra or extrahepatic\nbiliary dilatation.\n\nPancreas: Pancreas shows homogeneous signal intensity. No evidence of\npancreatic ductal dilatation.\n\nSpleen: Normal size.\n\nAdrenal Glands: Again seen is evidence of a right adrenal mass measuring 2.8 x\n1.3 cm showing diffuse signal dropout on the out of phase images consistent\nwith an adrenal adenoma. The left adrenal is normal in size.\n\nKidneys: Both kidneys are normal in size. There is no hydronephrosis.\n\nGastrointestinal Tract: Stomach and visualized bowel loops are within normal\nlimits.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal. Dextroscoliosis\nof the lumbar spine. No soft tissue abnormality.", "output": "Stable right adrenal adenoma." }, { "input": "There is no fat stranding, bowel wall thickening or free fluid in the right\nlower quadrant. The appendix is not confidently identified.\n\nBoth ovaries are visualized and normal in size (04:33 left, 35 right). A\nsmooth and thin walled cyst containing simple fluid and measuring 5.2 cm in\ndiameter is present in the right ovary, indicating the right bladder wall\n(04:41).\nThe uterus measures 12 x 5.6 cm. Intra uterine gestational sac is seen. The\ncervix is 4.3 cm in length.\nMinimal amount of fluid is seen in the pelvis (4:44).\n\nThe liver is grossly normal. The gallbladder and the biliary ducts are normal.\nThe spleen is not enlarged. The kidneys are normal without hydronephrosis. The\nadrenals are normal.\nNo significant retroperitoneal, mesenteric or pelvic lymphadenopathy is\npresent.\nThe bone marrow signal is normal.", "output": "1. No evidence of appendicitis.\n2. Early intrauterine pregnancy.\n3. Right ovarian simple appearing cyst measuring 5.2 cm." }, { "input": "Lower thorax: Partially imaged lung bases are clear.\n\nSolid organs: The solid organs including the liver, spleen, adrenals, pancreas\nand kidneys are within normal limits. There is no hydronephrosis. The\ngallbladder is normal in appearance. No cholelithiasis. No evidence of intra\nor extrahepatic biliary dilatation.\n\nGastrointestinal Tract: The visualized small and large bowel loops are normal\nin caliber. The appendix is normal in caliber measuring approximately 5 mm in\nmaximum diameter (5:6). There is no evidence of appendiceal wall thickening\nor periappendiceal inflammatory changes.\n\nPelvis: There is an intrauterine gestational sac, better evaluated on pelvic\nultrasound performed on same day. There is a cyst in the right ovary which\nmeasures up to 6.2 cm and is displaced into the right lower quadrant, just to\nthe right of the umbilicus (3:14). There is no surrounding fat stranding or\nfree fluid. The urinary bladder is normally distended with normal wall\nthickness. Trace pelvic free fluid is within physiologic limits.\n\nLymph Nodes: No significant lymphadenopathy.\n\nVasculature: The pelvic vasculature is patent on time-of-flight imaging.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal. No soft tissue\nabnormality.", "output": "1. Normal appendix. No evidence of acute appendicitis.\n2. The right ovary contains a 6.2 cm cyst which is displaced into the right\nlower quadrant, just to the right of the umbilicus. Although there is no\nsurrounding inflammatory change seen, and blood flow was seen to the right\novary on pelvic ultrasound performed on the same day, given patient's focal\nsymptoms in this region, intermittent torsion/detorsion remains in the\ndifferential diagnosis." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, bilateral lung bases\ngrossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is nodular in contour compatible with cirrhosis. There is no\nhepatic steatosis. No suspicious liver lesions are seen.\n\nBiliary: There is no evidence of intra or extrahepatic biliary dilation. The\ngallbladder has a thin wall and gallstones.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nductal dilation. No focal pancreatic lesions are seen.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral kidneys demonstrate ___ multiple T2 hyperintense cysts\nare seen in bilateral kidneys measuring up to 2.0 cm. L signal intensity. No\nsuspicious renal lesions are noted. No hydronephrosis. There is no perinephric\nabnormality.\n\nGI: The stomach and intra-abdominal loops of small and large bowel are within\nnormal limits.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. The major visualized branches of the aorta are patent.\n\nOsseous and Soft Tissue Structures: No bone marrow signal abnormalities\ndetected. No suspicious osseous or soft tissue lesions detected.", "output": "1. Cirrhotic liver without suspicious liver lesions.\n2. Cholelithiasis." }, { "input": "LOWER CHEST: The partially imaged lung bases are unremarkable.\n\nABDOMEN:\n\nLIVER: A lobulated, heterogeneous, centrally necrotic lesion centered in\nsegment VII and extending into the posterior aspect of segment VIII is\ndecreased in size since 4 months prior, previously measuring up to\napproximately 9 cm. Enhancement is predominantly peripheral and persistent. \nNo macroscopic or intravoxel fat. No additional lesions identified. Mild\nhepatic steatosis. The portal veins are patent. The hepatic veins are patent.\nHepatic arterial anatomy is conventional.\n\nTotal liver volume: 2184 cc\nLeft lobe volume: 767 cc\nRight lobe volume: 1417 cc\nSegment VI/VII: 552 cc\n\nBILIARY: Mild dilation of the common hepatic duct measuring up to 1.2 cm is\nnot significantly changed since the prior examination. Mild central\nintrahepatic biliary ductal dilation is similarly unchanged. No obstructing\nstone or lesion identified. Patient appears status-post cholecystectomy.\n\nPANCREAS: There is extensive fatty replacement of the pancreas. No concerning\nlesions. No main pancreatic duct dilation.\n\nSPLEEN: The spleen is normal size and signal intensity. No focal concerning\nlesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: Gastric bypass changes. There is nonspecific enhancement of\nthe distal esophagus/gastric pouch. partially imaged loops of large and small\nbowel are unremarkable.\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. There is an 8 mm right renal artery\naneurysm, unchanged since ___ (series 9, image 83; series 21, image\n1).\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: There are postoperative changes in the anterior abdominal wall. \nNo concerning soft tissue lesions.", "output": "1. A large liver mass predominantly in segment VII but extending to the\nposterior edge of segment VIII has decreased in size since 4 months prior.\n2. Liver volumes created in the Imaging Lab:\nTotal liver volume: 2184 cc\nLeft lobe volume: 767 cc\nRight lobe volume: 1417 cc\nSegment VI/VII: 552 cc\n3. There is nonspecific enhancement of the wall of the distal\nesophagus/gastric pouch.\n4. There is an unchanged 8 mm right renal artery aneurysm." }, { "input": "Lower Thorax: Please refer to separate report from CT chest performed the same\nday for description of the intrathoracic findings.\n\nLiver: There is no evidence of background hepatic steatosis. The large,\nmildly T2 hyperintense, heterogeneously enhancing hepatic mass, compatible\nwith known HCC/cholangiocarcinoma, involving the entire left and central right\nhepatic lobes, measures approximately 13.2 x 10.2 x 9.7 cm, increased in size\nfrom ___ CT at which time it measured 12.5 x 8.7 x 9.0 cm, and ___\nMRI when it measured 11.9 x 8.3 x 9.4 cm. There are increased areas of\nhypoenhancement within the mass, most pronounced in the left hepatic lobe,\ncompatible with treatment response status post Y-90 radio embolization. Note\nis made of a 1.0 cm rim enhancing lesion along the posterior margin of the\nmass in segment VII, new since prior examinations (series 1202, image 30),\ncompatible with a satellite lesion. Incidental note is made of a few\nscattered cysts, the largest measuring 1.0 cm in segment VIII.\n\nBiliary: Status post cholecystectomy. Mild diffuse intrahepatic biliary\ndilation has increased since ___. There is no extrahepatic biliary\ndilation.\n\nPancreas: Normal parenchymal signal without focal lesions. No main ductal\ndilatation. One or two ectatic side branches in the pancreatic head.\n\nSpleen: Measures 12.5 cm in length although prominent anteroposterior diameter\nsuggests it is mildly enlarged. No focal lesions.\n\nAdrenal Glands: The right adrenal glad is normal in size and shape. The left\nadrenal gland is not well visualized amid retroperitoneal collateral vessels.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal nephrograms.\nNumerous bilateral subcentimeter T2 hyperintense foci are compatible with\ncysts, measuring up to 1.0 cm in the lower pole right kidney and 1.0 cm in the\ninterpolar region of the left kidney. No suspicious renal lesion. No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. Visualized loops of\nsmall and large bowel are normal in caliber.\n\nLymph Nodes: Mild porta hepatis lymphadenopathy measuring up to 10 mm in short\naxis (series 1201, image 72) and periaortic lymphadenopathy measuring up to 7\nmm in short axis appears similar to ___. A right paraesophageal lymph node is\nminimally larger, measuring 11 mm, previously 9 mm (series 1201, image 34).\n\nVasculature: The main and right portal veins are patent. The left portal vein\nis again occluded by the mass. The splenic vein is chronically occluded with\nanterior abdominal, perigastric and perisplenic collateral vessels. The right\nhepatic vein is compressed as it courses along the posterior margin of the\nmass, and left and middle hepatic veins are not seen. The superior mesenteric\nvein, renal veins and IVC are patent.\n\nOsseous and Soft Tissue Structures: No concerning osseous or soft tissue\nabnormality.", "output": "1. Mild interval enlargement of known HCC/cholangiocarcinoma involving the\nentire left and central right hepatic lobes, with increased areas of\nhypoenhancement particularly in the left hepatic lobe, compatible with\ntreatment response status post Y-90 radioembolization. Associated occlusion\nof the left portal vein and middle and left hepatic veins. Mild diffuse\nintrahepatic biliary ductal dilatation, increased compared to ___ MRI.\n2. Unchanged mild porta hepatis and retroperitoneal lymphadenopathy. \nMinimally larger right paraesophageal lymph node.\n3. Chronic thrombosis of the splenic vein with anterior abdominal, perigastric\nand perisplenic collateral vessels.\n4. Splenomegaly." }, { "input": "Lower Thorax: No pleural or pericardial effusions. The heart is not enlarged.\n\nLiver: Stable size of the large central infiltrative mass in the liver, now\nmeasuring approximately 13 x 10 cm, previously measuring 13.2 x 10.2, with new\ncapsular retraction along the left lobe of the liver. The main and left\nhepatic veins are encased and occluded. The right hepatic vein is partly\nencased. The left portal vein is encased and occluded by the mass. The right\nportal vein is encased but patent. In addition, the mass now appears\ninseparable from the pylorus/antrum of the stomach, with loss of intervening\nfat plane. A new satellite lesion is present adjacent to the dominant mass in\nsegment 4A/8 measuring 2.1 x 2.0 cm. Smaller adjacent satellite lesions in\nthe same segment are either new or have increased in size measuring up to 1 cm\nin diameter. A 1 cm cyst/biliary hamartoma and segment 5 the liver stable. A\n1.1 cm enhancing lesion on arterial phase in segment 7 of the liver is also\nunchanged. This remains hyperintense on portal venous and delayed phases and\nmay reflect a small hemangioma.\n\nThere is mild drop in signal intensity on the later echo, suggesting iron\ndeposition.\n\nBiliary: The gallbladder is absent. There is mild intrahepatic biliary duct\ndilatation in the right hepatic lobe, with more severe segmental biliary duct\ndilatation in the left hepatic lobe.\n\nPancreas: The pancreas is normal in signal intensity and morphology. \nPancreatic duct is not dilated. 6 mm cystic lesion in the neck of the\npancreas is stable, likely representing a side-branch IPMN.\n\nSpleen: Spleen is borderline in size measuring up to 13 cm in craniocaudal\ndimension, at the upper limits of normal.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: No focal suspicious renal lesions identified. Bilateral renal\ncortical cysts measuring up to 9 mm at the lower pole of the right kidney. \nLeft parapelvic cyst.\n\nGastrointestinal Tract: There is loss of intervening fat plane between the\npylorus/antrum of the stomach and the large infiltrative mass in the liver. \nThere is no gastric outlet or bowel obstruction.\n\nLymph Nodes: There are multiple prominent retroperitoneal/periaortic lymph\nnodes, unchanged since the previous study. A retrocrural/paraesophageal lymph\nnode measures up to 1 cm short axis.\n\nVasculature: There is no abdominal aortic aneurysm. Chronic occlusion of the\nsplenic vein and multiple varices are again demonstrated.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions. Incidental\nnote is made of a left gluteus minimus intramuscular lipoma.\n\nSmall intramural uterine fibroids are partially visualized.", "output": "Stable size of the large intrahepatic cholangiocarcinoma, with new capsular\nretraction along the left hepatic lobe anteriorly. There are new and\nenlarging satellite lesions in segment 4A/8 of the liver measuring up to 2.1\ncm in diameter.\n\nLoss of intervening fat plane between the pylorus/antrum of the stomach and\nthe infiltrative liver mass. No definite extension of tumor into the stomach,\nand no evidence of bowel obstruction on the present study.\n\nChronic encasement and occlusion of the left portal vein, middle and left\nhepatic veins." }, { "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: Redemonstration of the large lobulated mass occupying most of the left\nhepatic lobe, and extending to the right, measuring 11.0 cm x 13.1 cm x 10.7\ncm previously 10.5 cm x 13.2 cm by 10.0 cm with associated capsular\nretraction. There is intrahepatic biliary dilatation and atrophy of the left\nlobe of the liver. Post-contrast injection, there is heterogeneous\nenhancement of the posterior component in the right lobe. The anterior\ncomponent extending into the left lobe has necrosis.\nThe middle and left hepatic veins as well as the left portal vein are\nobliterated, as before. No free fluid.\nThere is some intrinsic signal centrally, which could represent a small amount\nof hemorrhage.\nTwo segment 7 satellite lesions are slightly enlarged compared to previously,\nmeasuring up to 1.4 cm.\nOther satellite lesions at the anterior aspect are unchanged.\nBiliary: No extrahepatic bile duct dilatation. Previous cholecystectomy.\n\nPancreas: Normal T1 appearance of the pancreas. No pancreatic duct dilatation.\nTiny T2 cystic structures are seen in the neck and tail of the pancreas\n\nSpleen: The spleen is not enlarged and is homogeneous.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Small cortical cysts are seen in the kidneys bilaterally. No\nhydronephrosis.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No size significant lymph nodes. The pericardial lymph node is\nslightly smaller. Stable retrocrural lymph node measuring 9 mm in short axis.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: Degenerative changes are seen in the\nvisualized spine. No suspicious bone lesion.", "output": "1. Revisualization of the known treated cholangiocarcinoma replacing most of\nthe left hepatic lobe, measuring 11.0 cm x 13.1 cm x 10.7 cm, with associated\npost treatment changes with necrosis in the anterior component- too early from\ntreatment time to comment upon residual or recurrent disease.\n2. Two satellite lesions in segment VII of the liver- now measuring up to\n1.4cm in size are slightly enlarged compared to prior.\n3. The middle and left hepatic veins as well as the left portal vein are\nobliterated by the tumor, unchanged.\n4. No enlarged upper abdominal lymph nodes. Slight decrease in size of the\npericardial lymph node." }, { "input": "Lower Thorax: No pleural or pericardial effusion..\n\nLiver: The patient is status post left hepatectomy. Intrinsic abnormal signal\nin the posterior aspect of segment VII could represent posttreatment changes\nfrom prior chemoembolization.\n\nMultiple liver lesions are redemonstrated, most of the demonstrating mild\nincrease in size and/or conspicuity compared to most recent MRI, including:\n- 1.8 cm targetoid enhancing lesion in segment VIII (12:71) previously\nmeasured 1.1 cm (3:7, 8:11, 12:11, 4:1).\n- 0.8 cm targeted enhancing lesion in the subcapsular segment VIII previously\nmeasured 0.6 cm (4:2, 8:19, 12:19)\n- 1.4 cm targetoid subcapsular lesion segment VIII, previously measure 1.1 cm\n(8:12, 12:12, 3:6)\n- 0.8 cm enhancing in segment VIII appears more conspicuous than on prior\nstudy (8:29).\n-1.7 cm targetoid enhancing lesion in segment V, previously measured 1.5 cm\n(8:69, 12:69).\n-1.5 cm enhancing lesion in segment VII, previously measured 0.8 cm (8:60,\n12:60).\n-0.7 cm enhancing lesion in segment VII, appears more conspicuous in current\nstudy in spite of being similar in size (8:49, 12:49).\n-0.6 cm mildly enhancing lesion in segment VI is more conspicuous than on\nprior study (8:79, 12:79).\n\nThere are no definitive new liver lesions. Stable cyst measuring up to 1 cm\n(3:28).\nPatient is status post cholecystectomy.\n\nBiliary: There has been interval removal of a right anterior transhepatic\nbiliary drainage catheter. There is similar mild intrahepatic biliary\ndilation.\n\nPancreas: Normal intrinsic T1 signal throughout. No suspicious lesions or\nductal dilatation.\n\nSpleen: Spleen remains top-normal in size measuring up to 12.8 cm in\ncraniocaudal dimension.\n\nAdrenal Glands: The bilateral adrenal glands are normal and symmetric in size.\nNo focal lesions.\n\nKidneys: Bilateral kidneys are normal and symmetric in size with normal\nnephrogram. No suspicious renal lesions. Bilateral extrarenal pelvises are\nredemonstrated. There is no hydronephrosis.\n\nGastrointestinal Tract: Visualized loops of small and large bowel are normal\nin caliber.\n\nLymph Nodes: No mesenteric retroperitoneal adenopathy.\n\nVasculature: The portal vein, splenic vein and SMV are patent. Abdominal\naorta is patent and normal in caliber.\n\nOsseous and Soft Tissue Structures: New T2 hyperintense and enhancing focus in\nthe left transverse process of T10 is incompletely characterized on MRI. \nSimilar appearance of serpiginous sacral and bilateral iliac bone T1\nhypointensities and T2 hyperintensities without enhancement, are which could\nrepresent bone infarcts.A T2 hyperintense lesion in the right L2 vertebral\nbody is stable since at least ___ and likely represents a hemangioma.", "output": "1. Multiple enhancing liver lesions appear slightly larger in size or more\nconspicuous than on most recent MRI. No new liver lesions.\n2. Patient is status post removal of a right PTBD with mild intrahepatic\nbiliary dilation.\n3. New T1 hyperintense and possibly enhancing focus in the left transverse\nprocess of T10 is only partially imaged and incompletely characterized on MRI;\nunclear if this represents artifact or may be a true lesion. No definite\ncorrelate is seen on the same-day chest CT. If clinically relevant, bone scan\nmay be considered for further evaluation." }, { "input": "MRA:\n\nThere are bilateral fusiform common iliac artery aneurysms. On the right, the\naneurysm measures 7.1 cm in length. The maximum transverse diameter is 4.2\ncm. The lumen measures up to 3.0 cm. The proximal landing zone is 0.2 cm\nfrom the aortic bifurcation. The right internal iliac artery is ectatic\nmeasuring up to 1 cm in maximum transverse diameter over a length of 1.5 cm.\n\nOn the left, the aneurysm spans approximately 6.6 cm and demonstrates a\nmaximum transverse diameter of 4.2 cm. The lumen measures up to 2.2 cm. The\nproximal landing zone is a 1.2 cm. The left internal iliac artery is ectatic\nmeasuring up to 1.3 cm over a 2.0 cm length.\n\nThe remainder of the abdominal aorta is ectatic but of normal caliber\nthroughout measuring up to 2.1 cm.\n\nThe left common iliac artery aneurysm compresses the left common iliac vein;\nhowever, the vessel remains patent both distally and proximally. The\nremainder of the visualized pelvic veins appear patent.\n\nThere is an accessory left renal artery which appears narrowed at its origin.\n\nNON-ANGIOGRAPHIC FINDINGS:\n\n\n\nAlthough the study is not optimized for assessment of the abdominal viscera,\nno gross abnormalities are detected.\n\nLower thorax: The lung bases are clear.\n\nLiver: The liver is homogeneous in signal characteristics. There are no\nsolid or cystic lesions.\n\nBiliary: There is no intra or extrahepatic duct dilatation. The gallbladder\nis within normal limits.\n\nSpleen: The spleen is normal in size and signal characteristics. The adrenal\nglands are unremarkable.\n\nKidneys: The kidneys are normal in size and signal characteristics. No\nconcerning solid lesions are identified.\n\nPancreas: The pancreas is within normal limits. There is no pancreatic duct\ndilatation.\n\nGI tract: The GI tract is of normal caliber throughout.\n\nLymph nodes: There is no significant mesenteric or pelvic adenopathy by size\ncriteria.\n\nOsseous structures: Anterior wedge compression deformities of L1, L3 and L4\nare unchanged compared to the previous lumbar spine MRI dated ___. \nMultilevel degenerative change is noted throughout the lumbar spine. There\nare no concerning osseous lesions.", "output": "1. Bilaterally, there are common iliac artery aneurysms extending within 1.5\ncm of the aortic bifurcation and distally to the internal iliac arteries. \nThere is mass effect on the left common iliac vein; however, the vein remains\npatent both proximally and distally with no evidence of thrombosis. Vascular\nsurgery consult is recommended." }, { "input": "Lower thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Homogeneous signal of the liver parenchyma. No focal hepatic lesion.\n\nBiliary: The gallbladder is unremarkable no intra or extrahepatic biliary\nductal dilatation\n\nPancreas: Homogeneous signal of the pancreas. No pancreatic ductal\ndilatation.\n\nSpleen: No splenomegaly.\n\nAdrenal Glands: The adrenal glands are suboptimally visualized. No adrenal\nmass is identified.\n\nKidneys: Unremarkable. No hydronephrosis.\n\nGastrointestinal Tract: The appendix is dilated, measuring up to 14 mm in\ndiameter (sagittal series 11, image 5) with periappendiceal edema and\ninflammatory change (axial series 24, image 7) in keeping with acute\nappendicitis. No fluid collection or abscess is identified. The stomach is\nunremarkable. The small and large bowel are normal in caliber.\n\nPelvis: Single intrauterine gestation. Both ovaries appear unremarkable\n(axial series 4, image 48 and 51).\n\nLymph Nodes: No retroperitoneal or mesenteric adenopathy.\n\nVasculature: The aorta and major branch vessels are patent. The hepatic and\nportal venous systems are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "1. Findings are in keeping with acute appendicitis with marked\n___ inflammation.\n2. Single intrauterine gestation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 10:31 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "Limited examination of the solid/hollow abdominal viscera and vascular\nstructures due to the lack of intravenous contrast.\n\nLower Thorax: Pleural effusions, atelectasis/ consolidation at the lung bases\nbilaterally.\n\nLiver: Within both the left and right lobes of the liver, there are multiple\nT2 hyperintense lesions which demonstrate bright signal on the\ndiffusion-weighted sequences, largest within segment 6 measuring 2.6 x 2.4 cm\n(series 3, image 29), in keeping with hepatic metastases. No intra or\nextrahepatic ductal dilatation. The gallbladder is unremarkable.\n\nPancreas: The pancreas demonstrates normal T1 signal hyperintensity with no\nmain duct dilatation. Multiple sub cm cystic pancreatic lesions are\nidentified, favored to represent side branch IPMNs. No peripancreatic\nabnormality.\n\nSpleen: Spleen is normal in size and appearance.\n\nAdrenal Glands: Right adrenal gland is normal. The left adrenal gland is\ndeviated medially by a multiple enlarged retroperitoneal nodes.\n\nKidneys: The left kidney is markedly abnormal in appearance. Arising\nexophytically from the upper pole of the left kidney is a large mass that is\nheterogeneous on T2 hypointense with restriction on the diffusion-weighted\nsequences, measuring approximately 4.9 x 4.4 cm (maximal axial dimension,\nseries 6, image 41), which extends superiorly and anteriorly, abutting the\ninferior aspect of the spleen.\n\nAn additional nodular mass is seen arising from the inferior aspect of the\nkidney centrally, and extending medially, narrowing in the traversing left\nrenal vein and artery, and this nodular mass measures 7.2 x 5.4 cm in the\nmaximal axial dimension (series 6, image 48). There is subsequent moderate\nhydronephrosis. At this level there are multiple nodular masses seen within\nthe perinephric space (series 6, image 47, 50), largest measuring 2.1 x 1.8\ncm. There is an additional nodular mass seen within the subcutaneous tissues\nposterior measuring 1.8 cm (series 6, image 47).\n\nNo intra voxel fat or central necrosis is seen within either of the renal\nlesions described above.\n\nMultiple nodular masses are seen within the retroperitoneum at the level of\nthe left kidney, largest mass measuring 3.5 x 3.5 cm (series 6, image 44). \nMultiple nodular masses are seen within the left paraspinal region as well\n(series 6, image 44, 49).\n\n11 mm hemorrhagic cyst is seen within the right kidney. No dilatation of the\nright renal collecting system.\n\nGastrointestinal Tract: Visualized loops of large and small bowel are within\nnormal limits.\n\nVasculature: No aneurysmal dilatation of the abdominal aorta.\n\nOsseous and Soft Tissue Structures: Multiple osseous metastases are seen\nwithin the visualized thoracic and lumbar spine. These are best appreciated\non the sagittal series (Series 10), with a superior lumbar vertebral body\ndemonstrating moderate height loss, and therefore at risk of a pathologic\nfracture (series 10, image 23). Abnormal signal extends into the posterior\nelements. If it would alter patient management, further assessment with a\ndedicated MRI of the spine can be considered.", "output": "Multiple nodular masses are seen involving the left kidney, as described\nabove. A large conglomerate mass measuring up to 4.9 cm arises exophytically\nfrom the upper pole of the left kidney, while an additional nodular mass\narises from the inferior aspect of the kidney centrally and extends medially,\nnarrowing the traversing left renal vein and artery, and this mass measures up\nto 7.2 cm. Multiple enlarged left retroperitoneal, paraspinal and\nsubcutaneous lymph nodes are identified. Multiple hepatic and osseous\nmetastases, as described above. Constellation of findings is most concerning\nfor an aggressive renal cell carcinoma, possibly an aggressive collecting\nduct, papillary or sarcomatoid subtype.\n\nBilateral pleural effusions with adjacent atelectasis plus or minus\nconsolidation.\n\nNOTIFICATION: The findings were attempted to be discussed with ___, M.D.\nby ___.D. on the telephone on ___ at 6:17 ___, 10 minutes\nafter discovery of the findings, however no response was received following\npaging Dr. ___. ." }, { "input": "Lower Thorax: Please refer to the dedicated same day CT chest exam for full\ndescription of intrathoracic findings.\n\nLiver: The liver appears normal in signal intensity without signal drop on the\nopposed phase sequences indicate hepatic steatosis. A 5 mm T2 hyperintense\nprogressively enhancing lesion in hepatic segment 6 appears to have been\npresent on the MR from ___, and likely represents a hemangioma\n(1403:89).\n\nBiliary: Patient is status post cholecystectomy. There is no evidence of\nintrahepatic biliary dilatation. The common bile duct is mildly prominent,\nmeasuring up to 1.0 cm, which can be seen in the postcholecystectomy setting.\n\nPancreas: The pancreas demonstrates mild fatty replacement. There is a\nheterogeneously enhancing 2.2 x 2.8 x 1.9 cm lesion within the pancreatic\ntail, new since the prior CT in ___, concerning for metastasis (16:20).\n\nSpleen: The spleen is normal signal intensity without concerning focal lesion.\n\nAdrenal Glands: The left adrenal gland appears thickened. There is a 2.2 x\n2.1 x 1.9 cm right adrenal enhancing nodule (6:6) which appears to demonstrate\nsome microscopic fat, likely representing metastasis and increased in size\nsince ___.\n\nKidneys: Patient is status post left nephrectomy. The right kidney\ndemonstrates areas of cortical thinning on the upper and lower renal poles,\ncompatible with history of partial nephrectomy in ___. There is a\nsingle right and single left renal artery.\n\nGastrointestinal Tract: The visualized small and large bowel loops in the\nupper abdomen appear unremarkable without evidence of obstruction.\n\nLymph Nodes: A 1.3 cm enhancing paracaval soft tissue nodule abutting the\npancreatic head is suspicious for retroperitoneal lymph node vs metastatic\nlesion in the pancreatic head (06:13).\n\nVasculature: The abdominal aorta is normal in caliber without aneurysmal\ndilatation.\n\nOsseous and Soft Tissue Structures: Degenerative changes are noted along the\nvisualized lumbosacral spine and are moderate in the right hip. There are no\nconcerning osseous lesions identified.", "output": "1. Post left nephrectomy and right partial nephrectomy. Several enhancing\nlesions are suspicious for metastatic disease, including a new 2.8 cm\npancreatic tail lesion, a new 1.3 cm enhancing paracaval soft tissue nodule\nabutting the pancreatic head, and enlarging 2.2 cm right adrenal lesion as\ncompared to the prior CT in ___.\n2. Please refer to the dedicated same day CT chest exam for full description\nof intrathoracic findings" }, { "input": "Lower thorax: The visualized segments of the lower lungs are unremarkable. No\npericardial or pleural effusions.\n\nLiver: The liver is normal in size with smooth border and homogeneous\nparenchyma. No evidence of fat deposition. Small T2 hyperintense 0.6 cm\nlesion in segment 6 with mild peripheral enhancement (04:34), representing a\nhemangioma is unchanged.\n\nBiliary: Status post cholecystectomy. The intra and extrahepatic biliary tree\nis normal in caliber throughout with no identified lesions.\n\nPancreas: The pancreas is mildly atrophic however the pancreatic duct is\nnormal in caliber throughout. Redemonstration of a heterogeneous lesion in\nthe pancreatic tail measuring approximately 2.8 x 2.2 cm (1503:70), unchanged.\n\nSpleen: The spleen is normal in size and shape, with normal signal and no\nsuspicious focal lesions.\n\nAdrenal Glands: The left adrenal gland is unremarkable. Redemonstration of a\n2.8 cm heterogeneous lesion in the right adrenal gland (1502:65), slightly\nlarger than in prior study where it measured 2.4 cm.\n\nKidneys: Patient is status post total left nephrectomy. No suspicious lesions\nare noted in the surgical bed. The remaining right kidney is normal in size\nwith expected nephrogram and contrast excretion. Small area of cortical\nscarring in the mid third (1502:100) from prior partial nephrectomy. No new\nfocal lesions, hydronephrosis or perinephrenic abnormalities.\n\nGastrointestinal Tract: The stomach, duodenum and visualized segments of\nsmall and large bowel are unremarkable and undistended.\n\nPelvis: The bladder, uterus and adnexal regions are unremarkable.\n\nLymph Nodes: Enlarged portacaval lymph node measuring 1.1 cm (1502:86), stable\nfrom prior. Other prominent right iliac lymph nodes are seen, measuring up to\n0.8 cm (17:91), most of which were visualized and are stable in the abdominal\nCT from ___. Bilateral lower pelvic and external iliac lymph nodes\nwere not included in the imaging volume of prior study. Attention on\nfollow-up. No new retroperitoneal or mesenteric adenopathy.\n\nVasculature: All major vessels are patent and normal in caliber.\n\nOsseous and Soft Tissue Structures: Incidental note is made of a small Tarlov\ncyst (10:31). No worrisome osseous lesions. Minimal fluid in relation to the\nright distal iliopsoas tendon.", "output": "Status post total left and partial right nephrectomy with no evidence of\nrecurrence in the surgical beds.\n\nCompared to the MRI of ___, the right adrenal lesion has grown slightly\nin size. The other metastatic lesions in the pancreatic tail and portocaval\nstation are relatively unchanged.\n\nProminent lower pelvis lymph nodes are indeterminate however, similar in size\nwhen compared to the abdominal CT of ___. Bilateral lower pelvic\nand external iliac lymph nodes were not included in the imaging volume of\nprior study. Attention on follow-up." }, { "input": "Exam is degraded by motion.\n\nLower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology and signal intensity. No drop\nin signal on out of phase imaging compared with in phase imaging to indicate\nsteatosis. A 6 mm T2 high mildly hyperintense lesion with arterial\nenhancement is unchanged and compatible with a capillary hemangioma (5:34). \nNo suspicious focal liver lesion identified.\n\nBiliary: There is mild central intrahepatic and extrahepatic biliary duct\ndilatation, with the common bile duct measuring up to 10 mm and tapering\nnormally towards the ampulla, unchanged and compatible with post\ncholecystectomy state. Status post cholecystectomy.\n\nPancreas: A 2.7 x 2.2 cm heterogeneous lesion in the pancreatic tail is not\nsignificantly changed (1602:70). A 1.1 cm enhancing lesion in or adjacent to\nthe pancreatic head is not significantly changed, may be an aortocaval lymph\nnode or pancreatic lesion (1602:83).\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: A right adrenal nodule measuring 2.4 cm is not significantly\nchanged. No left adrenal nodule.\n\nKidneys: Status post left nephrectomy with no evidence of recurrence in the\nnephrectomy bed. Patient is status post partial right nephrectomy with\nunchanged cortical scarring in the mid right kidney. No hydronephrosis. No\nnew focal lesions.\n\nBowel: The stomach is unremarkable. The small and large bowel are\nunremarkable. The appendix is normal (11:23). There is no wall thickening,\nadjacent inflammatory change, or abnormal enhancement. There is no evidence\nof stricture or obstruction.\n\nPelvis: The bladder and distal ureters are unremarkable. There is a 11 mm\nright uterine fibroid. No adnexal abnormality. No free fluid in the pelvis.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: A 1.1 cm enhancing lesion in or adjacent to the pancreatic head\nis not significantly changed, may be an aortocaval lymph node or pancreatic\nlesion (1602:83). Subcentimeter common iliac and bilateral pelvic sidewall\nlymph nodes are not significantly changed. No new lymphadenopathy.\n\nOsseous/Soft Tissue: There are degenerative changes in the right hip, not\nsignificantly changed. There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Status post total left and partial right nephrectomy with no evidence of\nlocal recurrence.\n2. No significant change in a right adrenal mass, pancreatic tail mass, and\nenhancing soft tissue nodule in or adjacent to the pancreatic head. No new\nfoci of metastatic disease in the abdomen or pelvis." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver demonstrates normal contours without morphological signs of liver\ncirrhosis. There is no significant drop of signal on the out of phase imaging\nas compared to the in-phase imaging to suggest hepatic steatosis. No\nsuspicious enhancing hepatic mass lesions.\n\nBiliary: The gallbladder is present without gallstones. No gallbladder wall\nthickening or pericholecystic fluid. There is stable mild irregularity and\ndilatation of the central intrahepatic ducts as well as the left hepatic\nducts, not significantly changed from prior, compatible with patient's known\nsclerosing cholangitis. There is also a mild irregularity of the common\nhepatic duct, unchanged from prior. The common bile duct tapers normally\ntowards the ampulla without obstructing filling defects. There is no biliary\nduct wall thickening or enhancement. No mass-like enhancement to suggest\ncholangiocarcinoma. There is no peripheral or peribiliary arterial enhancement\nto suggest active cholangitis.\n\nPancreas: Pancreas maintains its normal bulk with normal signal\ncharacteristics on the T1 weighted images. It enhances homogeneously without\nsuspicious solid or cystic mass lesion. The main pancreatic duct is not\ndilated. No peripancreatic inflammatory changes or fluid collections.\n\nSpleen: The spleen is normal in size and signal characteristics. It enhances\nhomogeneously without focal mass lesion.\n\nAdrenal Glands: The adrenal glands are normal bilaterally without focal\nnodules.\n\nKidneys: The kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There is adequate excretion of contrast on\nthe more delayed phases. No suspicious renal masses or hydronephrosis. No\nperinephric abnormality.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are within normal limits. No ascites.\n\nLymph Nodes: No suspicious mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The abdominal aorta and its major branches are patent. There is\nan accessory left hepatic artery arising from the left gastric artery. The\nsplenic vein, SMV, portal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "Unchanged minimal biliary duct dilatation and irregularity of the left\nintrahepatic, central intrahepatic and common hepatic duct, not significantly\nchanged from prior, compatible patient's known sclerosing cholangitis. No\nmass like enhancement to suggest cholangiocarcinoma." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: Cirrhotic morphology of the liver. No abnormal arterial enhancing\nlesions or lesions demonstrating washout on delayed phases. A couple of small\nT2 hyperintense hepatic biliary hamartomas or cysts the largest measuring 11\nmm in diameter in the inferior aspect of the right lobe of liver.\n\nBiliary: Peribiliary cysts involving the left liver lobe and to a lesser\ndegree on the right. Mild intrahepatic bile duct dilatation. No extrahepatic\nbile duct dilatation. Collapsed gallbladder with mild gallbladder wall edema.\nThere is mild thickening of the distal CBD wall, but no abnormal enhancement.\n\nPancreas: Nonenhanced cystic lesion in the head and uncinate process of the\npancreas measuring 19 x 25 mm in the axial plane. No pancreatic duct\ndilatation. 7 mm cystic lesion in relation to the anterior aspect of the body\nof the pancreas (series 5, image 12).\n\nSpleen: Splenomegaly. Splenic varices.\n\nAdrenal Glands: No abnormalities\n\nKidneys: Small simple appearing cortical renal cysts\n\nGastrointestinal Tract: No bowel dilatation.\n\nLymph Nodes: Subcentimeter lymph node adjacent to the hepatic flexure of the\ncolon.\n\nVasculature: TIPS appears grossly patent.\n\nOsseous and Soft Tissue Structures: No suspicious bony lesions.", "output": "Cirrhotic morphology of the liver. Sequela of portal hypertension. No\nabnormal arterially enhancing lesions or lesions demonstrating rapid washout. \nNo extrahepatic bile duct dilatation. Collapsed gallbladder with mild\ngallbladder wall edema.\n\nCystic pancreatic lesions, the largest measuring 19 x 25 mm in the axial plane\nin the head/uncinate process of the pancreas. Statistically these lesions\nmost likely represent IPMNs. ___ year follow-up MRI advised." }, { "input": "Lower Thorax: Trace bilateral pleural effusions. Partially imaged lung bases\nare otherwise unremarkable.\n\nLiver: Liver iron concentration 152 micromol/g. Multiple small simple cysts\nor biliary hamartomas (series 6, images 8, 11, 15, 18). There is a small\nfocus of arterial hyper enhancement, probably a transient hepatic intensity\ndifference. No arterially enhancing lesions with washout. The liver contour\nis markedly nodular, consistent with cirrhosis. Patient is status-post TIPS. \nThe portal veins and TIPS stent appear patent.\n\nBiliary: Mild intrahepatic biliary ductal dilation, most prominent in the left\nlobe. Mild gallbladder wall edema related to cirrhosis.\n\nPancreas: There is an unchanged 1.9 x 1.4 cm T2 hyperintense, T1 hypointense,\nmulti septated lesion in the pancreatic head which is unchanged since ___. Multiple other tiny cystic lesions in the pancreatic head and body are\nunchanged. No main pancreatic ductal dilation.\n\nSpleen: Splenomegaly measuring 18 cm. Gamna Gandy bodies. No focal lesions.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The partially imaged kidneys are unremarkable.\n\nGastrointestinal Tract: Partially imaged loops of large and small bowel are\nunremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm imaged. Conventional hepatic\narterial anatomy. Small esophageal varices.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Cirrhosis with evidence of portal hypertension including esophageal varices\nand splenomegaly. No lesions meeting OPTN criteria for HCC.\n2. Liver iron concentration 152 micromol/g consistent with heavy iron\ndeposition.\n3. Unchanged 1.9 cm cystic lesion in the pancreatic head, likely reflecting a\nside branch intraductal papillary mucinous neoplasm (IPMN). On the basis of\nlesion size, recommend follow-up MRCP in 6 months.\n4. Unchanged mild intrahepatic biliary ductal dilation, most prominent in the\nleft hepatic lobe.\n\nRECOMMENDATION(S): Unchanged 1.9 cm cystic lesion in the pancreatic head,\nlikely reflecting a side branch intraductal papillary mucinous neoplasm\n(IPMN). On the basis of lesion size, recommend follow-up MRCP in 6 months." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: The liver is known to be cirrhotic. There is gain of signal in the out\nof phase consistent with iron overload. Multiple peribiliary cyts are noted.\nFew scattered cysts/biliary hamartomas are again noted throughout the liver.\n\nIn segment V, there is a new 16 mm arterially enhancing lesion with no\ndefinite areas of washout. This lesion is spontaneously bright on T1 weighted\nimaging and slightly T2 bright. Although this lesion does not meet strict\nOPTN 5 criteria, it is concerning.\n\nThere is a patent TIPS in place. The hepatic veins and portal veins are\npatent.\n\nBiliary: No intra or extra biliary duct dilatation. The gallbladder is\ncollapsed.\n\nPancreas: Unchanged 3.6 x 2.1 cm (measured on coronal images) T2 hyperintense\nT1 hypointense multi-septated lesion in the head of the pancreas (series 3,\nimage 24). This lesion is stable since ___ where it measured 3.5 x\n2.1 cm. No main duct dilatation. Additional tiny pancreatic cyst are\nunchanged.\n\nSpleen: Homogeneous splenomegaly measuring 16 cm\n\nAdrenal Glands: No focal lesion\n\nKidneys: Portion visualized of the kidneys are unremarkable besides few\nsubcentimeter left kidney cysts. No hydronephrosis.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No abdominal lymphadenopathy. No ascites.\n\nVasculature: No abdominal aortic aneurysm. Few perigastric and paraesophageal\nvarices are noted. Recanalization of the umbilical vein.\n\nOsseous and Soft Tissue Structures: No concerning bone lesions.", "output": "1. Cirrhotic liver with signs of portal hypertension.\n2. New 16 mm arterially enhancing lesion segment V concerning however not\nmeeting strict criteria for HCC.\n3. Unchanged 3.6 cm multicystic lesion in the head of the pancreas likely\nrepresenting a side-branch IPMN. This can be followed up on next liver\nscreenings." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: The liver is known to be cirrhotic. There is an increase of signal in\nthe out of phase sequences, consistent with iron overload. Multiple T2\nhyperintense lesions consistent with cysts or biliary hamartomas are again\nnoted.\n\nIn the liver segments V, there is an intrinsically bright T1 lesion that\ndemonstrates persistent enhancement and measures 12 x 15 mm, not significantly\nchanged from prior, however has grown since ___. There is a\npatent TIPS in place. Portal veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is normal.\n\nPancreas: Unchanged 3.5 x 1.9 cm T2 hyperintense multi-septated lesion in the\nhead of the pancreas (series 4, image 24). No ductal dilatation. Additional\npancreatic cysts are unchanged.\n\nSpleen: The spleen is enlarged measuring 17.6 cm.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: Left renal cysts are again noted. No hydronephrosis. There is no\nsuspicious renal lesion.\n\nGastrointestinal Tract: No focal abnormality.\n\nLymph Nodes: No lymphadenopathy by imaging criteria.\n\nVasculature: No focal abnormality.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. 15 mm enhancing right liver lesion is nonspecific and not meeting OPTN\ncriteria for imaging diagnosis of HCC, and is unchanged compared to prior,\nhowever given rapid growth since ___ should be followed up in ___\nmonths.\n2. Unchanged 3.5 cm multi-cystic lesion in the head of the pancreas, which\nmay represent an IPMN and can be followed on subsequent MR.\n3. Cirrhotic liver with splenomegaly." }, { "input": "Lower Thorax: Lung bases are within normal limits. No pleural or pericardial\neffusion.\n\nLiver: Posttreatment changes are seen in hepatic segment VI, with expected\ncoagulation necrosis in the ablation cavity. Geographic arterial enhancement\nabout the ablation cavity does not persist on additional post-contrast\nsequences, likely perfusional. Scattered foci of washout adjacent to the\nablation cavity are concerning for recurrence, however do not meet criteria. \nIn hepatic segment II, there is a 8 mm focus of arterial enhancement, without\ncorrelate on additional post-contrast sequences. 9 mm focus of arterial\nenhancement is noted in the dome. No lesions demonstrating washout or meeting\nOPTN criteria for hepatocellular carcinoma. The portal vein remains patent. \nThe liver has a nodular contour, consistent with cirrhosis.\n\nBiliary: The gallbladder is normal, without stones, wall thickening, or\npericholecystic fluid. No intra or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal, morphology, and enhancement. No\nconcerning pancreatic lesions. No ductal dilatation.\n\nSpleen: There is borderline splenomegaly, the spleen measuring up to 13.2 cm. \nNo concerning splenic lesions.\n\nAdrenal Glands: Normal adrenals. No masses.\n\nKidneys: 1.2 cm cyst in the midpole of the right kidney, anteriorly is\nunchanged. No concerning renal lesions or hydronephrosis.\n\nGastrointestinal Tract: The large field-of-view images of the bowel are\nunremarkable.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy. Aortocaval\nnodes measure up to 9 mm, unchanged. 1.2 cm portacaval node is likely\nreactive.\n\nVasculature: The abdominal aorta is not aneurysmal. The abdominal aorta is\nnot aneurysmal.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions or notable\nsoft tissue abnormality.", "output": "1. Posttreatment changes in hepatic segment VI. Subcentimeter foci of\nwashout adjacent to the ablation cavity likely represent local recurrence,\nhowever do not meet OPTN criteria. Attention on followup\n2. Geographic and subcentimeter foci of arterial enhancement, without\ncorrelate on additional post-contrast sequences are likely perfusional, and\nmay be followed on subsequent examinations. No lesions meet OPTN criteria for\nhepatocellular carcinoma.\n\nRECOMMENDATION(S): ___ month followup MR is recommended." }, { "input": "Liver: The liver demonstrates nodular contour reflecting advanced cirrhosis. \nNo steatosis demonstrated.\n\n In the inferior tip of the liver in segment 6 there is a 2.9 x 3.3 cm\narterially enhancing lesion with washout and pseudo capsule which meets OPTN\n5B criteria for HCC (11:341).\n\nThere are innumerable peripheral areas of arterial hyperenhancement multiple\nof which demonstrate washout, although no pseudocapsule. The majority of\nthese lesions are subcentimeter (11: 316, 11:335, 11:309, 11:312, 11:119,\n11:133, 11:140) and although none meet OPTN 5 criteria, these are highly\nconcerning for multifocal HCC. The largest of these lesions is in segment 6\nwhich measures 1.2 cm, without a definite pseudocapsule (11:313). This is\nhighly concerning for ___ although not meeting OPTN criteria.\n\nThe portal vein, SMV, and splenic vein are patent. The hepatic arterial tree\ndemonstrates conventional anatomy.\n\nBiliary: No biliary ductal dilatation. No cholelithiasis.\n\nPancreas: Unremarkable.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The kidneys are unremarkable aside for small cysts.\n\nGastrointestinal Tract: No bowel obstruction or ascites.\n\nLymph Nodes: A few prominent periportal and peripancreatic lymph nodes are\npossibly reactive.\n\nVasculature:There is a patent paraumbilical vein, sequela of portal\nhypertension\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen.", "output": "Cirrhosis. 3.3 cm OPTN-5 B HCC in segment 6 which has subsequently been\ntreated with TACE and RFA.\n\nThere are innumerable peripheral areas of arterial hyperenhancement with\nwashout throughout the liver, the majority of which are subcentimeter. None\nmeet OPTN 5 criteria but are concerning for multifocal HCC. The largest of\nthese lesions in segment 6 measures 1.2 cm, without a definite pseudocapsule. \nGiven the implications for treatment and in light of the fact that this\noutside study is approximately 3 months old, a repeat examination at this time\nis recommended to reassess these findings.\n\nHepatic arterial anatomy is conventional. The hepatic vasculature is patent.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 15:51 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: Liver has a cirrhotic morphology. Post treatment changes are seen in\nhepatic segment VI, with expected coagulation necrosis in the ablation zone. \nAblation zone now measures 3.6 cm, previously 3.9 cm (series 8, image 54). \nAgain seen, is arterial hyperenhancement involving the periphery of the\ntreatment bed with multiple subcentimeter focal areas of washout, similar in\nextent and distribution compared to prior (series 10, image 53; series 16,\nimage 53). There are additional arterial enhancing foci in the liver without\nassociated washout on delayed phase imaging. Unchanged arterial enhancing\nfoci are seen on (series 10, image 46, 36, 19, 69).\n\nIn addition, there is a 1.5 cm arterial enhancing lesion in hepatic segment VI\nwith persistent hyperenhancement on delayed imaging, only slightly\nhyperintense on T2-weighted sequences, possibly a sclerosed hemangioma\n(series 10, image 35).\n\nBiliary: There is cholelithiasis. There is no intra or extrahepatic biliary\nduct dilation.\n\nPancreas: The pancreas is normal in signal intensity and enhancement. No\nfocal lesion is seen.\n\nSpleen: Spleen is mildly enlarged measuring 13.4 cm.\n\nAdrenal Glands: Adrenal glands are unremarkable.\n\nKidneys: There is a 1.5 cm simple cyst in the interpolar region of the right\nkidney. There are no suspicious renal lesions. There is no hydronephrosis.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable.\n\nLymph Nodes: There are no enlarged mesenteric lymph nodes. Prominent\nretroperitoneal lymph nodes measuring up to 9 mm in the aortocaval station\n(series 16, image 70), are unchanged.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. There is an accessory left renal artery. The portal vein is\npatent.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. \nThere is mild bilateral gynecomastia. Superficial soft tissues are otherwise\nunremarkable.", "output": "1. Post treatment changes in hepatic segment VI. Unchanged distribution of\nmultiple subcentimeter foci of arterial enhancement and washout along the\nperiphery of the ablation zone, highly concerning for additional foci of\nhepatocellular carcinoma, though not meeting OPTN-5 size criteria.\n2. Mild splenomegaly." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion. \nThere is herniation of mesenteric fat into the anterior mediastinum suggestive\nof a Morgagni type hernia.\n\nLiver: Morphologic features of cirrhosis. Post treatment changes are noted\nwithin segments ___, measuring 4.6 x 6.7 cm with T1/T2 hyperintense signal and\nno central enhancement. However, there is a 1.8 cm region of arterial hyper\nenhancement along the anterior and cranial margin of the treatment cavity\nwhich demonstrates partial washout on the more delayed phases (axial series\n12, image 44; axial series 14, image 44). Smaller hypoenhancing lesion within\nsegment 5 (axial series 12, image 82) likely also represents a treated lesion.\nAdditional lesion within segment ___ measures 10 mm with washout in pseudo\ncapsule, now meeting OPTN 5A criteria for hepatocellular carcinoma. \nAdditional patchy areas of arterial enhancement scattered throughout the liver\nparenchyma which do not demonstrate definite washout or pseudo capsule not\nmeeting OTPN 5 criteria for HCC.\n\nBiliary: Mild thickening of the gallbladder wall. No intra or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: Normal T1 signal of the pancreas without ductal dilatation or mass.\n\nSpleen: The spleen is normal in size.\n\nAdrenal Glands: The adrenal glands are normal in size and morphology.\n\nKidneys: 10 mm cyst in the interpolar region of the right kidney. No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. No small or large bowel\ndistention.\n\nLymph Nodes: Several prominent retroperitoneal lymph nodes, none of which are\nenlarged by size criteria. Several prominent periportal lymph nodes.\n\nVasculature: Hepatic arterial anatomy is conventional. No abdominal aortic\naneurysm. The hepatic and portal venous systems are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "1. Status post interval trans arterial chemoembolization, with post treatment\nchanges within hepatic segments ___. 18 mm focus of arterial hyper\nenhancement with along the anterior/cranial margin of the treatment cavity may\nrepresent an area of residual disease but does not clearly correspond to an\narea of disease involvement on the pretreatment study; attention on follow-up\nis recommended.\n2. Additional lesion within segment ___ now measures 10 mm in keeping with\nOPTN 5A hepatocellular carcinoma." }, { "input": "Lower Thorax: There are no pleural or pericardial effusions.\n\nLiver: The liver has a nodular, irregular contour compatible with cirrhosis. \nThere is progressive, reticular enhancement throughout the liver, compatible\nwith fibrosis. There has been interval microwave ablation of a segment 2 HCC,\nwith a treatment cavity seen along the medial aspect of segment 2 measuring\n2.7 by 0.8 cm, with coagulative necrosis. No residual arterial enhancement to\nsuggest residual disease in the treatment cavity.\n\nThere are 2 adjoining post treatment cavities in segments 7 and 6 of the liver\nmeasuring approximately 4 x 3.2 and 3 x 2.8 cm, with intrinsic T1\nhyperintensity, compatible with coagulative necrosis. At the superomedial\naspect of the segment 7 ablation cavity, there is a stable nodular area of\narterial hyperenhancement measuring up to 1.5 cm, without definite washout. \nAt the border of segments 7 and 6 in the periphery of the liver, there is a 7\nmm arterially enhancing lesion (1101:56) which demonstrates washout and pseudo\ncapsule, compatible with an HCC, although not meeting optn criteria.\n\nIn segment 5 of the liver, there is a 1.1 cm arterially enhancing lesion\n(1101:72) which demonstrates washout and pseudo capsule, compatible with an\nOPTN 5A HCC.\n\nIn segment 8 of the liver near the dome, there is a 1.3 cm arterially\nenhancing lesion (1101:15), which demonstrates washout and pseudo capsule,\ncompatible with an OPTN 5A HCC.\n\nThere is a 1 cm lesion in segment 7 of the liver which is hyperintense on DWI\n(06:31) and demonstrates arterial enhancement without washout, stable to the\nprevious study. This possibly represents a hemangioma, although continued\nfollow-up is recommended.\n\nThere are other scattered areas of arterial enhancement without washout or\ndefinite correlates on other sequences, likely representing transient hepatic\nintensity differences.\n\nBiliary: There are subcentimeter adherent gallstones or polyps in the\ngallbladder. There is no intra or extrahepatic biliary duct dilatation.\n\nPancreas: The pancreas is normal in signal intensity and morphology. There is\npancreatic duct is not dilated.\n\nSpleen: Mild splenomegaly up to 13 cm.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: No focal renal masses. There is no hydronephrosis. 1 cm simple\nappearing cyst at the upper pole of the right kidney.\n\nGastrointestinal Tract: The visualized bowel loops in the upper abdomen are\nunremarkable, without evidence of obstruction.\n\nLymph Nodes: There are few porta hepatis and retroperitoneal lymph nodes, not\nenlarged by size criteria.\n\nVasculature: There is no abdominal aortic aneurysm. The hepatic and portal\nveins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions.", "output": "1. Interval microwave ablation to a segment 2 lesion, without evidence of\nresidual disease.\n\n2. There are 2 OPTN 5A HCCs seen in segments 8 and 5 of the liver, measuring\n1.3 cm and 1.1 cm respectively.\n\n3. 7 mm HCC in segment ___ of the liver, which does not meet OPTN criteria.\n\n4. Additional nonspecific areas of enhancement: stable nodular area of\narterial enhancement along the superomedial aspect of the treatment cavity in\nsegment 7, without washout, likely perfusional. 1 cm arterially enhancing\nlesion in segment 7 of the liver without washout, possibly representing a\nhemangioma, although close attention on follow-up is recommended. Multiple\nscattered areas of arterial hyperenhancement in the liver, without washout or\ndefinite correlates on other sequences, likely representing transient hepatic\nintensity differences." }, { "input": "Lower Thorax: The lung bases are clear. There is no pleural or pericardial\neffusion.\n\nLiver: The liver demonstrates a cirrhotic morphology. Patient is status post\ndrug-eluting TACE to lesions in segments V and VIII with areas of T2\nhypointensity (series 1302: Images 16, 50, 84) compatible with treatment zones\nwithout evidence of local recurrence or residual enhancement. Treatment zone\nwith coagulation necrosis centered in segment II measures 2.7 x 1.1 cm (series\n1302:32) and s grossly unchanged as compared to ___ without\nevidence of residual enhancement or recurrent disease. There are adjoining\nposttreatment cavities in segments VII and VI which measure 5.6 x 3.5 cm\n(series 1302:65) with intrinsic T1 hyperintense signal compatible with\ncoagulation necrosis, unchanged from ___. There is no evidence of\nresidual enhancement or recurrent disease.\n\nIn segment VII, there is an arterially hyperenhancing focus measuring 1.2 cm\n(series 1301:41) with persistent enhancement on delayed sequences which is\ngrossly unchanged from MRI ___ and roughly the same size as\ncompared to outside hospital MRI ___ there are ill-defined areas\nof arterial hyper enhancement (series 1301: 25 and 35) without correlate on\ndelayed phases likely representing transient hepatic intensity differences. \nOf note, the largest geographic area of arterial hyper enhancement in segment\n___ (series 1301:25) demonstrates areas of central hypointensity which is\ngrossly unchanged. There also multiple T2 hypointense foci scattered in the\nliver without enhancement likely representing nodules.\n\nBiliary: There is gallbladder wall thickening with stones and sludge, grossly\nunchanged as compared to ___, which could represent hepatic\ndysfunction versus chronic cholecystitis.\n\nPancreas: The pancreas demonstrates normal signal characteristics and\nmorphology without main ductal dilatation or focal lesion.\n\nSpleen: The spleen is top-normal in size measuring 12.5 cm in length across\ncraniocaudal dimension. There is no focal lesion.\n\nAdrenal Glands: Both adrenal glands are normal.\n\nKidneys: There is a simple cyst in the upper pole of the right kidney\nmeasuring 1.1 cm (series 7:29). Otherwise, both kidneys are unremarkable\nwithout hydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: Visualized small large bowel loops are unremarkable\nwithout evidence of obstruction or wall thickening.\n\nLymph Nodes: Porta hepatis lymph node measuring 1.0 cm(series 1302:55) and\nretroperitoneal lymph nodes measuring up to 0.9 cm in short axis in the\naortocaval region (series 1302:55) are unchanged from ___.\n\nVasculature: Abdominal aorta and major vessels are unremarkable. There is an\naccessory left renal artery.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous\nabnormality.", "output": "1. Status post interval TACE to segment V and segment VIII lesions without\nevidence of local recurrence or residual disease. Other treatment zones in\nsegments II and VI/VII are grossly unchanged as compared to MRI liver ___ without evidence of local recurrence or residual disease. No\nlesion meeting OPTN criteria.\n2. Arterially hyperenhancing focus in segment VII of the liver is grossly\nunchanged as compared to MRI ___ and present and roughly the same\nsize as compared to outside hospital MRI abdomen ___, unlikely to\nbe HCC. Attention on follow-up imaging is recommended." }, { "input": "Lower Thorax: The motion degraded lungs are grossly clear. No pericardial or\npleural effusion.\n\nLiver: The liver demonstrates a cirrhotic morphology. Progressive, reticular\nenhancement throughout the liver compatible with fibrosis is again seen. No\nsignificant background steatosis.\nPatient is status post TACE to multiple lesions; treatment zones throughout\nthe right hepatic lobe (10: 16, 47, 67) are stable in size without evidence of\nlocal recurrence or residual enhancement.\nTreatment zone with coagulation necrosis in segment II measures 2.6 x 1.3 cm\n(10:43) and is grossly unchanged compared to the prior study without evidence\nof residual enhancement or recurrent disease.\nAdjoining post treatment cavities within segments VI and VII which measure 5.6\nx 3.5 cm (10:53) and exhibit intrinsic T1 hyperintense signal compatible with\ncoagulation necrosis are unchanged. No evidence of residual enhancement or\nrecurrent disease. Ill-defined arterial enhancement along the inferior margin\nof the cavities (10:64) within segment V appear similar to the CT from ___ and likely represent post treatment changes.\nIn segment VII within the TACE bed, an arterially hyperenhancing focus (10:37)\nwith persistent enhancement on delayed sequences has slightly increased in\nsize, 1.5 cm, previously 1.2 cm. This lesion does not exhibit washout or\npseudo capsule.\nElsewhere there are scattered areas of arterial enhancement without washout or\ndefinite correlate on other sequences, likely transient hepatic intensity\ndifferences.\nTrace perihepatic fluid has slightly increased from prior.\n\nBiliary: Multiple subcentimeter adherent gallstones appear grossly similar. \nNo intrahepatic or extrahepatic biliary ductal dilation.\n\nPancreas: There is normal parenchymal signal intensity and homogeneous\nenhancement. No focal lesion. No pancreatic duct dilation.\n\nSpleen: The spleen is top-normal in size with normal signal and homogeneous\nenhancement. No focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal and symmetric in size with normal\ncorticomedullary differentiation and symmetric excretion of contrast. 1.0 cm\nsimple cyst in the right kidney stable. No concerning renal masses. No\nhydronephrosis.\n\nGastrointestinal Tract: Visualized loops of small and large bowel are normal\nin caliber.\n\nLymph Nodes: Multiple borderline enlarged porta hepatis lymph nodes measuring\nup to 1.1 cm (10:52 and 60) are stable, previously measuring up to 1.0 cm. \nProminent paraesophageal lymph nodes measure up to 0.7 cm (10:23) and were not\napparent on the prior study. Scattered prominent mesenteric and\nretroperitoneal lymph nodes elsewhere are not pathologically enlarged and are\nstable.\n\nVasculature: The abdominal aorta is normal in caliber. The celiac axis, SMA,\nand proximal ___ are widely patent. Hepatic arterial anatomy is conventional.\nPortal vein is patent.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions. \nGynecomastia is likely secondary to cirrhosis. Soft tissues are otherwise\nunremarkable.", "output": "- Cirrhotic liver morphology with multiple post treatment cavities in the\nliver as described in detail above with TACE to the right hepatic lobe on ___. No residual or new liver lesions meeting OPTN 5 criteria.\n-1.5 cm enhancing focus in the segment VII TACE bed does not meet OPTN\ncriteria for hepatocellular carcinoma; this lesion is indeterminate, but due\nto its increase in size -close attention on follow-up is advised.\n-Newly prominent paraesophageal lymph nodes are nonspecific but may be\nreactive. Prominent porta hepatis nodes may be reactive as well or reactive\nto chronic liver disease. Attention on follow-up is advised.\n-Trace perihepatic fluid- increased since the prior study." }, { "input": "Lower Thorax: No pleural effusion. Limited evaluation is unremarkable.\n\nLiver: The liver redemonstrates cirrhotic morphology. Cavities and lesions\nare seen as follows:\n\n1. The confluent treatment cavities, the largest in segment VI/VII measure up\nto 5.1 x 2.8 cm, previously 5.6 x 3.5 cm. No evidence of recurrent tumor.\n2. The cavity in segment 3 measures 2.3 x 0.7 cm, previously 2.6 x 1.3 cm. No\nevidence of recurrent tumor.\n3. There is a 6 mm arterially enhancing lesion in segment 4 B with washout,\nhighly suspicious for HCC although not meeting OPTN criteria (series 1101,\nimage 58).\n4. There are numerous regions of geographic arterial hyperenhancement some of\nwhich correspond to confluent fibrosis while others do not have washout on\ndelayed phases and could be related to perfusional changes.\n5. Stable 1.6 cm lesion with late arterial and delayed hyperenhancement,\nnonspecific (series 1101 image 52).\n\nBiliary: There are new regions of segmental biliary ductal dilatation/bile\nlakes in the right hepatic lobe, segment VIII, likely related to proximal\nbiliary strictures which could be secondary to treatment changes post TACE. \nNo extrahepatic biliary ductal dilatation. Sludge and cholelithiasis is again\nseen.\n\nPancreas: The pancreas is unremarkable. No main ductal dilatation.\n\nSpleen: The spleen is within normal limits.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: A hemorrhagic 1 cm right renal cyst is again seen. The kidneys are\notherwise unremarkable. No hydronephrosis.\n\nGastrointestinal Tract: No bowel dilation. Trace perihepatic ascites is\nimproved.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes.\n\nVasculature: The hepatic vasculature is patent. There is conventional celiac\nbranching.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are seen.", "output": "Cirrhotic liver and portal hypertension. New 6 mm lesion in segment 4B,\nsuspicious but not meeting OPTN criteria for HCC. No findings of recurrence\nin the treatment cavities.\n\nNew segmental right biliary ___ likely related to post\nTACE to the right hepatic lobe." }, { "input": "Lower Thorax: Visualized lung bases are clear. No pleural effusion.\n\nLiver: Redemonstration of cirrhotic liver morphology. Multiple previously\nseen treatment cavities and hepatic lesions are described as follows:\n\n-9 mm segment 4B lesion arterially enhancing is increased in size, previously\nmeasuring 6 mm (1001:45). This lesion now demonstrates pseudo capsule\nformation and washout.\n-5.1 x 2.7 cm treatment cavity in segment ___ previously measured 5.5 x 2.7 cm\n(1001:69). Confluent ill-defined arterial enhancement along the margin of the\ncavity appears similar to most recent prior exam and may represent post\ntreatment changes. There is no associated washout or pseudo capsule\nformation.\n-2.3 x 0.9 cm cavity in segment 3 previously measured 2.3 x 0.8 cm (1002:46). \nNo evidence of recurrent tumor.\n-A 1.9 x 1.5 cm the lesion with arterial enhancement and delayed\nhyperenhancement is minimally increased in size compared to prior exam were it\nmeasured 1.6 x 1.4 cm (1001:49).\nThere are numerous scattered areas of geographic arterial hyperenhancement,\nwhich do not demonstrate washout on delayed phase images and may be related to\nperfusional changes. This does not appear substantially changed compared to\nmost recent prior exam dated ___.\n\nBiliary: There are areas of segmental biliary ductal dilatation in the right\nhepatic lobe, unchanged. No extrahepatic biliary ductal dilatation. \nCholelithiasis without cholecystitis. The gallbladder wall is mildly\nthickened, likely related to post treatment changes.\n\nPancreas: The pancreas is normal in size and signal intensity. No focal\npancreatic lesions. No pancreatic ductal dilatation.\n\nSpleen: The spleen measures 12.3 cm, unchanged. The spleen otherwise\ndemonstrates normal signal intensity without evidence of focal lesions.\n\nAdrenal Glands: Adrenal glands are symmetric in size and signal intensity.\n\nKidneys: 1.0 cm right upper lobe renal cyst is unchanged. Bilateral kidneys\nare otherwise normal in size and signal intensity. No hydronephrosis.\n\nGastrointestinal Tract: Visualized small and large bowel loops are\nunremarkable. No obstruction. Trace perihepatic ascites.\n\nLymph Nodes: No abdominal lymphadenopathy.\n\nVasculature: The abdominal aorta is not dilated. The major abdominal aortic\ntributaries are patent. The portal and hepatic veins are pain.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions are seen.", "output": "1. Interval increase in size of a suspicious segment 4B lesion, now measuring\n9 mm and demonstrating washout and pseudocapsule formation. This lesion does\nnot currently meet OPTN 5 criteria. Continued close attention on follow-up\nimaging is recommended.\n2. Stable cirrhotic liver morphology. No recurrent tumor in the treatment\ncavities.\n3. Stable mild right intrahepatic biliary ductal dilatation likely reflects\nthe sequelae of prior treatment." }, { "input": "Lower Thorax: Small linear/nodular opacity at the right anterior lung base\nlikely represents atelectasis (___). Lung bases are otherwise clear. No\nevidence of pleural effusion.\n\nLiver:\n\nThere is cirrhotic liver morphology. There is evidence of mild steatosis (fat\nfraction 6.6%). The patient is status post multiple TACE right lobe, RFA\nsegment 6 lesion and microwave ablation segment ___ lesion, with stable\npostprocedural changes in the liver. The following lesions are noted:\n\n1. 1.0 cm arterially enhancing nodule in segment 5 (11:49) is stable in size\nbut now demonstrates more convincing pseudocapsular enhancement and washout\n(OPTN 5A).\n2. 1.4 cm arterially enhancing nodule in segment 5 (11:60) has increased from\n9 mm previously and also shows pseudocapsular enhancement and washout (OPTN\n5A).\n3. 1.9 x 1.5 cm arterially enhancing nodule in segment 7 (11:74) is unchanged\nin size and shows persistent hyperenhancement as on the prior study. This is\nnonspecific and can be re-evaluated at next follow-up.\n4. 1.0 cm persistently enhancing nodule in segment 3 (11:87) has minimally\nincreased from 0.6 cm and demonstrates diffusion restriction, concerning for\n___ though not meeting OPTN criteria.\n5. 0.6 cm arterially enhancing lesion in segment 4 A (11:105) has increased\nfrom 0.4 cm previously and shows delayed phase washout with pseudo capsular\nenhancement, concerning for ___ though not meeting OPTN criteria.\n\nThere is a stable pattern of patchy geographic enhancement throughout portions\nof the right lobe likely related to post treatment change, with numerous\nadditional small nonspecific arterially enhancing foci throughout the liver.\n\nBiliary: Stable focal areas of segmental biliary dilation in the right lobe\nare likely post-treatment in nature. There is stable dilation of the\nextrahepatic duct up to 1 cm without evidence obstructing lesion. There is\ncholelithiasis and mild gallbladder wall thickening as noted previously.\n\nPancreas: Unremarkable with no evidence of focal lesion or main duct dilation.\n\nSpleen: The spleen is normal in sized at 12.3 cm in coronal dimension. \nEnhancement is normal aside from a stable subcentimeter nonenhancing focus at\nthe inferior aspect (13:31, likely a granuloma or other benign lesion.\n\nAdrenal Glands: Normal bilaterally.\n\nKidneys: Normal bilaterally aside from a small right cortical cyst.\n\nGastrointestinal Tract: Visualized bowel is grossly unremarkable.\n\nLymph Nodes: No enlarged lymph nodes.\n\nVasculature: Major portal and hepatic venous structures are patent. No\nabdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No aggressive bone or soft tissue lesions\nidentified.", "output": "1. Cirrhotic liver morphology with grossly stable post treatment changes.\n2. Multiple small but enlarging lesions concerning for ___, including 2\nmeeting OPTN 5A criteria in segment 5." }, { "input": "Lower Thorax: No gross abnormality is identified. No evidence of pleural\neffusion or pericardial effusion.\n\nLiver: The liver shows nodular contours with prominence of fissures. There is\nno significant hepatic steatosis. Extensive perfusional differences are\nidentified particularly in the right hepatic lobe on early arterial phase,\nwhich are not appreciated on other sequences.\n\nAblation cavity in segment 7 measures 6.1 x 4.6 cm without evidence of\nassociated enhancement to suggest residual disease. There is intrinsic T1\nsignal hyperintensity and minimal restricted diffusion, likely related to\ncoagulative necrotic changes.\n\nAblation cavity in segment ___ measures 4.8 x 4.0 cm at the level of the SMA\norigin. Mild adjacent parenchymal enhancement likely relates to\nshunting/perfusion differences. Intrinsic T1 hypertintensity is noted.\n\nAblation cavity in segment 3 measures 3.9 x 4.1 cm, and shows no definite\nevidence of residual disease. There is intrinsic internal T1 hyperintensity\nand minimal restricted diffusion, again, likely related to coagulated necrotic\nchanges.\n\nA small focus of early arterial enhancement with early washout and\npseudocapsule is identified in segment 5 measuring 1.3 x 1.2 cm (series 1001,\nimage 61). No other suspicious appearing new hepatic lesion is identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is unremarkable.\n\nPancreas: Pancreas is mildly atrophic without evidence of a focal lesion. \nThere is no main pancreatic ductal dilatation.\n\nSpleen: Spleen shows normal enhancement without evidence of focal lesion.\n\nAdrenal Glands: Unremarkable\n\nKidneys: The kidneys show symmetric nephrogram without evidence of a solid\nmass. Is 0.9 cm cyst is noted in the anterior right kidney. There is no\nhydronephrosis or evidence of nephrolithiasis.\n\nGastrointestinal Tract: Included small and large bowel are normal in caliber\nwithout evidence of obstruction. The stomach is under distended.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes are identified.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious appearing osseous lesion is\nidentified. Redemonstration of subcutaneous edema in the right lateral\nabdominal wall relates to post ablation changes.", "output": "1. A new 1.3 cm focus of early arterial enhancement with early washout is\nidentified in segment 5 in close proximity to an ablation site, concerning for\nnew versus recurrent disease and meeting OPTN 5 criteria.\n2. Extensive post-treatment and fibrosis related perfusional changes are\npresent in the cirrhotic liver as detailed above." }, { "input": "LUNGS: There is mild bibasilar dependent atelectasis. No significant pleural\neffusion.\n\nLIVER: The liver exhibits homogeneous attenuation. There is no focal mass or\nlesion. There is no perihepatic ascites or evidence of acute injury. No\nintra or extrahepatic biliary ductal dilatation. The gallbladder is not\nvisualized.\n\nPANCREAS: The pancreas is normal sized. There is no pancreatic ductal\ndilatation.\n\nSPLEEN: The spleen is normal sized with homogeneous attenuation. There is no\nabnormal splenic signal or perisplenic fluid to suggest injury.\n\nKIDNEYS: The kidneys are normal sized. There is prominence of the right renal\npelvis with mild hydronephrosis, physiologic in pregnancy. The left renal\npelvis is within normal limits. No perinephric fluid or other abnormality to\nsuggest renal injury. There is no distention of the proximal ureter.\n\nADRENAL GLANDS: The adrenal glands are symmetric and unremarkable.\n\nREPRODUCTIVE ORGANS: The patient has a gravid uterus. The uterus is intact. \nThe placenta appears homogeneous and is located anteriorly.\n\nThe ovaries are normal.\n\nThere is no free-fluid within the pelvis.\n\nLYMPH NODES: No adenopathy.\n\nBLADDER AND DISTAL URETERS: The bladder is mildly distended. There is no\nevidence of bladder injury. There is no distal ureteral distension.\n\nBOWEL: The bowel is displaced secondary to the enlarged uterus. The bowel is\nnonobstructed nonobstructed. The appendix is normal.\n\nVASCULATURE: There is no abdominal aortic aneurysm. There is prominence of\npelvic vasculature consistent with pregnancy.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES: The visualized thoracic and lumbar spine\nappear within normal limits. There is no evidence of an acute fracture or\ndisc herniation.", "output": "1. No acute abdominopelvic process.\n2. Gravid uterus.\n3. Please refer to dedicated pelvic ultrasound for further details." }, { "input": "Lower Thorax: Lower lung bases and pleural spaces are clear.\n\nAgain noted within the distal pancreas is a cystic lesion which appears\ntrilobed and spans approximately 15 mm in the craniocaudal dimension, with the\nlargest cystic component again measuring 7 mm in diameter. The lesion is\nunchanged in size and appearance from the comparison study. There remains no\ndefinite extension/communication with the main pancreatic duct, which is\nnondilated. The pancreas itself demonstrates normal signal intensity and\nappearance. No new pancreatic mass lesions are identified.\n\nThe liver demonstrates normal signal intensity. No concerning hepatic mass is\nseen.\n\nNo intra or extrahepatic ductal dilatation.\n\nThe gallbladder is normal in appearance.\n\nSpleen is normal in size and appearance.\n\nVisualized adrenal glands are unremarkable.\n\nThe kidneys are normal in size. There is no hydronephrosis.\n\nVisualized gastrointestinal tract is unremarkable with no dilated loops of\nbowel are areas of wall thickening.\n\nNo upper abdominal lymphadenopathy.\n\nNo aneurysmal dilatation of the abdominal aorta. Visualized vasculature is\npatent.\n\nAgain noted are small sacral Tarlov cysts, as seen on the comparison study. \nNo acute or aggressive osseous lesions are demonstrated.", "output": "Cystic lesion within the body of pancreas is stable in size and appearance\nwhen compared to the most recent MRCP performed in ___.\n\nRECOMMENDATION(S): MRCP in ___ years." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, the bilateral lung bases\nare grossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in size and smooth in contour. No focal lesion is\ndetected within the limits of this noncontrast study.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. Again seen are\nmultiple (at least 10) scattered cystic lesions and ectatic side branches in\nthe pancreas, the largest measuring 4 mm in the pancreatic head (series 9,\nimage 87), 5 mm in the pancreatic body (series 9, image 38) and 4 mm in the\npancreatic tail (series 9, image 56), overall unchanged compared to the prior\nMRCP from ___. There is no main ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are normal in size and\nshape.\n\nKidneys: The kidneys are symmetric in size. There is a 4 mm cyst in the medial\nlower pole of the left kidney.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Again seen is a 1.2 x 0.9\ncm splenic artery aneuysm, unchanged.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. The abdominal wall is within normal limits.", "output": "1) Multiple (at least 10) scattered cystic lesions and ectatic side branches\nin the pancreas, measuring up to 5 mm. Per departmental protocol, MRCP\nfollow-up in ___ years is recommended.\n\n2) 1.2 x 0.9 cm splenic artery aneuysm, unchanged.\n\nRECOMMENDATION(S): MRCP follow-up in ___ years" }, { "input": "Limited assessment of the lung bases are clear. No pleural effusion.\nVisualized heart is unremarkable without pericardial effusion.\n\nThe liver is homogeneous in signal intensity and smooth in contour. There is\nno signal dropout on out of phase imaging when compared to in phase T1\nweighted imaging to suggest fatty deposition in the liver. There are multiple\nsmall nonenhancing T2 hyperintense lesions throughout the liver, compatible\nwith small hepatic cysts/biliary hamartomas. There are 3 cystic lesions\nwithin the right hepatic lobe, which corresponds to the concerning findings on\nprior ultrasound, measuring 24 x 23 mm in segment 7 (series 12, image 7); 12 x\n9 mm in segment ___ (series 12, image 15) ; and 13 x 11 mm in segment 4A\n(series 12, image 16). These 3 lesions demonstrate progressive, peripheral\nenhancement with centripetal fill in on postcontrast images, compatible with\nhemangiomas. A 9 x 8 mm mildly hyperintense lesion on T2 weighted images in\nsegment 4B shows no definite enhancement on post contrast images and is most\ncompatible with either a slow filling versus sclerosed hemangioma. No\nconcerning hepatic lesions identified.\n\nThere is no intra or extrahepatic biliary ductal dilatation. The gallbladder\nis within normal limits without filling defects to suggest gallstones. The\nspleen and adrenal glands are unremarkable. There are multiple small T2\nhyperintense cystic lesions in the pancreas, the largest measuring up to 7 x 6\nmm in the pancreatic tail (series 12, image 21). The pancreas is normal in\nsignal intensity without pancreatic ductal dilatation or enhancing lesion.\nThere is a 1.7 x 1.7 cm left upper pole renal cyst. The kidneys are otherwise\nunremarkable without hydronephrosis or renal masses.\n\nLimited assessment of the esophagus is unremarkable without hiatal hernia.\nVisualized stomach, small bowel, and colon are within normal limits. There is\nno ascites. There are no pathologically enlarged lymph nodes. Visualized\nportions of the abdominal aorta are of normal caliber. The celiac axis, SMA,\nand bilateral renal arteries are patent.\n\nThe bone marrow signal is grossly unremarkable.", "output": "1. Three hepatic hemangiomas in the right hepatic lobe, corresponding to the\nlesions seen on prior ultrasound examination. Smaller lesion within segment\n4B of the liver is most compatible with either a slowly filling or sclerosed\nhemangioma. No concerning hepatic mass.\n2. Multiple diffuse T2 hyperintensities throughout the liver, likely biliary\nhamartomas and/or small hepatic cysts.\n3. Subcentimeter pancreatic cystic lesions, likely reflective of side branch\nIMPNs. One year followup is recommended.\n\nRECOMMENDATIONS ___ year followup MRCP." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Again noted are T2 hyperintense lesions in the right hepatic lobe, that\nwere previously characterized as hemangiomas, measuring up to 2.5 x 1.9 cm in\nsegment 8. Otherwise, there are innumerable unchanged subcentimeter T2\nhyperintense lesions throughout liver, likely representing cysts or biliary\nhamartomas.\n\nBiliary: There is no cholelithiasis or choledocholithiasis. There is no intra\nor extrahepatic biliary ductal dilatation.\n\nPancreas: There are multiple unchanged cystic lesions throughout the pancreas\nwhich demonstrate communication with the main pancreatic duct, suggesting\nside-branch IPMNs, measuring up to 1.2 cm in the pancreatic tail on coronal\nimages (9:4), and measuring 0.7 x 0.6 cm on axial images, unchanged from\nprior. No new lesions are identified. There is no evidence of main duct\ndilation or intracystic nodularity.\n\nSpleen: The spleen is normal in size.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size with no hydronephrosis. There is an\nunchanged 2.3 cm cyst in the upper pole of the left kidney.\n\nGastrointestinal Tract: Visualized loops of large and small bowel are\nunremarkable.\n\nLymph Nodes: No enlarged upper abdominal or retroperitoneal lymph node is\nnoted.\n\nOsseous and Soft Tissue Structures: Degenerative changes are noted throughout\nthe lumbar spine.", "output": "1. Multiple unchanged cystic pancreatic lesions suggestive of side-branch\nIPMNs.No main duct dilation or other suspicious features. Continued\nsurveillance is recommended in one year.\n2. Stable previously characterized hepatic hemangiomas and innumerable \nbiliary hamartomas/ cysts; stable left upper pole renal cyst.\n\nRECOMMENDATION(S): ___ year MRCP follow-up is recommended to assess stability\nof side-branch IPMNs." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are notable for trace\nbilateral pleural effusions.\n\nLiver: Innumerable subcentimeter T2 hyperintense cystic lesions are scattered\nthroughout the liver consistent with hepatic cysts or biliary hamartomas. \nAgain noted are multiple hepatic hemangiomas fully characterized on prior\nstudy, largest measuring 3.1 x 2.5 cm within segment 8 (05:15). No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The common\nbile duct smoothly tapers to the level of the ampulla without obstructing\nstone or periampullary mass.\n\nPancreas: Again noted are multiple T2 hyperintense cystic lesions throughout\nthe pancreas which are unchanged since ___, many of which are\nagain noted to communicate with the main pancreatic duct, suggestive of side\nbranch IPMNs. Largest measures 1.1 x 0.4 x 0.5 cm within the pancreatic tail,\nunchanged since ___ (05:29).\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: 1.6 cm left upper pole renal cyst noted. Kidneys are otherwise\nhomogeneous in signal intensity without suspicious mass. No hydronephrosis or\nperinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are not enlarged.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. Multiple pancreatic cystic lesions, largest measuring 1.1 cm in the\npancreatic tail, likely IPMN unchanged since ___.\n2. Stable previously characterized hepatic cysts/biliary hamartomas, hepatic\nhemangiomas, and left upper pole renal cysts.\n3. Trace bilateral pleural effusions." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion. The cardiac size\nis not enlarged.\n\nLiver: There are innumerable subcentimeter T2 hyperintense cystic lesions\nscattered throughout the liver, compatible with hepatic cysts or biliary\nhamartomas. Multiple hepatic hemangiomas are redemonstrated, previously fully\ncharacterized on prior exams with the largest measuring up to 2.9 cm in\nsegment 8. The main portal vein is patent. There is no perihepatic fluid.\n\nBiliary: The gallbladder is normal without evidence cholelithiasis. There is\nno intrahepatic or extrahepatic biliary dilatation.\n\nPancreas: The pancreas is normal in signal intensity and bulk. There are\nmultiple cystic lesions scattered throughout the pancreas which demonstrate\ncommunication with the main pancreatic duct suggestive of side branch IPMNs\nmeasuring up to 1.3 cm in the pancreatic tail on coronal images (08:29). \nThere is no evidence of main pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity without focal\nlesions.\n\nAdrenal Glands: The adrenal glands are normal signal intensity without focal\nlesions.\n\nKidneys: Note is made of a 2.1 cm left upper renal pole cyst, unchanged. \nOtherwise, the kidneys are normal and symmetric in caliber without evidence\nnephrolithiasis or hydronephrosis. There is no perinephric abnormality.\n\nGastrointestinal Tract: The visualized small and large bowel loops are normal\nin caliber without evidence of obstruction.\n\nLymph Nodes: There is no adenopathy in the visualized upper abdomen.\n\nVasculature: The aorta is normal in caliber without evidence of aneurysmal\ndilatation.\n\nOsseous and Soft Tissue Structures: Degenerative changes are seen along the\nvisualized spine. Otherwise, no osseous abnormality is seen.", "output": "1. Overall, there is stable appearance of multiple pancreatic cystic lesions,\nthe largest measuring up to 1.3 cm in the pancreatic tail, as compared to\n___.\n2. Stable previously characterized hepatic hemangiomas, hepatic cysts/biliary\nhamartomas, and left upper pole renal cyst.\n\nRECOMMENDATION(S): For management of pancreatic cyst(s) between 6-15 mm in\npatients between 65- ___ years at presentation, recommend non-contrast MRCP\nfollow-up every other year up to a total of ___ years.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Pancreas is mildly diffusely atrophic without ductal dilatation. No\nperipancreatic inflammatory changes or fluid collections. No cystic or solid\nmasses are seen. Preserved T1 hyperintensity of the pancreas on the\npre-contrast imaging. No intrahepatic or extrahepatic biliary ductal\ndilatation. Normal gallbladder without gallstones or gallbladder wall\nthickening. No associated inflammatory changes. The liver enhances normally\nand is of normal signal intensity. The spleen is normal in size and\nenhancement. Adrenal glands are within normal limits. The splenic vein,\nportal vein, and portal vein branches are patent. Hepatic veins are patent. \n\nKidneys enhance symmetrically and excrete contrast symmetrically. A 4-mm T2\nhyperintense focus at the interpolar region of the left kidney is likely a\ncyst. A tiny T2 hyperintense focus measuring 2 mm at the lower pole of the\nright kidney is likely a cyst but too small to further characterize. No\nhydronephrosis or hydroureter. Small subcentimeter retroperitoneal nodes are\nseen, not pathologically enlarged. \n\nAbdominal aorta is normal in caliber. The celiac axis and SMA are normal at\ntheir origins. Renal arteries are patent bilaterally.\n\nThe stomach is collapsed. No evidence of gastric outlet obstruction. The\nduodenum and small bowel loops seen within the upper abdomen have normal\nmorphology without abnormal distension. No free fluid is seen. Colon\ncontains a moderate amount of stool.\n\nOverlying soft tissues are preserved.\n\nNo suspicious osseous lesions are seen. Minor degenerative changes of the\nlower lumbar spine. Minimal levoscoliosis of the lumbar spine.", "output": "1. Mildly and diffusely atrophic pancreas without main pancreatic ductal\ndilatation or peripancreatic inflammatory changes. No fluid collections. No\nfocal pancreatic abnormality is identified. Normal enhancement and signal\nintensity of the pancreas. If present, calcifications often associated with\nchronic pancreatitis are better visualized with CT. \n\n2. No biliary ductal dilatation. Normal gallbladder.\n\n3. Probable tiny renal cysts, measuring 2 and 4 mm." }, { "input": "Liver: The liver is unremarkable without imaging features of advanced\ncirrhosis.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilation. The\ngallbladder is within normal limits\n\nPancreas: Patient is status post distal pancreatectomy with surgical material\nalong the proximal body. The remaining pancreas is unremarkable.\n\nSpleen: Post splenectomy changes again seen. No drainable fluid collection is\ndemonstrated. At the splenectomy side, there is hypointense T2 signal without\nenhancement measuring 5.5 cm, unchanged in size. This either represents\nevolving hematoma or fat necrosis.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Unremarkable except for a 1.4 cm left hemorrhagic cyst. Otherwise,\nthere is no suspicious lesion in the kidneys. There is no hydronephrosis. No\nhydronephrosis.\n\nGastrointestinal Tract: There is no bowel obstruction.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is seen. \nPostsurgical changes are noted in the anterior abdominal wall.", "output": "Redemonstration of distal pancreatectomy and splenectomy withlikely evolving\nfat necrosis or hematoma in the splenectomy bed. No drainable fluid\ncollection." }, { "input": "The lung bases are grossly clear. Mild scattered ascites, mostly surrounding\nthe liver, is slightly decreased from the prior study.\n\nLiver: Diffuse nodularity of the liver is again demonstrated, compatible with\nknown cirrhosis. Similar to prior exam there is peripheral reticular\nenhancement indicative of fibrosis. A subcentimeter T2 hyperintense lesion\nwith restricted diffusion at the dome of the liver (02:27, 5:6) was not\npresent on the prior MRI. This does not exhibit arterial hyper enhancement or\nwashout. The location is distinct from the hypoechoic nodule described on\nprior ultrasound. No other suspicious hepatic lesion is identified.\n\nGallbladder and biliary tree: The gallbladder is absent. There is no intra or\nextrahepatic bile duct dilatation.\n\nPancreas: The pancreas enhances homogeneously. There is classic pancreatic\nductal anatomy with normal caliber main pancreatic duct.\n\nSpleen: The spleen is enlarged, measuring 15.4 cm in length, similar to prior\nexam.\n\nKidneys and Adrenals: The adrenal glands are normal bilaterally. The kidneys\ndisplay symmetric enhancement and excretion of contrast, without\nhydronephrosis.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: No pathologically enlarged abdominal lymph nodes are identified.\n\nVessels: The right, left, and main portal vein are patent, as are the splenic\nvein and superior mesenteric vein. The abdominal aorta is non aneurysmal\nthroughout.\n\nBones: The bone marrow is normal in signal intensity.", "output": "1. Cirrhotic liver without lesion meeting OPTN 5 criteria for HCC. No MRI\ncorrelate is identified for the nodule seen on prior ultrasound.\n2. New sub-centimeter focus of restricted diffusion at the liver dome without\narterial hyperenhancement is of low suspicion, but attention on future\nsurveillance exams is recommended.\n3. Splenomegaly and mild ascites compatible with portal venous hypertension. \nAscites is slightly decreased in volume from ___." }, { "input": "Lower Thorax: There is a 0.5 cm pulmonary nodule in the right lower lobe\n(series 3, image 10) which has been stable since ___. There is mild\nbibasilar atelectasis. The lungs are otherwise clear. No pleural or\npericardial effusion.\n\nLiver: The liver is nodular in contour consistent with known cirrhosis. There\nis no suspicious focal lesion. There is no steatosis. The hepatic arterial\nanatomy is conventional. There is extensive periportal, gastric, perisplenic\ncollaterals.\n\nBiliary: The gallbladder contains numerous small gallstones. The gallbladder\nis otherwise within normal limits. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: The pancreas demonstrate normal morphology and enhancement without\nfocal lesion or pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size and enhancement without focal lesions.\n\nAdrenal Glands: The adrenal glands are normal bilaterally.\n\nKidneys: The kidneys are symmetric in size and enhancement. There are\nbilateral peripelvic cysts and scattered simple cysts in the right kidney. \nThere is no hydronephrosis or hydroureter. There is no perinephric\nabnormality.\n\nGastrointestinal Tract: Stomach is unremarkable. Visualized small and large\nbowel demonstrates obstruction or wall thickening.\n\nLymph Nodes: There is no lymphadenopathy.\n\nVasculature: The abdominal aorta and its branches are patent with normal\ncaliber.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Cirrhotic liver with extensive periportal, gastric, and perisplenic\ncollaterals. No suspicious focal lesion.\n2. Cholelithiasis." }, { "input": "Lower Thorax: 0.4 cm right lower lobe pulmonary nodule stable (series 4, image\n10). Heart size is normal.\n\nLiver: The liver demonstrates enlargement with diffuse nodularity consistent\nwith known cirrhosis. There is reticular hepatic enhancement, consistent with\nfibrosis. There are no suspicious hepatic lesions.. There is no ascites.\n\nBiliary: There is cholelithiasis without MR evidence of acute cholecystitis. \nThere is no intra or extrahepatic biliary duct dilation.\n\nPancreas: The pancreas is normal in morphology and signal intensity. Note is\nmade of pancreas divisum. No focal pancreatic lesions are seen.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. Note is made of bilateral\nperipelvic cysts measuring up to 1.5 cm in the left lower pole collecting\nsystem. There are sub centimeter cortical cysts in the right kidney,\nincluding a hemorrhagic cyst measuring 0.6 cm in the right mid pole. There is\nno hydronephrosis.\n\nGastrointestinal Tract: There is a small hiatal hernia. Views of the small\nand large bowel are unremarkable.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. The portal vein is patent. Hepatic veins are patent. Note\nis made of extensive periportal and perihepatic collateral vessels most\npronounced in the right lower abdomen. There is a recanalized paraumbilical\nvein. No paraesophageal varices are seen.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. There\nis no superficial soft tissue abnormality.", "output": "1. Cirrhotic and fibrotic liver morphology. No focal hepatic lesions.\n2. Sequela of portal hypertension including extensive perihepatic collateral\nvessels." }, { "input": "Lower thorax: The lung bases are clear. No pleural effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nsignal loss on the out of phase sequence as opposed to the in-phase to suggest\nthe presence of hepatic steatosis. There is a subcentimeter T2 hyperintense,\nnon-enhancing lesion in segment 2 most in keeping with a hamartoma. The\ncontours are smooth. The portal and hepatic veins appear patent. There is\nconventional hepatic arterial anatomy.\n\nBiliary: There is no intra- or extra-hepatic duct dilatation. The common\nbile duct is within normal limits. The gallbladder is unremarkable.\n\nSpleen: The spleen is normal in size and signal characteristics. No focal\nlesions.\n\nPancreas: The pancreas is normal in signal characteristics and bulk. \nMultiple stable subcentimeter, non-enhancing, T2 hyperintense cysts are most\nin keeping with side-branch IPMN. The largest measures 5 mm. The pancreatic\nduct is not dilated.\n\nAdrenal glands: Unremarkable.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained. A 9 mm cyst is noted in\nthe interpolar region of the left kidney. There are parapelvic cysts on the\nright.\n\nGI tract: The GI tract is of normal caliber throughout. Diverticulosis is\nnoted in the descending colon.\n\nLymph nodes and mesentery: Ill-defined stranding in the mid mesentery is\nunchanged compared to the previous CT and MRI. Multiple enlarged mesenteric,\nbilateral paraaortic, common iliac and retroperitoneal lymph nodes are stable\nin size and morphology. The largest lymph node is located in the left\nperiaortic artery/common iliac region and measures 1.1 x 1.6 x 2.1 cm. \nCompared to the previous MRE, the enhancing soft tissue near the root of the\njejunal mesentery with sparing of the vessels is unchanged but allowing for\ndifferences in technique more solid and prominent compared to the previous CT.\nThe vessels within the region remain patent. There is tethering of loops of\nsmall bowel in this region but no caliber change to suggestion an obstruction.\n\nPelvis: On the post contrast sequences, there is an indeterminate focal\nenhancing lesion in the anterior bladder measuring 6 x 11 mm (series 13, image\n118). This finding is not well seen on any other sequences. The distal\nureters are within normal limits.", "output": "1. Intra-abdominal lymphadenopathy with stranding of the mesentery and low\nlevel mass like enhancement in the right lower quadrant with tethering of\nbowel is most in keeping with sclerosing mesenteritis. Findings are unchanged\ncompared to the previous MRE.\n2. Indeterminate focal enhancing lesion in the anterior bladder which is only\nseen on the post-contrast sequences. Correlation with urinalysis/urine\ncytology and/or urology consultation is recommended.\n3. Multiple stable subcentimeter, non-enhancing, T2 hyperintense cysts are\nmost in keeping with side-branch IPMN." }, { "input": "Very limited study due to significant motion artifacts as the patient could\nnot hold his breath during the exam.\n\nLower Thorax: Moderate right and small left pleural effusions with compressive\natelectasis in the lung bases. No pericardial effusion.\n\nLiver: Liver demonstrates normal contours. There is diffuse low signal\nintensity of the hepatic parenchyma on the T2 weighted images with diffuse\ndrop of signal on the in-phase images as compared to the out of phase images\ncompatible with diffuse hepatic iron overload. This has worsened when\ncompared to prior MRI dated ___. No worrisome enhancing hepatic\nmass lesions within limitations of motion artifact.\n\nBiliary: Gallbladder is present containing multiple gallstones. No\ngallbladder wall thickening or pericholecystic fluid. There is no\nintrahepatic or extrahepatic biliary duct dilatation. The common bile duct\ntapers normally towards the ampulla without obstructing filling defects or\ncholedocholithiasis.\n\nPancreas: Pancreas demonstrates normal morphology. There is diffuse low\nsignal intensity of the pancreatic parenchyma on the T2 weighted images with\ndrop of signal on the in-phase images as compared to the out phase images\ncompatible with iron deposition. The main pancreatic duct is not dilated. No\nperipancreatic inflammatory changes or fluid collections.\n\nSpleen: Mild splenomegaly measuring 13.7 cm in maximal craniocaudal dimension.\nIt also demonstrates diffuse low signal intensity on T2 weighted images with\ndrop of signal on the in-phase images compatible with iron overload. It\nenhances homogeneously without focal mass lesion.\n\nAdrenal Glands: Adrenal glands are normal bilaterally without focal nodules.\n\nKidneys: Kidneys are symmetric in size bilaterally demonstrate good\ncorticomedullary differentiation. No suspicious renal masses or\nhydronephrosis.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are within normal limits. No ascites.\n\nLymph Nodes: No suspicious mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta is normal in caliber and its major branches are\npatent. The splenic vein, SMV, portal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: Diffuse low signal intensity of the bone\nmarrow compatible with iron overload. No suspicious osseous or soft tissue\nmass lesions.", "output": "Limited examination due to motion.\n\n1. Hepatic, splenic and pancreatic iron deposition, which has worsened from\nprior.\n2. No focal hepatic mass.\n3. Moderate right and small left pleural effusions slightly worse when\ncompared to prior." }, { "input": "Lower thorax: Right greater than left basilar atelectasis.\n\nLiver: Cirrhotic morphology of the liver. The liver demonstrates\nheterogeneous enhancement, with equilibration on the later phases. No focal\nmass lesions are identified.\n\nBiliary: The gallbladder contains tumefactive sludge. The extrahepatic bile\nduct is mildly dilated. No intrahepatic biliary dilatation.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: The spleen is massively enlarged measuring 20.6 cm.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid lesions. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. The\ncolon appears thick walled throughout, likely secondary to portal\nhypertension.\n\nPelvis: The bladder is moderately well distended without wall thickening or\nmass. Small hemorrhagic cyst in the right ovary. The uterus and ovaries are\notherwise normal in appearance.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Upper abdominal varices are noted. The portal vein is patent.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.\n\nAscites is noted, moderate in the lower pelvis. No significant hemorrhage is\nidentified.\n\nThere is a region of T2 hypointensity in the lesser sac, likely representing\nflow artifact, as there is no T1 hyperintense correlate or blooming artifact\nto suggest blood or gas.", "output": "1. The portal vein is patent.\n2. Tumefactive sludge is noted in the gallbladder. No gallbladder mass\nidentified.\n3. Ascites, moderate in the lower pelvis. No appreciable hemorrhage is\nidentified.\n4. Cirrhotic morphology of the liver. Massive splenomegaly. Upper abdominal\nvarices are noted." }, { "input": "The liver demonstrates a nodular cirrhotic morphology. The study is limited by\nmotion artifact. Allowing for this there are innumerable nodules demonstrated\nwithout obvious enhancement or washout. Accessory left hepatic artery is seen\narising from the left gastric artery, and there is an accessory right hepatic\nartery arising from the SMA. The portal vein is patent.\n\nThe spleen is enlarged measuring 14.8 cm. There is a large volume of ascites. \nGastroesophageal varices are noted. The gallbladder is thick-walled and\nsomewhat distended. Small dependent gallstones are noted.\n\nThere is no pancreatic mass or ductal dilatation. The adrenal glands are\nunremarkable. There is a 6 mm cortical cyst in the lower pole of the right\nkidney. There is no hydronephrosis.\n\nNo osseous lesion is demonstrated.", "output": "1. Cirrhotic morphology of the liver with features of portal hypertension\n(splenomegaly, ascites, and gastroesophageal varices).\n2. No lesion concerning for HCC. Innumerable regenerative nodules are noted.\n3. Cholelithiasis." }, { "input": "The lung bases are grossly clear. There is no ascites.\n\nLiver: The liver is nodular in appearance compatible with cirrhosis. There are\nnumerous subcentimeter enhancing foci in the right and left hepatic lobes\nwhich do not demonstrate intrinsic increased T1 signal or washout on delayed\npostcontrast sequences. These may represent perfusion changes versus \nregenerative/dysplastic nodules. Grossly, the appearance is stable compared to\nthe prior exam.\n\nSegment VIII: 16 x 10 mm enhancing nodule (series 1001, image 27). Evaluation\nof washout is difficult given the background of patchy fibrosis.\n\nSegment IVb: 14 mm x 14 mm arterially enhancing nodule (series 1001, image 73)\nwhich demonstrates washout and a pseudo capsule (series 1004, image 69).\n\nGallbladder: The gallbladder is normal. There is no evidence of\ncholedocholithiasis or stricture.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nfocal mass or ductal dilatation. There is classic pancreatic ductal anatomy.\n\nSpleen: The spleen is normal in appearance.\n\nKidneys and Adrenals: The adrenal glands are normal. The kidneys are normal in\nsize and enhancement. There is no hydronephrosis. Incidental note is made of a\nsolid 5 mm subcortical cyst in the right kidney (series 6, image 29).\n\nBowel: Note is made of a small hiatal hernia. The visualized bowel loops and\nmesentery are within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is widely patent.\n\nBones: There are compression fractures in the mid thoracic spine, likely T9\nand T12. There are multiple mildly T2 hyperintense foci in the lumbar spine\nlikely representing benign hemangiomas.", "output": "1. Hepatic cirrhosis with numerous subcentimeter enhancing nodules which\nlikely represent a combination of transient perfusion change and\nregenerative/dysplastic nodules. Given the diffuseness and number of these\nnodules it is not possible to exclude that there might be\nearly/well-differentiated HCC in some of these nodules.\n\n2. 14 mm nodule in segment IVb the which demonstrates washout and\npseudocapsule, meeting the criteria for hepatocellular carcinoma (OPTN-5A).\n\n3. 16 mm nodule in segment VIII which demonstrates arterial enhancement\nhowever washout is difficult ascertain given background of fibrosis. This\ndoes not meet criteria for OPTN 5 lesion. Attention to this nodule is\nrecommended on subsequent exams." }, { "input": "Lower Thorax: The lower thorax is unremarkable.\n\nLiver: The liver demonstrates diffusely nodular contour compatible with the\nknown underlying cirrhosis. The previously seen RFA zone in liver segment 4B\nmeasures 2.0 x 2.3 cm. There is spontaneously hyperintense material seen on\nthe T1 pre gadolinium sequences compatible with focal coagulative necrosis. \nThere is no enhancement noted within the RFA zone to suggest residual or\nrecurrent tumor. There are no other suspicious hepatic lesions identified.\n\nThere are multiple peripheral areas of geographic like arterial enhancement\nwithout corresponding washout or other suspicious features. These are likely\nperfusional phenomenon.\n\nA 4 mm hepatic cyst is noted in segments ___.\n\nNormal anatomic portal vein and hepatic artery branching is seen.\n\nBiliary: The gallbladder and biliary tree are within normal limits.\n\nPancreas: Visualized pancreas is unremarkable.\n\nSpleen: The spleen is within normal limits.\n\nAdrenal Glands: Visualized adrenal glands are unremarkable.\n\nKidneys: 4 mm cyst is seen within the left kidney. A 3 mm mid polar cyst is\nseen within the right kidney. The kidneys are otherwise unremarkable.\n\nGastrointestinal Tract: Visualized small and large bowel loops are\nunremarkable.\n\nLymph Nodes: No size significant lymphadenopathy.\n\nVasculature: Normal anatomic portal vein and hepatic artery branching patterns\nare seen.\n\nOsseous and Soft Tissue Structures: Benign hemangiomas are seen at the L1, L2,\nand L3 levels.\n\nCompression fracture of the T12 vertebral body, unchanged from previous CT.\n\nNo suspicious bony lesion.", "output": "Successful RFA in liver segment 4B, with no evidence of recurrent or residual\ndisease.\n\nNo other suspicious hepatic lesions identified.\n\nIncidental findings as detailed above." }, { "input": "Lower Thorax: Please see the chest CT obtained immediately prior to this exam\nfor complete thoracic details.\n\nLiver: The liver is shrunken and nodular, compatible with the known history of\ncirrhosis. Mild fibrosis is noted. There is no hepatic steatosis. Again,\nthere is an ablation zone in segment 4B, which is unchanged in size, measuring\n22 x 23 mm. It is hyperintense on the precontrast T1 weighted images, due to\ncoagulation necrosis. Immediately adjacent to the ablation zone, there is non\nmass-like arterial enhancement, which persists on the delayed phases. There\nis no washout or pseudocapsule. This is likely perfusional (11, 62). In\ncomparison the prior exam, it is similar. No local recurrence is identified.\n\nThroughout the liver, there are multiple foci of arterial hyperenhancement\nwhich have no correlate on the T2 weighted images, or washout. There is no\nassociated diffusion abnormality. These are most compatible with transient\nhepatic intensity differences. The largest measures 17 mm in segment 5 (11,\n66), and is unchanged. Overall, in comparison to the prior exam, several of\nthese foci are slightly smaller. The majority are unchanged.\n\nThe hepatic arterial anatomy is conventional. The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is collapsed, limiting its assessment. Within the limitations, no\nobvious stones are identified.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is mildly enlarged, measuring 13.9 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. Bilateral sub-centimeter simple\ncysts are unchanged. There are no worrisome renal lesions, hydronephrosis, or\nperinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is mild to moderate atherosclerotic. Small esophageal and\ngastric varices are noted.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nSeveral T2 hyperintense foci in the vertebral bodies most likely represent\nhemangiomas. Compression deformities in T9 and T12 are unchanged dating back\nto ___. No new fracture is identified. The soft tissues are unremarkable.", "output": "1. Post RFA changes in segment 4B without evidence of recurrence.\n2. No suspicious liver lesions are identified. Multiple enhancing foci are\nnot significantly changed and most consistent with transient hepatic intensity\ndifferences.\n3. Cirrhosis, splenomegaly, and small varices. No ascites." }, { "input": "LOWER THORAX: Clear visualized lungs.\n\nLIVER: Nodular liver surface with caudate hypertrophy are consistent with\ncirrhosis. Segment 4b zone of ablation measures 2.1 x 2.7 cm with coagulative\nnecrosis, unchanged. No residual or recurrent disease.\n\nNo new concerning lesions. There are multiple foci of transient perfusion\ndifferences throughout the liver. The largest is in segment ___ measures 2.3\ncm without washout, unchanged. There is a subcentimeter right hepatic\nsubcapsular cyst (3:25). No ascites.\n\nBILIARY: Unremarkable gallbladder. No ductal dilation.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: 13.6 cm splenomegaly.\n\nADRENAL GLANDS: No nodules.\n\nKIDNEYS: Simple bilateral renal cysts. No hydronephrosis. Trace perinephric\nfluid.\n\nGASTROINTESTINAL TRACT: No intestinal obstruction.\n\nLYMPH NODES: No adenopathy.\n\nVASCULATURE: Patent aorta, major branches, and hepatic vasculature. No\ndefinite varices.\n\nOSSEOUS AND SOFT TISSUE STRUCTURES: Chronic T9 and T12 compression fracture. \nNo soft tissue mass.", "output": "Cirrhosis. Status post segment 4b lesion RFA. No recurrence or new lesions.\n\nMild splenomegaly." }, { "input": "Lower Thorax: The lung bases are clear. The visualized heart and pericardium\nare within normal limits.\n\nLiver: As before, the liver shows a nodular contour and there is hypertrophy\nof the caudate lobe consistent with cirrhosis. There is no evidence of\nhepatic steatosis. Within segment 4B there is a zone of ablation which\nmeasures 2.2 x 2.1 cm consistent with coagulative necrosis, unchanged in size\nfrom the prior examination. No evidence of recurrent or residual disease in\nthat area.\n\nNo new concerning hepatic lesions are identified. There are innumerable\narterially enhancing foci throughout the liver without correlate on\npre-contrast or delayed imaging consistent with perfusional anomalies. A\nsub-centimeter right hepatic subcapsular cyst (1203:69) is unchanged. There\nis no ascites.\n\nBiliary: The gallbladder is within normal limits. No ductal dilatation is\nseen.\n\nPancreas: The pancreas is normal in size and signal intensity. No pancreatic\nlesions identified.\n\nSpleen: The spleen measures 13.7 cm consistent with splenomegaly. The spleen\nis normal in in signal intensity.\n\nAdrenal Glands: The adrenal glands are normal bilaterally.\n\nKidneys: Simple bilateral renal cysts are unchanged in size from the prior\nexamination. No hydronephrosis. Trace perinephric fluid.\n\nGastrointestinal Tract: The GI tract is within normal limits without evidence\nof obstruction, or mural thickening.\n\nLymph Nodes: No intra-abdominal lymphadenopathy.\n\nVasculature: The aorta is normal in caliber and its major branches are patent.\nNo esophageal varices identified.\n\nOsseous and Soft Tissue Structures: Chronic T9 and T12 compression fractures\nare re- demonstrated and unchanged.", "output": "Cirrhotic liver status post segment 4B lesion RFA. No evidence of recurrence\nor new hepatic lesions. Mild splenomegaly." }, { "input": "Lower Thorax: The heart is normal in size. There is no pleural or pericardial\neffusion.\n\nLiver: The liver is small with atrophy of the right hepatic lobe and relative\nhypertrophy of the caudate and lateral segment of the left hepatic lobe, as\nwell as a nodular contour, compatible with morphologic changes of cirrhosis. \nThere is mild diffuse hepatic steatosis. Again seen is a post ablation cavity\nin segment 4B with coagulative necrosis, measuring 2.2 x 2.0 cm, unchanged\ncompared to the prior study from ___. There are numerous scattered\narterially enhancing foci throughout the liver without correlate on the\nT2-weighted, precontrast or equilibrium phase images, compatible with\nperfusion anomalies, overall unchanged. Note is made of a 5 mm cyst in the\nperipheral aspect of segment 6. Diffuse parenchymal reticular enhancement is\ncompatible with fibrosis. No suspicious hepatic lesion is seen.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity. No focal lesion is\nseen. The pancreatic duct is normal in caliber.\n\nSpleen: The spleen is enlarged, measuring 13.6 cm in length.\n\nAdrenal Glands: The adrenal glands are within normal limits. No adrenal\nnodule is identified.\n\nKidneys: There are a few small cortical cysts in both kidneys. There is no\nsolid mass or hydronephrosis.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent. Luminal irregularity of the aorta is\ncompatible with atherosclerosis.\n\nOsseous and Soft Tissue Structures: There are unchanged chronic compression\nfractures of T9 and T12. Note is made of hemangiomas in the L1, L2 and L3\nvertebral bodies. The abdominal wall is within normal limits.", "output": "1. Cirrhosis of the liver. Post ablation cavity in segment 4B, unchanged in\nsize and appearance compared to the prior study from ___. Numerous\nscattered arterially enhancing foci throughout the liver, compatible with\nperfusion anomalies, overall unchanged. No suspicious hepatic lesion.\n\n2. Chronic compression fractures of T9 and T12." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Status post liver transplantation. There is mild diffuse drop of\nsignal on the out of phase images as compared to the in-phase images,\ncompatible mild diffuse hepatic steatosis. The liver enhances homogeneously\nwithout focal suspicious hepatic mass lesions. Few nodular peripheral areas\nof enhancement within the right hepatic lobe inferiorly that do not washout or\nwithout other imaging correlates, most likely transient hepatic intensity\ndifferences.\n\nBiliary: Status post cholecystectomy. There is no intrahepatic or\nextrahepatic biliary duct dilatation. The common bile duct tapers normally\ntowards the ampulla without obstructing filling defects or\ncholedocholithiasis.\n\nPancreas: Pancreas demonstrates normal signal intensity on the T1 weighted\nimages and enhances homogeneously without suspicious solid or cystic mass\nlesions. The main pancreatic duct is not dilated. No peripancreatic\ninflammatory changes or fluid collections.\n\nSpleen: Spleen is top-normal in size measuring 13 cm in maximal craniocaudal\ndimension. Otherwise enhances homogeneously without focal mass lesion.\n\nAdrenal Glands: Adrenal glands are normal bilaterally without focal nodules.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There are bilateral T2 hyperintense foci\ncompatible with simple renal cysts. No suspicious renal masses or\nhydronephrosis.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are within normal limits. No ascites.\n\nLymph Nodes: No suspicious mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Mild atherosclerotic disease of the abdominal aorta. Its major\nbranches are patent. The hepatic artery is patent without significant\nstenosis at the anastomosis site. The splenic vein, SMV, portal vein and\nhepatic veins are patent.\n\nOsseous and Soft Tissue Structures: Chronic compression of T9 and T12\nvertebral bodies, unchanged from prior. No suspicious osseous or soft tissue\nmass lesions. There are scattered T2 hyperintense lesions within the upper\nlumbar vertebral bodies, unchanged from prior most likely representing\nintraosseous hemangiomas. Postsurgical changes in the anterior abdominal\nwall.", "output": "1. Post liver transplant. No concerning hepatic lesion.\n2. Mild hepatic steatosis." }, { "input": "Lower Thorax: Lung bases are clear.\n\nLiver: Transplant liver is normal in morphology. No focal lesions are seen. \nThere is drop of signal on out-of-phase imaging, consistent with steatosis,\nfat fraction of 5%. No focal hepatic lesions are seen.\n\nBiliary: The gallbladder is absent. There is no intra or extrahepatic biliary\nduct dilation.\n\nPancreas: The pancreas is mildly atrophic but otherwise normal in morphology. \nNo focal pancreatic lesion is seen. There is no pancreatic duct dilation.\n\nSpleen: The spleen is normal in size.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. There are scattered subcentimeter\ncortical cyst. There is no suspicious lesion.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable.\n\nLymph Nodes: There are no enlarged retroperitoneal or mesenteric lymph nodes.\n\nVasculature: There is mild-to-moderate atherosclerotic disease. There is no\nabdominal aortic aneurysm. There is a single renal artery bilaterally. \nHepatic arterial anatomy is conventional and patent. Hepatic veins and portal\nvein are patent. Susceptibility adjacent to the distal main portal vein, is\nlikely postsurgical.\n\nOsseous and Soft Tissue Structures: Susceptibility from prior surgery noted in\nthe anterior abdominal wall. Note is made of chronic compression deformities\nof T12 and T9.", "output": "1. Post liver transplant with patent vasculature. No concerning hepatic\nlesions.\n2. Mild hepatic steatosis." }, { "input": "Lower Thorax: Unremarkable. No pleural effusion.\n\nLiver: Status post liver transplant. The transplant liver is normal in\nmorphology. No significant steatosis. No concerning hepatic lesions are\nseen. Again seen is a 6 mm arterially enhancing focus in segment VIII with no\nwashout and no correlate on other sequences, likely a transient hepatic\nintensity difference.\n\nBiliary: Status post cholecystectomy. No intra or extrahepatic biliary duct\ndilatation. Mild narrowing of the biliary anastomosis (series 3, image 24) is\nslightly more pronounced compared to prior MRI from ___. The\nnative common bile duct measures up to 6 mm.\n\nPancreas: The pancreas is slightly atrophic. There is no focal pancreatic\nlesion or any pancreatic duct dilatation.\n\nSpleen: The spleen measures 13 cm. There are no focal lesions.\n\nAdrenal Glands: Unremarkable\n\nKidneys: Right and left kidneys are symmetric in size with no hydronephrosis. \nBilateral subcentimeter cysts are seen.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The hepatic veins, portal veins and hepatic arteries are patent. \nModerate atherosclerotic plaque of the aorta.\n\nOsseous and Soft Tissue Structures: Chronic compression deformity of T12 and\nT9. Susceptibility from prior surgery are noted in the anterior abdominal\nwall.", "output": "-Status post liver transplant with patent vasculature.\n-No concerning hepatic lesions." }, { "input": "Lower thorax: The lung bases are grossly clear. There is a fat containing\ndiaphragmatic hernia on the right.\n\nLiver: The liver demonstrates normal morphology and signal intensity. There\nare a few scattered T2 hyperintense lesions measuring under 5 cm in both lobes\nof the liver consistent with cysts. The largest is a segment 5 cyst. No\nsuspicious focal liver lesion identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: There is a solid partly exophytic mass arising from the posterior\naspect of the upper pole region of the right kidney which measures 2 x 1.6 x 2\ncm. The mass is hypointense on T1 and T2 weighted images, demonstrates\nrestriction of diffusion and is hypoenhancing relative to the background renal\nparenchyma. Kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid. A focus of increased enhancement at the tip\nof the L3 vertebral body is likely to be degenerative (19:47). Focal areas of\nincreased enhancement involving lower ribs on both sides most likely\ncorresponds to costochondral junctions (19:17 and 27)", "output": "1. A 2 x 1.6 x 2.6 cm right upper pole renal mass demonstrates MR\ncharacteristics most compatible with renal cell carcinoma, likely papillary\nsubtype. No renal sinus invasion or vascular extension.\n2. No abdominal lymphadenopathy." }, { "input": "Lower Thorax: The bases of the lungs are clear. There are small bilateral\npleural effusions, greater on the left than the right. The base the heart is\nnormal in size. There is no pericardial effusion. There is apparent\nthickening of the distal esophagus in increased enhancement particularly of\nthe mucosa that suggests esophagitis.\n\nLiver: The liver is normal in shape and contour. There is no hepatic\nsteatosis. Within the limitations of this exam, there is no worrisome liver\nlesion. Note, the entire liver is not included in the field of view.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. There is\ncholelithiasis without cholecystitis.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or evidence of a mass.\n\nSpleen: The spleen is normal in size, measuring 7.9 cm. There no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The right kidney, there is a 20 x 16 x 18 mm lesion which corresponds\nto the lesion seen on CT with multiple calcifications. It is heterogeneous on\nthe T2 weighted images, with foci of low signal that likely represent the\ncalcifications. Within the upper portion of the lesion, there is a 5 mm focus\nof enhancement (14, 25). This lesion is not exophytic and enters into the\nrenal sinus fat (2, 25). Additionally in the right kidney, there are 2 tiny\nsimple cyst measuring up to 5 mm (14, 24 and 19). There is no hydronephrosis\nor perinephric abnormality.\n\nIn the lower pole of the left kidney, there is a 16 x 13 x 12 mm lesion which\nis predominantly hyperintense on the T2 weighted images. There are several\nthin septae. The enhancement of the septae is difficult to evaluate, given\nmotion artifact but does not appear significant. There is no nodularity. \nSeveral other tiny simple cysts are noted in the left kidney measuring up to 3\nmm (2, 23). There is a duplicated collecting system. There is no\nhydronephrosis or perinephric abnormality.\n\nThere is a single renal artery bilaterally. The renal vein anatomy is\nconventional. There is no thrombus.\n\nGastrointestinal Tract: Near the pylorus, there is a roughly 3.5 cm lesion\nthat is predominantly slightly hyperintense on the T2 weighted images to the\nmuscular wall of the adjacent portions of the stomach but with some areas of\nT2 hyperintensity particularly along its surface. It also has clearly\nrestricted diffusion and increased enhancement though it is not well evaluated\nbecause of significant respiratory and bowel motion. The small bowel is\nnormal in course and caliber. There is no evidence of obstruction. The\nimaged portions of the large bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber with mild\natherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nModerate multilevel degenerative changes are noted throughout the spine. The\nsoft tissues are unremarkable other than mild anasarca.", "output": "20 mm right renal lesion with partial thick rimmed calcifications and an\nenhancing nodular region centrally, highly suspicious for a renal cell\ncarcinoma. The subtype is difficult to determine due to technical limitations\n(motion and poor breath holds). If this lesion is going to be followed,\nconsider ultrasound or CT given the patient's difficulty with MRI.\n\n16 mm left lower pole renal cyst with thin septa without concerning features.\n\nDuplicated left renal collecting system. No hydronephrosis on either side.\n\nEnhancing gastric mass-like lesion within the pylorus, which is incompletely\ncharacterized but very concerning for malignancy. Small adjacent lymph nodes.\nThe patient is already scheduled for an EGD.\n\nFindings concerning for esophagitis. The patient is scheduled for EGD.\n\nCholelithiasis without cholecystitis.\n\nSmall bilateral pleural effusions.\n\n\nRECOMMENDATION(S): Urology consultation.\n\nNOTIFICATION: The findings regarding the gastric mass were discussed by Dr.\n___ with Dr. ___ on the telephone on ___ at 10:39 AM, 5 minutes\nafter discovery of the findings. The patient is having an endoscopy later\ntoday." }, { "input": "Lower Thorax: There are no pleural or pericardial effusions.\n\nLiver: The liver is normal in contour and morphology. There is no steatosis\nor iron deposition. No focal liver lesions identified on this noncontrast\nstudy.\n\nBiliary: The gallbladder is unremarkable. There is no intra or extrahepatic\nbiliary duct dilatation.\n\nPancreas: The pancreas is atrophic. There is a large, encapsulated cystic\nlesion in the head of the pancreas measuring 7.3 x 6.2 x 6.1 cm, without\ninternal debris, or nodularity. The cystic lesion is in intimate contact with\nthe pylorus. The upstream pancreatic duct is mildly dilated measuring up to 4\nmm, with numerous ectatic side branches.\n\nSpleen: The spleen is nonenlarged.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There are bilateral renal cortical cysts, some of which have layering\nhemorrhagic components, the largest in the interpolar region of the right\nkidney measuring 2 cm.\n\nGastrointestinal Tract: The visualized bowel loops in the upper abdomen are\nunremarkable, without evidence of obstruction.\n\nLymph Nodes: There are no size significant mesenteric or retroperitoneal lymph\nnodes.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There are no suspicious bone lesions.", "output": "1. Atrophic pancreas, with mildly prominent pancreatic duct up to 4 mm, with\nnumerous ectatic side branches. There is an encapsulated cystic lesion in the\npancreatic head measuring up to 7.3 cm, compatible with a pseudocyst in the\nsetting of known prior pancreatitis. The pseudocyst lies against the pylorus.\n2. No solid mass identified." }, { "input": "Lower Thorax: Included lung bases are grossly clear. There is no large\npleural or pericardial effusion.\n\nLiver: Mild diffuse drop in signal of the partially imaged liver on the out\nof phase sequences is compatible with fatty deposition.No worrisome lesion is\ndetected.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal.\n\nPancreas: Normal without focal lesions or duct dilation.\n\nSpleen: Normal in size and signal intensity.\n\nAdrenal Glands: Normal.\n\nKidneys: There are multiple bilateral peripelvic cysts. Patient is status\npost right upper pole partial nephrectomy with similar postsurgical changes\nalong the resection margin with fat necrosis and mild stranding. Similar\nappearing areas of probable fat necrosis are also seen in the inferior most\naspect of the right perirenal space in the right hemipelvis. There is no\nevidence of local recurrence or worrisome mass in either kidney. There is no\nhydronephrosis.\n\nGastrointestinal Tract: The partially imaged stomach and included loops of\nsmall and large bowel are normal in caliber without obstruction.There are a\nfew scattered sigmoid diverticula.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and iliac arteries are normal in caliber and\nwell opacified. The celiac axis and SMA are patent. Two right and two left\nrenal arteries are patent.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is normal.", "output": "1. Stable post right partial nephrectomy changes. No evidence of new or\nrecurrent renal tumor.\n2. Hepatic steatosis\nPlease note that after the study the patient developed a single hive on the\nchest and was treated with Benadryl by Dr. ___, body MRI fellow. The\npatient's allergy list was updated in the ___ medical record. Please refer\nto the ___ medical record for complete documentation." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nThe hepatic parenchyma demonstrates very low signal intensity on T2 weighted\nsequences (series 8, image 24), with slight signal drop-off on\nlonger-echo-time images of the in- and out-of-phase series, denoting abnormal\niron deposition (series 8, image 24). No concerning hepatic mass is detected.\nBlooming artifacts along the posterior aspect of the right hepatic lobe are\nmost likely from hemosiderin, possibly from prior biopsy (series 9, image 52,\nseries 5, image 71).\n\nThere is no intra or extrahepatic bile duct dilation. The gallbladder contains\nseveral stones near the neck (series 3, image 18). No ductal stones are\ndetected.\n\nThe spleen is mildly enlarged, measuring 13.9 cm (series 3, image 7). The\npancreas, kidneys, adrenal glands, stomach, and intra-abdominal loops of small\nand large bowel are normal. There is no mesenteric or retroperitoneal\nlymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal in caliber. Conventional hepatic arterial anatomy is demonstrated. The\nportal and hepatic veins are patent.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "1. Abnormal iron deposition isolated to the hepatic parenchyma. Should\nquantitative iron evaluation of the liver be desired, a dedicated\nquantification imaging protocol could be obtained on a 1.5 T system.\n2. No concerning hepatic mass.\n3. Cholelithiasis.\n4. Normal appearance of the pancreas." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: Liver is homogeneous in signal intensity without suspicious mass. \nSignal loss on the longer echo time in phase sequence within the liver is\ncompatible with iron deposition. No steatosis is identified. No ascites. No\nsuspicious hepatic lesions.\n\nIron level: 112 Micromol/g, calculated using the TE of 14 msec, and 136\nMicromol/g, calculated using the TE of 9 msec.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The\ngallbladder is unremarkable.\n\nPancreas: Homogeneous in signal intensity without suspicious mass. No\npancreatic duct dilatation. No peripancreatic fat stranding.\n\nSpleen: Normal in size without suspicious mass.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Homogeneous in signal intensity without suspicious mass. No\nhydronephrosis. No perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal with mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, accessory right renal artery are patent. Hepatic anatomy is\nconventional. Hepatic veins, main portal vein, SMV, and splenic vein are\npatent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. Moderate iron deposition within liver. 112 Micromol/g, calculated using\nTE of 14 msec, and ___ Micromol/g, calculated using TE of 9 msec.\n2. No morphologic changes to suggest cirrhosis." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: The liver is homogeneous in signal intensity without suspicious mass. \nNo imaging features suggestive of cirrhosis. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The common\nbile duct smoothly tapers to the level the ampulla without obstructing stone\nor large periampullary mass. Gallbladder is surgically absent with clips in\nthe gallbladder fossa\n\nPancreas: Pancreas is homogeneous in signal intensity without suspicious mass.\nNo pancreatic duct dilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands symmetric in size without discrete\nnodule.\n\nKidneys: 0.2 cm left upper pole simple renal cyst as well as a 0.6 cm\nhemorrhagic/proteinaceous left lower pole renal cyst. (7:80; 05:29). Kidneys\nare otherwise homogeneous in signal intensity without suspicious mass. No\nhydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: The distal esophagus, stomach, and visualized small\nbowel are unremarkable. Normal terminal ileum. Mildly prominent segment of\ncolon at the splenic flexure may be due to collapsed segment versus resolving\ncolitis (1402:72; 05:29). No fat deposition within the bowel wall to suggest\nchronic inflammatory bowel changes. Large bowel is otherwise unremarkable. \nModerate stool burden noted. No obstruction.\n\nLymph Nodes: 0.6 cm left paraaortic lymph node does not meet criteria for\nenlargement (15:71). Retroperitoneal and mesenteric lymph nodes are not\nenlarged.\n\nVasculature: No abdominal aortic aneurysm. Apparent mild celiac artery\nnarrowing with minimally prominent celiac artery distally without substantial\npost-stenotic dilatation may be due to mild indentation of the median arcuate\nligament. SMA, bilateral renal arteries, accessory right renal artery, and\n___ are patent. Hepatic veins, main portal vein, SMV, and splenic vein are\npatent.\n\nPelvis: Possible 1.2 x 0.7 cm enhancing fibroid noted in the lower uterine\nsegment.\n\nOsseous and Soft Tissue Structures: Mild anterior wedge compression\ndeformities noted of T10 and T11. No aggressive osseous lesions. Soft tissues\nare unremarkable.", "output": "1. Mildly prominent segment of colon at splenic flexure may be due to\ncollapsed segment versus resolving colitis.\n2. Apparent mild celiac axis narrowing with minimally prominent celiac axis\ndistally without substantial post-stenotic dilatation may be physiologic from\nindentation of the median arcuate ligament.\n3. Possible fibroid uterus.\n\nRECOMMENDATION(S): 1. Correlation of splenic flexure findings with\ncolonoscopy is recommended.\n2. Consider nonurgent pelvic ultrasound for further evaluation of the\npelvis." }, { "input": "Bilateral lung bases bronchiectasis are present, more on the right. There is\nno pleural or pericardial effusion. Small hiatal hernia is demonstrated.\n\nThe liver is normal in size and morphology. The signal characteristics of the\nliver parenchyma are normal on T1 and T2WI. There are no gross focal liver\nlesions. The portal and hepatic veins are patent.\nThe gallbladder contains small gallstones (06:42), without wall thickening or\npericholecystic edema.\nThe intra and extrahepatic biliary ducts are normal in caliber. There is no\nevidence of choledocholithiasis.\nThe pancreas is normal in size and signal. The main pancreatic duct is mildly\ndilated, less prominent than on CT the from prior day.\n1.6 x 0.8 cm well-defined lobulated cystic lesion with thin septa is seen in\nthe uncinate process (4:9) and connects to the main pancreatic duct via side\nbranch (9:16), consistent with side branch IPMN.\n\nThe kidneys are normal. The adrenals are normal.\nThe spleen is normal in size.\nSmall amount of perihepatic ascites is demonstrated.\nThere is no concerning and retroperitoneal or mesenteric lymphadenopathy.\nThe bone marrow signal is normal.", "output": "1. Cholelithiasis without signs of acute cholecystitis. Resolution of\ndilation of the pancreatic duct and the CBD seen on CT. No evidence of\ncholedocholithiasis.\n2. Uncinate process pancreatic cystic lesion, most probably side branch IPMN.\nThe standards recommendations would be to follow-up in ___ year.\n3. Lung base fibrosis and bronchiectasis, more on the right." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: There are multiple solid T2 hyperintense hypovascular masses scattered\nthroughout the liver parenchyma with progressive enhancement. The largest is\nconfluent soft tissue mass measuring 6.4 x 8.2 cm centrally within the liver\nspanning segments 4, 5, and 6. Additional index lesions: Largest on the right\nmeasures 4.5 x 6.1 cm in segment 8 and the largest on the left measures 2.6 x\n3.5 cm in segment 3. No intrahepatic fluid collection is identified to\nsuggest intrahepatic abscess.\n\nBiliary: Gallbladder is unremarkable. Focal segmental biliary ductal\ndilatation within segment 5.\n\nPancreas: Several sub 5 mm cystic lesions are noted within the pancreatic body\nand tail, likely small side branch IPMNs.\n\nSpleen: Spleen is normal in size.\n\nAdrenal Glands: The adrenal glands are normal in size and morphology.\n\nKidneys: Bilateral renal cortical cysts, the largest measuring 22 mm in the\ninterpolar region of the left kidney.\n\nGastrointestinal Tract: The stomach is unremarkable. The small and large\nbowel are normal in caliber.\n\nLymph Nodes: No retroperitoneal or mesenteric adenopathy.\n\nVasculature: Hepatic arterial anatomy is conventional. No abdominal aortic\naneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion is identified", "output": "Multiple solid hepatic lesions, corresponding to lesions identified on CT,\nmost consistent with metastatic disease. No intrahepatic fluid collection or\nabscess is identified.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 12:29 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "Lower Thorax: The visualized lung bases are clear. The heart size is normal. \nThere is no pericardial or pleural effusion.\n\nLiver: The hepatic parenchyma is normal in signal intensity. A 7 mm T2\nhyperintense lesion in segment II (series 3, image 20) is consistent with a\nsimple cyst. No worrisome hepatic lesions are noted.\n\nBiliary: There is no intrahepatic biliary ductal dilatation, however there is\nwall thickening and mild enhancement of the intrahepatic biliary tree adjacent\nto the confluence, consistent with cholangitis. The common bile duct measures\nup to 9 mm. No ductal stones are detected. A biliary stent is again noted in\nthe distal common bile duct with associated pneumobilia.\n\nPancreas: An ill-defined pancreatic head mass was recently evaluated on CTA\n___. The right aspect of the mass appears hypo-enhancing,\nfilling the pancreaticoduodenal groove (series 904, image 103), and appears to\nsurround the distal CBD (series 904, image 107). The main pancreatic duct is\nmoderately dilated, with a sharp transition point at the level of the mass\n(series 904, image 95, series 3, image 118) The mass slightly contacts the\nupper SMV without encasement. The SMA is distant from the mass. The main\npancreatic duct measures up to 1.0 cm. There is significant atrophy of the\nbody and tail of the pancreas.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: T2 hyperintense lesions in the kidneys bilaterally are consistent\nwith simple cysts. The kidneys enhance symmetrically without hydronephrosis\nor hydroureter.\n\nGastrointestinal Tract: The visualized small and large bowel are normal in\ncourse and caliber without wall thickening or abnormal enhancement.\n\nLymph Nodes: Multiple porta hepatis lymph nodes are prominent measuring up to\n1.2 cm. There is no retroperitoneal or visualized remote mesenteric\nlymphadenopathy.\n\nVasculature: The arterial anatomy is conventional. There is no aneurysmal\ndilatation or flow-limiting stenosis.\n\nOsseous and Soft Tissue Structures: Moderate dextroscoliosis of the lumbar\nspine is unchanged. No osseous lesions are worrisome for infection or\nmalignancy.", "output": "1. The left hepatic lesion detailed on the CT ___ is consistent\nwith a simple cyst. No concerning hepatic mass.\n2. Known pancreatic head mass, as detailed on the CT examination from ___. No distal abdominal metastasis. Upstream main pancreatic duct\ndilation with moderate parenchyma atrophy.\n3. Mild wall thickening and enhancement of the central intrahepatic bile\nducts reflect mild cholangitis, likely reactive. No fluid collections. No\nintrahepatic bile duct dilation. CBD stent in place." }, { "input": "Lower Thorax: Visualized lung bases show mild right atelectasis.\nCardiomediastinal structures are normal.\n\nLiver: Normal in size. Parenchyma is normal in signal and enhancement. no\nsolid mass. No evidence of hepatic steatosis on the dual-echo GRE images. At\nthe junction of hepatic segments 2 and 3 there is a 3.1 x 1.8 cm simple cyst. \nAt the inferior aspect of hepatic segment 6 there is a lobulated lesion which\nshows high signal on T2 weighted images and enhancement characteristics\ntypical for a hepatic hemangioma (peripheral nodular discontinuous enhancement\nwith centripetal progression).\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nis normal. No gallstone.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.\n\nSpleen: Normal in size, signal, and enhancement.\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No right hydronephrosis. There is mild left hydronephrosis and\nproximal hydroureter likely due to compression from the perinephric\nretroperitoneal hematoma. Left ureter shows abnormal increased enhancement,\nlikely reactive.\n\nKidneys are normal in size, signal, and enhancement. There is a small amount\nof blood products in the left collecting system.\n\nAbutting the inferior aspect the left kidney and extending downward within the\nperinephric space there is a 5.2 x 7.1 x 10.0 cm collection which is unchanged\nin size when compared to ___. The inferior aspect of this mass\nshows high signal on T1 weighted images consistent with subacute blood\nproducts and hematoma formation. There is no enhancement. There is no\nunderlying lesion. This is consistent with a perinephric retroperitoneal\nhematoma. At the superior aspect of the perinephric retroperitoneal hematoma\nwhere it abuts the inferior aspect of the left kidney there is a circumscribed\nsemi circular defect in the kidney. This finding suggests that a space\noccupying lesion may have been present at the inferior aspect of the kidney,\nlikely a cyst as no underlying lesion is seen presently, which may have\nhemorrhaged and ruptured causing the retroperitoneal hematoma\n\nThere is edema in the left retroperitoneum.\n\nGastrointestinal Tract: No evidence of obstruction. No mass.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Origin of the celiac artery, superior\nmesenteric artery, and inferior mesenteric artery are patent. Portal veins and\nhepatic veins are patent. Replaced right hepatic artery off the SMA.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal. There\nis a small fat containing umbilical hernia\n\nPelvis: The prostate gland is enlarged. The seminal vesicles are bilaterally\nsymmetric. There is no concerning pelvic mass. The bladder is moderately\ndistended and within normal limits.\n\nMesenteric panniculitis", "output": "Abutting the inferior aspect the left kidney and extending downward within the\nperinephric space there is a 5.2 x 7.1 x 10.0 cm collection which is unchanged\nin size when compared to ___. This collection does not show\nenhancement and there is no underlying mass. Findings are most consistent with\na retroperitoneal hematoma.\n\nAt the inferior aspect of the left kidney where it abuts the superior aspect\nof the retroperitoneal hematoma there is a semi circular discrete cortical\ndefect which suggests that a space-occupying lesion used to be in this area. \nAs no mass is currently identified this mass was most likely a cyst which\nhemorrhaged and ruptured into the perinephric space" }, { "input": "Lower Thorax: The lung bases are clear. There is no pericardial pleural\neffusion. The heart size is normal.\n\nLiver: The hepatic parenchyma demonstrates normal signal intensity on T1 and\nT2 weighted sequences. There is no focal hepatic lesion.\n\nBiliary: There is no intra or extrahepatic bile duct dilation. The patient is\npost cholecystectomy. No ductal stones are detected.\n\nPancreas: The main pancreatic duct appears dilated, measuring up to 12 mm at\nthe body, tapering gradually along the tail, with multiple dilated side\nbranches (series 12, image 18, 15). There is no abrupt transition point at\nthe pancreatic neck (series 4, image 26). No discrete mass is detected. At\nleast 2 subcentimeter cystic lesions are also seen in the pancreatic head\n(series 12, image 17, 16). These findings were not present on the CT\nexamination from ___.\n\nSpleen: The spleen size within normal limits. There are no focal splenic\nlesion.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. Arising from the posterior interpolar aspect of the right\nkidney is a well-circumscribed 1.2 x 1.4 cm lesion demonstrating high internal\nsignal intensity on T2 weighted sequences without appreciable internal\ncontrast enhancement, compatible with a cyst (series 12, image 6, series 4,\nimage 35). Additional subcentimeter cysts arise from the interpolar lower\npole of the left kidney (series 12, image 6, 7).\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal lesion.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy, and no\nascites.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries are\npatent and normal in caliber. A retroaortic left renal vein is patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. Moderate dilation of the main pancreatic duct at the body, with a sharp\ntransition point at the neck and smooth tapering along the tail. While no\ndiscrete lesion is detected, an underlying mass remains a possibility, and\nfurther evaluation endoscopic ultrasound is recommended.\n2. Subcentimeter cystic lesions within the pancreatic head may represent side\nbranch IPMN." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in signal intensity and morphology. The a 5 mm T2\nhyperintensity in segment VI demonstrates no postcontrast enhancement is\nconsistent with a simple cyst or biliary hamartoma (05:24). There is no\nsuspicious liver lesion.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is surgically absent.\n\nPancreas: Similar to the prior study, there is a relatively hypoenhancing\nlesion at the head/neck junction of the pancreas with marked upstream ductal\ndilatation and irregularity, incompletely assessed on this nondedicated study.\nThis was better evaluated by dedicated CTA dated ___ and is not\nappreciably changed.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Both adrenal glands are diffusely thickened without focal\nnodule suggesting adrenal hyperplasia.\n\nKidneys: Simple peripelvic and parapelvic cysts are seen bilaterally. There\nis no suspicious lesion or hydronephrosis.\n\nGastrointestinal Tract: Colonic diverticulosis is noted. Visualized loops\nlarge and small bowel are otherwise unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: The splenic vein is diminutive and the portal vein is diminutive\nat the confluence with the SMV, both remain patent. A retroaortic left renal\nvein is noted\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. There is a\nfat containing umbilical hernia.", "output": "1. Previously seen hypodensity in liver corresponds to a simple cyst or\nbiliary hamartoma. No evidence of hepatic metastasis.\n2. Similar appearance of the pancreatic head/neck mass with upstream ductal\ndilatation and irregularity, better characterized on dedicated CTA pancreas\ndated ___." }, { "input": "Lower Thorax: No abnormality. No effusion.\n\nLiver: Normal hepatic parenchyma. Normal gallbladder. No bile duct\ndilatation.\n\nBiliary: Normal gallbladder, no pericholecystic fluid. No bile duct\ndilatation.\n\nPancreas: No abnormality.\n\nSpleen: No abnormality\n\nAdrenal Glands: No abnormality\n\nKidneys: There is mild right hydroureteronephrosis, right ureter is dilated to\nthe level of the uterus. No left-sided nephro since. Kidneys are otherwise\nnormal. No perinephric stranding.\n\nGastrointestinal Tract: Normal appendix, projects medially and superiorly\nfrom the cecum. No appendiceal dilatation, no adjacent fluid. No other\nabnormalities\n\nLymph Nodes: No adenopathy\n\nVasculature: Bilateral iliac veins are compressed secondary to pregnancy, are\npatent. No other abnormalities\n\nOsseous and Soft Tissue Structures: Intrauterine pregnancy is partially seen\nwith vertex presentation.", "output": "Normal appendix.\nMild right hydroureteronephrosis." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base of the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver has a macronodular contour, compatible with cirrhosis. There\nis extensive nonenhancing periportal fibrosis associated with capsular\nirregularity and retraction. No hepatic steatosis is identified. There are\nno focal liver lesions. The portal and hepatic veins are patent.\n\nBiliary: Again, the intrahepatic bile ducts are irregular and strictured,\nsimilar to the prior exam. There is an abrupt cut off at the distal portion\nof the common bile duct, likely due to sphincter of Oddi dysfunction. This is\nalso similar to the prior exam. The common bile duct is slightly more\ndilated, measuring 8 mm, as opposed to 6 mm. The previous seen filling\ndefects thought to be stones are not definitely seen on this exam. There is\nno definite evidence of an choledocholithiasis. There is no abnormal\nenhancement around the bile ducts to suggest active cholangitis. The\ngallbladder is surgically absent.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or solid mass. Again, there is a T2\nhyperintense lesion in the head of the pancreas, compatible with a cyst. It\nmeasures 8 mm (2, 21). Allowing for changes in measurement technique, this is\nnot significantly changed. Additionally, a tiny 4 mm cystic lesion in the\nuncinate process is unchanged. No new pancreatic lesions are identified.\n\nSpleen: The spleen is enlarged, measuring 14.2 cm. In the posterior inferior\naspect of the spleen, there is a 10 mm T2 hyperintense lesion, which is\nnonenhancing, and most compatible with a cyst.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size with multiple subcentimeter cysts. \nThere are no worrisome renal lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract: There is a small hiatal hernia. The stomach and\nsmall bowel are otherwise normal in course and caliber. The imaged portions\nof the large bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There are multiple paraesophageal perigastric, and perisplenic\nvarices.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nAgain, there is a mild levoscoliosis in the lumbar spine and minimal\nmultilevel degenerative changes. The soft tissues are unremarkable.", "output": "1. No significant change in the appearance of the liver which is nodular with\nlarge bands of fibrosis related to known chronic sclerosing cholangitis. No\nfocal liver mass.\n2. Unchanged stricturing and irregularity of the bile ducts without a new\ndominant stricture. Previously-seen filling defects are not present on the\ncurrent study. No choledocholithiasis. No active cholangitis.\n3. Splenomegaly and varices, reflecting chronic portal hypertension. No\nascites.\n4. Unchanged subcentimeter pancreatic cystic lesions, which likely represent\nside branch IPMNs. These can be followed on subsequent liver surveillance\nstudies." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion. 6\nmm right diaphragmatic node.\n\nLiver: Macrolobulated appearance of the liver parenchyma with caudate lobe\nhypertrophy and linear areas of fibrosis in keeping with cirrhosis secondary\nto primary sclerosing cholangitis. There is no significant hepatic steatosis.\nNonspecific subcentimeter arterially enhancing lesion at the hepatic dome\n(axial series 1001, image 26) without washout or pseudo capsule. No lesions\nmeeting OPTN 5 criteria for hepatocellular carcinoma.\n\nBiliary: The gallbladder is surgically absent. The current examination has\nnot been optimized for evaluation of the biliary tree, however there is\nirregularity of the intra and extrahepatic biliary ducts which appears similar\nto previous. The common bile duct is prominent measuring up to 7 mm, which\nappears increased in comparison to the prior examination. No intraductal\nfilling defect is identified.\n\nPancreas: There are several small cystic pancreatic lesions in the pancreatic\nhead, largest measuring 8 mm, similar to previous. No pancreatic ductal\ndilatation.\n\nSpleen: The spleen is moderately enlarged measuring 14.9 cm. 12 mm cyst\nwithin the posterior pole of the spleen. 20 mm accessory splenic tissue\nadjacent to the inferior pole of the spleen.\n\nAdrenal Glands: The adrenal glands are normal in size and morphology.\n\nKidneys: Bilateral subcentimeter renal cortical cysts. No hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. No small or large bowel\ndistention.\n\nLymph Nodes: No retroperitoneal or mesenteric adenopathy.\n\nVasculature: Extensive esophageal and gastric varices, splenorenal varices,\nand right anterior abdominal wall collateral vessels. Hepatic arterial\nanatomy is conventional. No abdominal aortic aneurysm. The hepatic and\nportal venous systems are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "1. No MRI evidence of hepatocellular carcinoma.\n2. Morphologic features of cirrhosis secondary to PSC, with sequelae of portal\nhypertension including extensive esophageal varices.\n3. Stable pancreatic cystic lesions." }, { "input": "Lower Thorax: The imaged lung bases are clear. There is no evidence of\npleural or pericardial effusion.\n\nLiver: The liver is normal in contour. There is no significant chemical shift\nto suggest hepatic steatosis or iron deposition. No focal lesions are\nidentified. A normal enhancement pattern is demonstrated.\n\nBiliary: The gallbladder is within normal limits. There is no intrahepatic or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity, without focal\nlesions identified. There is no main pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size, without focal lesion seen.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal and symmetric in size, with normal\nnephrograms. No focal lesions are identified. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. There is no evidence of\ngastrointestinal obstruction.\n\nLymph Nodes: There is no evidence of abdominal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber and its major branches\nare patent. Conventional hepatic arterial anatomy is demonstrated. The\nportal, hepatic, superior mesenteric and splenic veins are patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are\nidentified. The abdominal wall is within normal limits.", "output": "The previously noted reticular enhancement pattern of the liver has resolved. \nUnremarkable study with patent hepatic vasculature." }, { "input": "Lower Thorax: The included lung bases demonstrate no pleural or pericardial\neffusion.\n\nLiver:\nThe liver demonstrates a cirrhotic morphology with a nodular contour.\nThere are band like areas of T2 hyperintensity with capsular retraction\n(series 5, image 10) in segment 4A and 8 demonstrating progressive enhancement\ncompatible with confluent hepatic fibrosis.\n Again seen are 2 hepatic hemangiomas in the caudate lobe measuring 1.9 x 1.4\ncm and in segment 4B measuring 2.2 x 2.4 cm in diameter unchanged compared to\nprior exam.\nAgain seen are scattered punctate foci of arterial hyper enhancement through\nthe liver demonstrating no washout on subsequent images compatible with\ntransient hepatic intensity difference.\nNo focal liver lesion with imaging features suspicious for ___.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is normal.\n\nPancreas: The pancreas is normal throughout with no focal lesion or ductal\ndilatation.\n\nSpleen: The spleen is enlarged measuring 13.9 cm. Punctate scattered\ncirrhotic nodules are seen in the spleen.\n\nAdrenal Glands: The adrenal glands are normal\n\nKidneys: The kidneys are normal in size with no evidence of hydronephrosis. \nThere is a 1.5 cm cyst within the lower pole of left kidney. Multiple smaller\nsubcentimeter bilateral small renal cysts are unchanged.\n\nGastrointestinal Tract: There is no bowel obstruction.\n\nLymph Nodes: Subcentimeter short axis porta hepaticus lymph nodes and\nretroperitoneal lymph nodes do not meet size criteria for pathologic\nenlargement.\n\nVasculature: Previously reported attenuation of the posterior right portal\nvein is not appreciated on this exam. The left portal vein drains to the vein\nof sappy and abdominal wall varices. Incidental note is made of hepatic\nartery arising directly from the aorta.\n\nOsseous and Soft Tissue Structures: There is no emesis lesion.", "output": "1. Cirrhotic liver morphology with no focal liver lesions meeting OPTN 5\ncriteria for HCC.\n2. Stable hepatic hemangiomas and scattered THIDS." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver again demonstrates a nodular contour with bandlike areas T2\nhyperintensity, representing fibrosis. There is redemonstration of a 2.2 x\n2.3 cm T2 hyperintense round lesion with nodular incomplete enhancement in\nsegment IVB, most compatible with a hemangioma (series 3, image 32)\n(previously 2.5 x 2.1 cm). There is an additional 1.9 x 1.7 cm T2\nhyperintense nonenhancing lesion in segment I (series 3, image 14) (previously\n1.8 x 1.5 cm). There is also a 0.9 x 0.7 cm T2 hyperintense nonenhancing\nlesion and segment II (series 2, image 17) (previously 0.9 x 0 7 cm). There\nare other punctate foci of arterial enhancement without correlate seen on\ndelayed images, representing transient hepatic intensity differences. No OPTN\n5 lesions are detected.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is top-normal in size, measuring up to 12.8 cm (series 2,\nimage 37) and contains Gamma Gandy bodies.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis. There are multiple T2 hyperintense nonenhancing\nlesions throughout kidneys, measuring up to 1.5 cm in the interpolar region of\nthe left kidney, compatible with renal cysts (series 2, image 27).\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: There multiple collateral vessels seen in the anterior abdomen\nand recanalized umbilical vein. Abdominal aorta is normal in caliber and\nmajor branch vessels are patent. The portal vein, splenic vein and SMV are\npatent. Incidentally, it is noted that the common hepatic artery arises from\nthe superior mesenteric artery.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There are multilevel degenerative changes throughout the\nthoracolumbar spine. There are no osseous lesions concerning for malignancy\nor infection.", "output": "Cirrhotic liver with multiple hemangiomas and sequela of portal hypertension\nincluding splenomegaly and collateral vessels, similar to prior exam. No OPTN\n5 lesion." }, { "input": "There is an encapsulated progressively enhancing 4.6 x 4.1 x 3.6 (AP x\ntransverse X CC ___ mass within the inferior pole of the right kidney\nwith internal foci of hemorrhage. This right renal mass has no specific\nbenign features however there is no clear drop-off of fat which is often seen\nin clear cell renal cell carcinoma and no significant early hypervascularity. \nFeatures are however most suggestive of a clear cell type renal cell carcinoma\nalthough other oncocytic neoplasms such as oncocytoma or a chromophobe type\nrenal cell carcinoma cannot be excluded from the differential diagnosis. \nThere is displacement and dilatation of the calyces within the lower pole of\nthe right kidney due to this right renal mass. Overall, the mass is similar\nin size when compared to the prior examination.\n\nThere is a single early dividing right renal artery. The renal vein and\ninferior vena cava are patent with no findings to suggest tumor thrombus. \nThere is no significant upper abdominal or retroperitoneal lymphadenopathy.\n\nThere is a 3.8 x 2.6 cm mass within the left adrenal gland with peripheral\ndrop-off of signal on T1 out-of-phase imaging, which suggests an adenoma. \nHowever, there is also a central 1.6 x 1.3 cm heterogeneous component of the\nleft adrenal mass with T2 hyperintensity and enhancement within the left\nadrenal gland. Therefore, the findings within the left adrenal gland are most\nsuggestive of a collision tumor most likely representing an adrenal adenoma\nwith a hemangioma, however an adenoma with a metastasis, particularly from\nrenal cell carcinoma cannot be excluded.\n\nThere is significant atherosclerosis of the abdominal aorta. In addition,\nthere is a large infrarenal abdominal aortic aneurysm measuring 5.4 x 6.9 cm\n(AP x transverse dimension); overall similar when compared to the prior\nexamination. The infra-renal aortic aneurysm extends over a length of 10 cm\nin CC dimension of the infrarenal abdominal aorta. There is significant\neccentric thrombus formation noted at the level of the abdominal aortic\naneurysm.\n\nThere is a 5 mm cystic lesion within the tail of the pancreas which may\nrepresent an intraductal papillary mucinous neoplasm (IPMN) (4:13).\n\nThe liver, gallbladder, spleen, appear unremarkable. There is a small hiatal\nhernia. There is a probable small fibroid within the uterus, partially imaged.\n\nThe lung bases appear unremarkable.\n\nThe bone marrow signal intensity within normal limits.", "output": "1. Encapsulated, progressively enhancing renal mass in the inferior pole of\nthe right kidney which most likely represents a clear cell renal cell\ncarcinoma however an oncocytoma or chromophobe type renal cell carcinoma\ncannot be excluded. Early division of a single right renal artery. Renal\nvein and inferior vena cava are patent without tumor thrombus.\n\n2. 3.8 cm left adrenal lesion with central heterogeneous component; findings\nare most suggestive of a collision tumor most likely representing an adrenal\nadenoma with a hemangioma, however an adenoma with a metastasis, particularly\nfrom renal cell carcinoma cannot be excluded.\n\n3. Large infrarenal abdominal aortic aneurysm measuring 5.4 x 6.9 cm (AP x\ntransverse dimension), with eccentric thrombus; overall similar when compared\nto the prior examination.\n\n4. 5 mm cystic lesion within the pancreatic tail may represent intraductal\npapillary mucinous neoplasm (IPMN) which may be followed up in ___ year with an\nMRI to evaluate stability.\n\nNOTIFICATION: Findings discussed with Dr. ___ at 17:40 on ___, 5 minutes after discovery of findings as well as on ___ at\n9:15AM. Findings of a pancreatic cystic intrapapillary mucinous neoplasm and\nadrenal mass were discussed with Dr. ___ at 18:10 on ___, 15\nminutes after discovery of the findings." }, { "input": "Lower Thorax: The lower thorax is unremarkable. There is no pericardial or\npleural effusion.\n\nLiver: The liver demonstrates normal contour. There are no morphologic signs\nof liver cirrhosis. There is mildly heterogenous fat deposition measuring up\nto 5%.\n\nThere are 4 very mildly T2 hyperintense lesions without arterial enhancement\nwhich are actually more hypointense on the postcontrast images compared to the\nprecontrast images and do not retain Eovist:\n\n- 0.8 cm at the junction of segments 8 and 4A (13:8)\n- 1.7 cm and 1.0 cm in segment 8 (13:7)\n- 1.1 cm in the dome (13:6)\n\nThere are additional smaller subcentimeter scattered lesions seen best on the\n20 minutes delayed sequences without arterial enhancement and which do not\nretain Eovist on delayed imaging which are not well seen on T2 images (series\n20, images 34, 45, 46, 32).\n\nNo suspicious hepatic lesions are seen.\n\nBiliary: The gallbladder is present. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation. Incidental note is made of the right anterior\nhepatic duct inserting on the left hepatic duct.\n\nPancreas: The pancreas demonstrates normal signal intensity on the T1 weighted\nimages and enhances homogeneously. There are a few scattered tiny T2\nhyperintense nonenhancing cystic lesion within, the largest within the\nuncinate process measuring 0.4 cm, most likely side-branch IPMN. The main\npancreatic duct is not dilated. There are no suspicious solid mass lesions.\n\nSpleen: The spleen is normal in size and signal intensity without focal lesion\nseen. There is a small splenule.\n\nAdrenal Glands: The adrenal glands are normal in shape and size.\n\nKidneys: The kidneys demonstrate normal corticomedullary differentiation and\nare symmetric and normal in size without hydronephrosis.No renal lesions are\nseen.\n\nGastrointestinal Tract: The visualized large and small bowel demonstrate\nnormal thickness and caliber.\n\nLymph Nodes: There is no lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in size. Note is made of a replaced\nleft hepatic artery from the left gastric artery.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen. \nThe body wall is within normal limits.", "output": "1. No suspicious hepatic lesions are seen. There are several (8) lesions seen\nscattered throughout the liver which do not demonstrate arterial\nhyperenhancement and do not retain Eovist on delayed imaging. The 4 largest\nlesions are very slightly T2 hyperintense. This constellation of imaging\nfindings suggests a degree of fibrosis and these lesions are favored to\nrepresent benign lesions. These can be followed up on imaging performed for\nre-evaluation of the pancreas.\n2. Stable appearance of cystic non-enhancing lesions within the pancreas, the\nlargest measuring 0.4 cm in the uncinate process, most likely side-branch\nIPMNs. Per the interdisciplinary institutional guidelines, ___ year follow-up\nwould be recommended in a patient of average risk.\n3. Mild hepatic steatosis.\n\nRECOMMENDATION(S): MRCP for pancreatic cyst follow up in 1 or ___ years\ndepending on patient's pancreatic cancer risk" }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver capsule is smooth. Hepatic parenchyma is homogeneous. Mild\nhepatic steatosis. Subcentimeter nonenhancing T2 hyperintense lesions\nthroughout the liver likely represent cysts or biliary hamartomas. No\nenhancing liver lesions.\n\nBiliary: No intra or extrahepatic biliary dilatation. Gallbladder\nunremarkable in appearance. Note is made of a Phrygian cap.\n\nPancreas: 3 mm T2 hyperintense lesion within the pancreatic head likely\nrepresents a side branch IPMN (series 3, image 29). Otherwise, pancreas is\nnormal in bulk and signal intensity. No main ductal dilatation. No\nperipancreatic stranding.\n\nSpleen: Spleen is not enlarged. No focal splenic lesions. Small accessory\nspleen near the hilum.\n\nAdrenal Glands: Adrenal glands are normal in size and shape bilaterally.\n\nKidneys: Subcentimeter cyst within the upper pole right kidney. Otherwise,\nthe kidneys enhance homogeneously and symmetrically. No enhancing renal\nlesions. No hydronephrosis. No perinephric stranding.\n\nGastrointestinal Tract: Partially imaged stomach, small, and large bowel are\nunremarkable in appearance. No bowel obstruction.\n\nPelvis: The bladder, prostate, and seminal vesicles are unremarkable in\nappearance. No pelvic free fluid.\n\nLymph Nodes: No upper mesenteric or retroperitoneal lymphadenopathy. No\npelvic or inguinal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Major abdominal branches are\npatent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. \nPostsurgical changes within the midline anterior abdominal wall.", "output": "1. No evidence of recurrence or metastatic disease within the abdomen or\npelvis. Previously visualized mesenteric lymph nodes have decreased in size\ncompared to prior, now within normal limits.\n2. Mild hepatic steatosis.\n3. 3 mm cystic lesion within the pancreatic head, likely a side branch IPMN.\n\nRECOMMENDATION(S): For management of pancreatic cyst(s) up to 5 mm in\npatients in less than ___ years of age, a non-contrast MRCP follow-up is\nrecommended in ___ years.\n\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Lower thorax: Partially imaged lung bases are clear.\n\nLiver: Liver demonstrates normal parenchymal morphology with heterogenous\nenhancement, likely related to OCP related changes. There is diffuse loss of\nsignal intensity on the out of phase images consistent with hepatic steatosis\nwith few areas of fatty sparing. The total fat fraction is estimated to be 18\npercent in keeping with moderate steatosis.\n\nAgain seen is the T2 hyperintense lesion in the left lobe with progressive\nperipheral nodular enhancement on the postcontrast images (series 19 image 24)\nmeasuring 5.1 x 5.5 x 6.4 cm (TRV x AP x CC), in keeping with a hemangioma\n(previously on ultrasound this measured 5.5 x 6.5 x 7.5 cm). This is\npartially exophytic (more than 50%). The lateral most aspect of the left lobe\nappears mildly atrophic likely related to mass effect. Smaller hemangioma is\nalso seen inferiorly in segment 3 measuring 7 mm (series 19, image 38). There\nis no ascites.\n\nBiliary: The gallbladder is normally distended without evidence of wall\nthickening. No intra or extrahepatic biliary dilatation.\n\nPancreas: Pancreas shows homogeneous signal intensity enhancement. No\nevidence of pancreatic ductal dilatation or focal masses. Punctate T2\nhyperintensity in the pancreatic tail likely represents a tiny cyst.\n\nSpleen: Normal size without evidence of focal lesions.\n\nAdrenal Glands: Normal size and shape bilaterally.\n\nKidneys: Both kidneys are normal in size and show symmetric enhancement. Few\nsubcentimeter T2 hyperintense nonenhancing lesions in bilateral cortices in\nkeeping with simple cysts. No suspicious renal mass identified. There is no\nhydronephrosis.\n\nGastrointestinal Tract: The stomach and visualized bowel loops are within\nnormal limits.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: No evidence of abdominal aortic aneurysm. Conventional aortic\nbranches patent. Portal veins are patent.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal. No soft tissue\nabnormality.", "output": "1. Hepatic hemangiomas, stable compared to the prior ultrasound. Larger 1 in\nthe left lobe is partially exophytic.\n2. Diffuse hepatic steatosis with areas of fatty sparing. Given degree of fat\nsteatohepatitis cannot be excluded." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nAgain seen is diffuse reticular contrast enhancement throughout the hepatic\nparenchyma on delayed sequences (series 313, image 32), compatible with\nconfluent fibrosis. Heterogeneous areas of signal drop-off on T1 weighted out\nof phase images in comparison to in phase sequences denotes steatosis (series\n3, image 14, 39). The portal and hepatic veins remain patent. Replaced right\nlateral hepatic arteries are again seen arising from the celiac trunk (series\n10, image 70). A replaced left hepatic artery arises from the left gastric\n(series 10, image 43).\n\nRF ablation zones within segment VIII (3.9 x 2.2 cm, series 13, image 21), and\nsegment VI (3.0 x 2.8 cm, series 13, image 43), are well-circumscribed and\nnonenhancing, with central areas of increased signal intensity on T1 weighted\nprecontrast images denoting coagulation necrosis (series 7, image 24, 45),\nremaining stable since the prior MRI examination from ___. A\npreviously chemoembolized segment II hepatic mass is no longer detectable. No\nnew hepatic mass is detected.\n\nThere is no intra or extrahepatic bile duct dilation. Cholelithiasis is again\nseen (series 4, image 17). No ductal stones are present.\n\nCystic lesions within the pancreatic tail, neck, and body are unchanged,\nmeasuring up to 8 mm in diameter (series 4, image 24), likely side branch\nIPMN. The main pancreatic duct remains normal in caliber. Moderate pancreatic\nsteatosis is present.\n\nThe adrenal glands, kidneys, spleen, stomach, and intra-abdominal loops of\nsmall and large bowel are normal. There is no mesenteric or retroperitoneal\nlymphadenopathy, and no ascites. There is mild rectus diastasis without hernia\n(series 4, image 25).\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal in caliber.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "1. Post RF ablation within segments VI and VIII, with no evidence of local\nrecurrence. Previously-seen chemoembolized segment II mass is no longer\nvisualized. No new hepatic mass.\n2. Confluent hepatic fibrosis. Heterogeneous steatosis.\n3. Cystic pancreatic lesions measuring up to 8 mm, likely side branch IPMN,\nremain stable." }, { "input": "There is right basilar atelectasis but no pleural effusion. There is no\ncardiomegaly.\n\nThere is mild heterogeneous hepatic steatosis. There are several\nwell-circumscribed intrinsically T1 hyperintense foci without abnormal\nenhancement, consistent with areas of coagulative necrosis from prior\nradiofrequency ablation. The 3.8 x 2.4 cm site in segment 8 (16:27) and the\n2.8 x 2.8 cm site in segment 6 are stable (16:44). The newest RF ablation\nsite, also in segment 8, measures 5.3 x 3.6 cm (16:25). There are several\nfoci of arterial hyperenhancement which do not washout on delayed phase\nimaging, likely perfusion abnormalities (12:30, 42, 48, 57). Reticular\nenhancement is consistent with mild but stable hepatic fibrosis. There are no\nareas suspicious for malignancy.\n\nVariant hepatic arterial anatomy is again noted, with a replaced right hepatic\nartery arising from the celiac trunk and a replaced left hepatic artery\narising from the left gastric artery. The portal, splenic, and superior\nmesenteric veins are patent. The hepatic veins and IVC are patent.\n\nThere is cholelithiasis without evidence of cholecystitis. There is no\nsignificant intra- or extrahepatic bile duct dilation.\n\nThe pancreas is normal in signal intensity. There are several stable cystic\npancreatic lesions, likely side branch IPMNs, the largest in the body\nmeasuring 11 x 8 mm (5:27). The 8 x 6 mm cyst in the uncinate process of\npancreas is more conspicuous on today's study (5:22) but stable from ___. The main pancreatic duct is normal in caliber. The spleen is minimally\nenlarged but stable, measuring 13.8 cm in craniocaudal length (5:10). There is\nno focal splenic lesion. The kidneys are normal bilaterally with no focal\nlesion. The adrenal glands are normal bilaterally.\n\nThe imaged small and large bowel are normal in caliber, without focal\nabnormality.\n\nThere is no significant mesenteric or retroperitoneal lymphadenopathy. The\nabdominal vasculature is normal and patent. There is no ascites.\n\nThe osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "1. No evidence of recurrent malignancy or metastatic disease.\n2. Coagulative necrosis from prior radiofrequency ablation.\n3. Right basilar atelectasis without residual pleural effusion.\n4. Several stable cystic pancreatic lesions, likely side branch IPMNs. These\ncan continue to be assessed for stability on future oncologic follow-up scans." }, { "input": "There are linear atelectasis in the right lung base. There is no pleural or\npericardial effusion.\n\nThe liver is nodular with cirrhotic morphology. In segments VII and VIII there\nare 2 ablation zones, measuring 2.9 x 2.3 cm and 5.4 x 3.6 cm (4:10, 16).\nThere are intrinsically T1 hyperintense contents within the zones of\ntreatment, consistent with lobulation necrosis. There are no foci of\nrestricted diffusion, arterial hyper enhancement or washout in the vicinity of\ntreatment zones. Several arterial hyper enhancing foci without correlation on\nlater phases of the postcontrast study or on diffusion-weighted images are\ndemonstrated (901:25, 62), consistent with transient hepatic intensity\ndifferences. No concerning liver lesions are seen.\nThere is variant arterial hepatic anatomy with left hepatic artery arising\nfrom the left gastric artery. The portal and hepatic veins are patent.\n\nCholelithiasis is present.\nThe intra and extrahepatic biliary ducts are normal in caliber.\nPancreas is normal in size and signal, without focal masses or ductal\ndilatation.\nThe spleen is mildly enlarged, measuring 14 cm in craniocaudal dimension.\nSubcentimeter cortical renal cysts are seen bilaterally. The adrenals are\nnormal.\nThere is no free fluid in the abdomen.\nThere are prominent portocaval lymph nodes, in keeping with underlying liver\ndisease.\nThe bone marrow signal is normal.", "output": "Cirrhotic liver with mild splenomegaly.\nTreated liver lesions, without concern for recurrence.\nCholelithiasis" }, { "input": "Lower Thorax: Again seen in the right mediastinum on localizer images is a 3.4\nx 2.5 cm circumscribed cystic structure, likely corresponding to loculated\nfluid in a pericardial recess better appreciated on CT chest from ___. This is unchanged in appearance since prior exam. There is no pleural\nor pericardial effusion.\n\nLiver: There is diffuse hepatic steatosis (fat fraction approximately 8%). A\nnodular hepatic surface contour with left hepatic lobe hypertrophy is\ncompatible with cirrhosis. Again seen are multiple sites of post treatment\nchange in segments VII, VIII, and on the border of VII/VIII, measuring 2.7 cm,\n2.2 cm, and 3.9 x 3.0 cm, respectively (series 17, image 37). Areas of\ninternal intrinsic T1 hyperintensity are compatible with coagulation necrosis\nin the setting of prior RFA. There is no evidence of intralesional\nenhancement to suggest recurrence. No focus of arterial hyperenhancement or\nother concerning focal lesion is identified elsewhere the liver. The portal\nvein is patent.\n\nBiliary: There is no intra- or extrahepatic biliary ductal dilation. Multiple\ngallstones are seen layering within the gallbladder lumen. A 3 mm T2\nhypointensity measuring adheres anti-dependently to the lateral gallbladder\nwall (series 4, image 24), likely a small polyp. Otherwise, the gallbladder\nis unremarkable.\n\nPancreas: Diffuse fatty replacement of the pancreas is most prominent in the\npancreatic head. There are multiple circumscribed T2 hyperintense lesions\nseen throughout the pancreas, the largest of which is in the pancreatic body\nand measures 10 mm (series 4, image 13). Additional scattered smaller\nsubcentimeter cystic foci are seen in the posterior pancreatic body, head, and\ntail measuring up to 3-4 mm, not appreciably changed since prior exam from\n___.\n\nSpleen: There is no splenomegaly or focal splenic lesion.\n\nAdrenal Glands: A 13 x 12 mm left adrenal nodule does not demonstrate signal\ndrop on in a phase gradient echo images, however is stable dating back to at\nleast ___. The right adrenal gland is normal.\n\nKidneys: There may be a tiny, 1-2 mm simple cyst in the medial left upper\nrenal pole. Otherwise, the partially imaged kidneys demonstrate normal signal\nintensity and enhancement characteristics. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. Partially\nimaged non-dilated small bowel loops are normal in course and caliber without\nevidence of wall thickening, mural or mucosal hyperenhancement, or\nobstruction. The partially imaged colon is unremarkable.\n\nLymph Nodes: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. Major proximal tributaries are patent. The right and\nleft hepatic arteries arise separately from the celiac trunk, with a\nportocaval position of the right hepatic artery (series 17, image 84 and 85).\n\nOsseous and Soft Tissue Structures: No suspicious foci of abnormal marrow\nsignal are seen.", "output": "1. Stable multifocal posttreatment changes in segments VII, VIII, and segment\nVII/VIII. No concerning focal hepatic lesions or evidence of local\nrecurrence.\n2. Stable 13 mm left adrenal nodule, unchanged since at least ___.\n3. Stable multifocal pancreatic cystic foci, likely side-branch IPMNs. \nAttention on followup imaging.\n4. Cholelithiasis. Small, approximately 3 mm gallbladder polyp.\n5. Diffuse hepatic steatosis.\n6. The right and left hepatic arteries arise separately from the celiac trunk,\nwith a portocaval position of the right hepatic artery." }, { "input": "Uterus: Uterus is in neutral position measuring 4.2 x 6.6 x 4.9 cm and has\nslightly decreased in size since prior MR.\n\n___ zone: Unremarkable.\n\nEndometrium: Normal in thickness measuring 3 mm.\n\nCervix: In comparison to ___ there is evidence of treatment response\nwith significant interval decrease in size of the cervical mass which now\nhypoenhancing and measures 1.4 x 2.8 x 1.2 cm (SI x TV x AP) along the left\nlateral cervix os without definite parametrial extension at this level and is\nhyperenhancing and measures approximately 2.7 x 2.4 x 1.9 cm along the right\nlateral cervical os with right lateral and anterolateral parametrial\nextension, which has overall decreased since prior examination (AP x TV x SI).\n(04:25; 03:15). Assessment for tumor viability is limited due to\nsusceptibility artifact from right ureteral, likely metallic stent which\nlimits diffusion-weighted imaging abdominal as well as fat saturation. \nAdditionally, evaluation for bladder involvement, and distal right ureter\nencasement as well as portions of the right lateral residual tumor are\nobscured due to susceptibility from the stent.\n\nNondistended vagina: Unremarkable.\n\nOvaries: Bilateral ovaries are visualized and within normal limits.\n\nBowel: Rectum, visualized small and large bowel are unremarkable. No\nobstruction.\n\nBladder: Bladder is unremarkable without suspicious mass. Previously noted\nencasement of tumor of the distal right ureter is not well visualized due to\nsusceptibility artifact.\n\nLymph Nodes: No new lymphadenopathy. Inguinal lymph nodes are\nnonenlarged.Previously noted enlarged bilateral pelvic sidewall lymph nodes\nhave significantly decreased in size with residual right pelvic sidewall lymph\nnode now measuring 1.5 x 0.9 cm (06:21; (previously 3.4 x 2.4 cm). Previously\nnoted large left pelvic sidewall lymph node is no longer evidence.\n\nVasculature: Patent vasculature. No aneurysmal dilatation.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. Evidence of treatment response with residual 2.8 cm tumor within the left\nlateral cervical os without definite parametrial extension and 2.7 cm right\nlateral cervical os with right lateral and anterolateral parametrial\nextension. Evaluation for tumor viability, posterior bladder involvement, and\ndistal right ureter encasement is limited due to susceptibility artifact from\nadjacent metallic stent.\n2. Significant decrease in right pelvic sidewall lymphadenopathy with\nresidual 1.5 x 0.9 cm lymph node. Previously noted left pelvic sidewall\nlymphadenopathy has resolved. No new lymphadenopathy." }, { "input": "The lung bases are grossly clear.\n\nLiver: Two liver lesions located in segments VI and VII (series 14, image 27\nand 41) are low signal on the precontrast T1 weighted images, high signal on\nT2 weighted images and demonstrates rim enhancement. There is a simple cyst or\nbiliary hamartoma and segment VI. Otherwise, the liver is normal in signal\nintensity. There is no significant intra or extrahepatic biliary ductal\ndilatation.There is no ascites.\n\nGallbladder: The gallbladder contains a stone. There is no evidence of\ncholedocholithiasis or stricture.\n\nPancreas: There is loss of the high signal within the head, neck and proximal\nbody of the pancreas on the pre contrast T1-weighted images that is\nhypoenhancing relative to the remaining pancreatic parenchyma and measures 7.7\nx 4.6 x 2.6 cm (TRV x AP x CC). The distal pancreatic duct in the distal body\nand tail is dilated with an abrupt change in caliber in the distal body at the\nbeginning of the mass (series 5, image 25). The tumor encases the celiac axis\nincluding the common hepatic artery, gastroduodenal artery, the proper hepatic\nartery and the splenic artery. All of the arteries are patent, however, the\norigin of the celiac axis is narrowed. The splenic vein is thrombosed. The\nportal vein and the superior mesenteric vein are patent, however, the portal\nconfluence is encased. There is classic pancreatic ductal anatomy.\n\nSpleen: The spleen is normal in appearance.\n\nKidneys and Adrenals: The adrenal glands are normal bilaterally. There\nsubcentimeter renal cysts in each kidney. There is no hydronephrosis or\nworrisome renal lesions.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: The multiple prominent retrocrural lymph nodes up with central\nhypo enhancement concerning for necrosis (series 14, image 26, 49 and 92).\n\nBones: The osseous structures are unremarkable.\n\nVessels: The superior mesenteric artery is patent. The patient is status post\ninfrarenal abdominal aortic aneurysm repair. There are stents in the bilateral\ncommon iliac arteries and the left external iliac artery.", "output": "1. A large pancreatic mass centered in the neck of the pancreas measuring 7.7\ncm encases the major vessels of the celiac axis and the portal confluence\nwhich are patent. The splenic vein is thrombosed. Multiple retrocrural lymph\nnodes with central hypo enhancement likely represent necrotic lymph node\nmetastases. Hypodense lesions with rim enhancement in the liver are concerning\nfor metastasis. These findings are most concerning for adenocarcinoma of the\npancreas. Upper endoscopic ultrasound with biopsy is recommended.\n\n2. Cholelithiasis without evidence of acute cholecystitis.\n\nNOTIFICATION: Findings discussed by telephone with Dr. ___ by Drs. \n___ at ___ 1635." }, { "input": "The liver is normal in size and contour. There is no signal abnormality to\nsuggest the presence of hepatic steatosis. There are multiple T2\nhyperintense, T1 hypointense and nonenhancing structures scattered throughout\nthe parenchyma. The largest has diameter of 1.8cm within segment V (3:14). \nThese represent hepatic cysts and/or biliary hamartomas and correlate with the\nhypoattenuating lesions seen on recent CT.\n\nThere is cholelithiasis without evidence of cholecystitis (5:34). The intra\nand extrahepatic bile ducts are of normal caliber and contour, without filling\ndefect.\n\nMultiple bilateral renal cysts are noted. Each is T2 hyperintense, T1\nhypointense and nonenhancing, without concerning features. Several foci of\nparenchymal thinning are noted (3:21), likely relating to a prior insult. \nThere is no hydronephrosis or solid renal mass.\n\nThe pancreatic parenchyma is normal in bulk, signal and enhancement. There\nare scattered parenchymal cystic lesions, presumably side branch IPMNs, the\nlargest measuring 6mm within the head (3:12).\n\nThe adrenal glands and spleen are normal. There is no lymphadenopathy or\nascites. A small duodenal diverticulum is noted. Osseous structures are\nunremarkable. Arterial vascular anatomy is conventional. Venous structures\nare patent.", "output": "1. Multiple hepatic cysts/biliary hamartomas. No metastases detected.\n2. Subcentimeter pancreatic cystic lesions, likely side branch IPMNs, for\nwhich surveillance with noncontrast MRI is recommended in ___ year." }, { "input": "The pancreatic tail and portion of the long uncinate process appear slightly\ndecreased in T2 and T1 signal, suggesting resolving pancreatitis. Otherwise,\nthe remaining pancreas appears homogeneous on the T1- and T2-weighted signal\nsequences with homogeneous enhancement. No pancreatic ductal dilatation or\nperipancreatic inflammatory changes. Resolution of inflammatory changes\nadjacent to the pancreatic body and tail. Resolution of phlegmonous change in\nthe lesser sac superior to the pancreatic body. No pseudocyst is evident. \nUpon secretin injection, appropriate increase in caliber of the main\npancreatic duct diffusely without visualization of the side branches. No\nintrahepatic or extrahepatic biliary ductal dilatation. Abnormal filling of\nthe gallbladder following secretin administration is seen. Although the\npancreatic duct and common duct appear to have normal anatomical relationship,\nthe existence of a common channel is raised. The gallbladder is collapsed on\nthe initial images. Stable gallbladder polyp, better measured on ultrasound.\n\n9-mm T2 hyperintense focus in segment VIII of the liver demonstrates\ndiscontinuous peripheral enhancement compatible with a hemangioma. A 3mm\narterially enhancing focus in segment II (series 1701, iamge 33) likely\nrepresents a hemangioma. A 1-cm T2 hyperintense non-enhancing focus at the\nsegment VII dome of the liver is compatible with a cyst. Additional smaller\nT2 hyperintense foci are seen without apparent enhancement likely representing\nadditional cysts. No intrahepatic biliary ductal dilatation. The portal vein\nand branches are patent. The hepatic veins, SMV, splenic vein are normally\nopacified. The spleen is normal in size and signal intensity. At the tail of\nthe pancreas, a stable splenule is present measuring 1.2 cm with signal\ncharacteristics and enhancement similar to the spleen. No significant celiac\naxis or mesenteric adenopathy by size criteria. The adrenal glands are\nunremarkable bilaterally. The kidneys enhance and excrete contrast\nsymmetrically. Preserved corticomedullary differentiation. No hydronephrosis\nor hydroureter. No significant retroperitoneal adenopathy or fluid\ncollections. The abdominal aorta is normal in caliber and opacification. \nConventional arterial anatomy is seen. Branches of the celiac axis and SMA\nare patent. Single bilateral renal arteries are symmetric in caliber and\nopacification.\n\nThe visualized small bowel loops appear to have normal morphology and wall\nthickening. No mesenteric ascites or significant adenopathy. The colon is\ncollapsed with left colonic diverticulosis.\n\nOverlying soft tissues appear preserved.\n\nBone marrow signal is age appropriate. No destructive osseous lesions are\nseen. Mild degenerative changes of the lumbar spine.", "output": "1. No pseudocyst is evident. Resolution of phlegmon in the lesser sac\nsuperior to the pancreatic body and peripancreatic inflammatory changes near\nthe tail. Decreased T1 and T2 signal of the pancreatic tail and portion of the\nvery long uncinate process suggestive of resolving pancreatitis. \n2. Normal response to secretin of the main pancreatic duct. Abnormal filling\nof the gallbladder following secretin administration is seen. Although the\npancreatic duct and common duct appear to have normal anatomical relationship,\nthe existence of a common channel is raised.\n3. Segment VIII and II hemangioma. Numerous scattered hepatic cysts are seen\nin addition.\n4. Splenule at the pancreatic tail." }, { "input": "Study is incomplete and markedly degraded by motion. Only the localizer and\nthe coronal SSFSE series were obtained.\n\nThere is a partially evaluated large hiatal hernia. On the limited images,\nthere is no obvious renal mass. The left adrenal gland is unremarkable. The\nright adrenal gland is not definitively visualized. No evidence of bowel\nobstruction. A Foley catheter is present in a decompressed bladder. Mild\nS-shaped curvature of the lumbar spine. No ascites.", "output": "Incomplete examination. The provided sequences are markedly degraded by\nmotion artifact. If the patient is unable to hold still for an MRI, further\nevaluation and characterization of the previously described left renal mass\ncould be obtained with a renal protocol CT." }, { "input": "The patient was unable to complete the examination secondary to\nclaustrophobia. Only coronal and axial T2 weighted sequences were obtained,\ntherefore evaluation is limited.\n\nLower Thorax: The heart is normal in size. There is no pleural or pericardial\neffusion.\n\nLiver: The liver is normal in size and smooth in contour. The presence of\nhepatic steatosis cannot be assessed in the absence of in and out-of-phase\nsequences. No MRI correlate is identified for the left hepatic lobe lesion\ndescribed on abdominal ultrasound from ___, noting that evaluation is\nlimited.\n\nBiliary: Multiple gallstones are present. There is no intra or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: The pancreas is grossly unremarkable. There is no pancreatic ductal\ndilatation.\n\nSpleen: The spleen is normal in size.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric. There is no renal mass or hydronephrosis.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The aorta and major mesenteric branch vessels are normal in\ncaliber.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is normal. The\nabdominal wall is within normal limits.", "output": "Limited evaluation, as the patient was unable to complete the study. No MRI\ncorrelate identified for the left hepatic lobe lesion described on abdominal\nultrasound from ___. Hepatic steatosis cannot be assessed in the\nabsence of in and out-of-phase sequences.\n\nRECOMMENDATION(S): If there is continued concern regarding abnormal LFTs, and\ngiven the patient's difficulty tolerating MRI, consider a CT or ultrasound\nfollow-up in 3 months." }, { "input": "The bases of the lungs demonstrate multiple lesions, better evaluated on the\nrecent prior chest CT and shown to have internal calcifications, likely\nreflecting pulmonary hamartomas in this patient with ___'s syndrome. A\nsmall left pleural effusion is also seen.\n\nMultiple T2 hyperintense lesions are seen within the liver, measuring up to 6\nmm, likely secondary to simple cysts or biliary hamartomas. No hepatic\nlesions concerning for malignancy are identified. The spleen is enlarged\nmeasuring up to 16 cm without a focal mass. The gallbladder is normal\nwithout evidence of wall thickening, or stones. The pancreas is normal\nwithout evidence of focal lesions or pancreatic ductal dilatation. The common\nbile duct is normal.\n\nThe inferior pole of the right kidney demonstrates a T2 hyperintense lesion,\nmeasuring approximately 7 mm, compatible with a simple renal cyst. Remainder\nthe right kidney is unremarkable. Both adrenal glands are normal.\n\nThe left kidney demonstrates a T2 heterogeneously hyperintense, lobulated\ncystic lesion arising from the upper pole of the left kidney which extends to\ninvolve the collecting system centrally measuring approximately 8.7 cm TRV x\n5.2 cm AP x 7.2 cm CC. This mass has heterogeneous areas of T1 and T2\nhyperintensity as well as a T2 hypointense circular area within the right\nkidney with susceptibility artifact likely secondary to hemosiderin\ndeposition, and exhibits peripheral rim enhancement. No internal enhancing\nsolid component concerning for malignancy is identified. An enhancing linear\ncomponent of the lesion (1201;34) appears to increase in signal intensity on\nthe delayed phase post-contrast imaging, and likely represents excretion of\ncontrast within the upper pole collecting system which is involved by this\nlesion. A second curvilinear area of enhancement within an exophytic\ncomponent of the lesion (1401;61), likely represents a septation or prominent\nvessel. The lesion extends exophytically posterolaterally and inferiorly to\nthe inferior pole of the spleen, and abuts the left psoas muscle, with\nadjacent stranding, edema, and inflammation resulting in enhancement of the\nfascia of Zuckerkandl, Gerota's fascia, and the splenic capsule.\n\nThe remainder of the left kidney demonstrates subtle striated restricted\ndiffusion, and mildly heterogeneous enhancement, likely secondary to\npyelonephritis. There is no evidence of hydronephrosis.\n\nExtensive retroperitoneal lymphadenopathy is seen, measuring up to 1.8-cm in\nshort-axis, primarily in the left paraaortic region, likely reactive.\n\nModerate atherosclerotic disease is seen throughout the aorta. No marrow\nsignal abnormalities are identified.", "output": "1. Large 8.7 cm complex cystic mass arising from the upper pole of the left\nkidney with involvement of the upper pole collecting system and surrounding\nrim enhancement and stranding, most compatible with an abscess complicated by\ninternal hemorrhage. No solid internal enhancing component concerning for\nmalignancy is identified. The lesion extends exophytically to abut the spleen\nand left psoas muscle and there is adjacent surrounding inflammation and\nextensive retroperitoneal lymphadenopathy measuring up to 1.8 cm, likely\nreactive.\n\n2. Evidence of pyelonephritis in the remainder of the left kidney.\n\n3. Innumerable lesions throughout the lung bases, better evaluated on the\nchest CT and shown to have internal calcifications. These likely reflect\npulmonary hamartomas in this patient with Cowden's syndrome.\n\n4. Moderate splenomegaly.\n\nNOTIFICATION: ___ were d/w Dr. ___ at 11:20A on ___ by phone by Dr.\n___." }, { "input": "Lower Thorax: No pleural or pericardial effusion. Lung bases are within\nnormal limits.\n\nLiver: Hepatic steatosis noted.\n\nBiliary: There is a large, 2.9 cm stone noted in the gallbladder. No wall\nthickening or pericholecystic fluid.\n\nPancreas: Pancreas is normal in signal and morphology. No ductal dilatation.\n\nSpleen: The spleen is normal in signal and morphology. No focal splenic\nlesions.\n\nAdrenal Glands: Normal signal and morphology. No masses.\n\nKidneys: There is an 8 mm cyst in the midpole of the left kidney.\n\nGastrointestinal Tract: Visualized bowel is unremarkable. No evidence for\nobstruction.\n\nLymph Nodes: No lymphadenopathy by size criteria.\n\nVasculature: There is dense atherosclerotic plaque at the origin of the right\nrenal artery, producing moderate to severe narrowing (image 45, series 1501). \nThere is an accessory right renal artery (image 38, series 1501), which is\nwidely patent. Incidental note is made of a duplicated right renal vein. \nAtherosclerotic plaque at the origin of the left renal artery produces mild\nnarrowing (image 46, series 1501). Mild atherosclerotic narrowing is noted at\nthe origin of the SMA. Regions of stenosis are apparent on the 3D MIP series\n(\"Tumble\" series 1050, \"Spin\" series 1051, \"Cor MIP\" series 1053).\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. Moderate to severe atherosclerotic narrowing at the origin of the right\nrenal artery. Widely patent accessory renal artery and duplicated right renal\nvein incidentally noted.\n2. Mild atherosclerotic narrowing at the origin of the left renal artery and\nSMA.\n3. Hepatic steatosis." }, { "input": "MRE: Loops of small and large bowel demonstrate normal peristalsis. There is\nno bowel obstruction. There is no small bowel wall abnormality or small bowel\nlesions identified. There is no fistula formation or strictures. There are\nscattered colonic diverticula with no evidence of acute diverticulitis.\n\nThe appendix is borderline enlarged, measuring up to 7 mm, unchanged in size\nas compared to prior CT examination from ___. There may be some\nareas of low signal intensity possibly reflecting intramural fat deposition\nwithin the appendix, seen best within FIESTA sequences (series 67, image 46). \nThe appendiceal wall is slightly thickened and the appendix demonstrates\nprogressive homogeneous mural hyperenhancement. These findings are changed as\ncompared to CT examination from ___ and could reflect chronic\nsubclinical inflammation of the appendix.\n\nMR abdomen and pelvis:\n\nLimited assessment of the lung bases show small bilateral pleural effusions\nwith associated atelectasis.\nDiffuse hypointensity of the liver and spleen on FIESTA sequences is\ncompatible with hemosiderosis, potentially from prior transfusions. There is\na 5 mm cyst/biliary hamartoma in segment 6 of the liver (series 14, image 61;\nseries 1202, image 48). There is no intra or extrahepatic biliary duct\ndilatation. Multiple gallstones are seen within an otherwise unremarkable\ngallbladder. The portal vein and SMV are patent. The adrenal glands are\nunremarkable. The pancreas is normal in signal intensity without pancreatic\nductal dilatation or enhancing lesion. The kidneys are unremarkable without\nhydronephrosis or obstructing stones.\n\nThere is a 1.9 x 1.7 cm fibroid within the right aspect of the uterus (series\n13, image 69). The uterus is otherwise grossly unremarkable. The urinary\nbladder is normal. There is no pelvic free fluid.\n\nThere is diffuse anasarca. Visualized aorta is normal in caliber without\naneurysmal dilatation. The celiac axis, SMA, bilateral renal arteries and ___\nare patent. The bone marrow signal is grossly unremarkable.", "output": "1. No small bowel lesions identified.\n\n2. Possible intramural fat deposition and progressive homogeneous\nhyperenhancement of the appendix with a slightly thickened appendiceal wall\ncould reflect chronic, subclinical inflammation of the appendix. Borderline\nenlarged appendiceal size remains unchanged as compared to prior CT\nexamination from ___ but new from ___.\n\n3. Diffuse hypointensity of the liver and spleen is compatible with\nhemosiderosis, potentially from prior transfusions.\n\n4. Small bilateral pleural effusions.\n\n5. Cholelithiasis.\n\n6. Uterine fibroid." }, { "input": "The liver is normal in size and contour, without evidence of hepatic\nsteatosis. Several biliary hamartomas are noted. The largest diameter of 11\nand 14 mm, seen within segments VIII and II, respectively. Patchy foci of\narterial hyperenhancement are noted, without correlate on precontrast or\ndelayed post-contrast sequences, thought to represent perfusional anomalies\n(1101:35).\n\nThere are multiple T2 hyperintense structures scattered throughout the splenic\nparenchyma as well. These are all subcentimeter in size and appear to be\nprogressively enhancing, consistent with hemangiomas.\n\nThere are also multiple pancreatic cystic lesions. The largest has diameter of\nup to 3.4 cm within the pancreatic neck. This is multi loculated with multiple\nthin, partial septations. The content is T2 hyperintense, T1 hypointense and\nnonenhancing. There is no capsule, thickened septation or nodularity.\nAdditional smaller cystic structures are noted within the pancreatic tail,\nbody and head. The multiplicity suggests multiple side branch IPMNs. A serous\ncystic neoplasm within the neck is not excluded. The main pancreatic duct\nmaintains normal caliber in contour. The pancreatic parenchyma itself\ndemonstrates normal signal and enhancement pattern.\n\nAdrenal glands are unremarkable. There bilateral renal cysts, several on the\nright containing hemorrhagic or proteinaceous content. The remainder are\nsimple in appearance without concerning features.\n\nThere is no lymphadenopathy or ascites. Arterial vascular anatomy is\nconventional. Venous structures are patent.\n\nThere is a small hiatal hernia. Osseous structures are notable for several T2\nhyperintense fat containing hemangiomas within lumbar vertebral bodies. There\nis no concerning osseous lesion.", "output": "No abdominal lesion concerning for metastatic disease. Hepatic biliary\nhamartomas, splenic hemangiomas, renal cysts and pancreatic cystic lesions. \nThe latter likely represent multifocal side branch IPMNs, although\ndifferential for the largest includes serous cystic neoplasm. Given the size\nof the largest (3.4 cm), consideration should be given to endoscopic sampling." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: Partially visualized liver is homogeneous in signal intensity without\nsuspicious mass. No imaging features suggestive of advanced cirrhosis. No\nhepatic steatosis. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The common\nbile duct smoothly tapers to the level of the ampulla without obstructing\nstone or large periampullary mass. Gallbladder is surgically absent.\n\nPancreas: There is a unchanged 0.6 x 0.6 x 0.6 cm T2 hyperintense nonenhancing\npancreatic cystic lesion within the body (03:13), likely side branch\nintraductal papillary mucinous neoplasm (IPMN). No pancreatic duct dilatation\nor peripancreatic fat stranding. No suspicious mass.\n\nSpleen: Normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule\n\nKidneys: Patient is status post left upper pole partial nephrectomy with\nassociated postsurgical changes and scarring (03:12). No evidence of residual\nor recurrent disease at this level. There are bilateral simple renal cysts,\nmany of which are hemorrhagic or proteinaceous in contents, largest measuring\n1.6 x 1.3 cm in the interpolar region of the left kidney (03:18). Kidneys are\notherwise homogeneous in signal intensity without suspicious mass. No\nhydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and proximal ___ are patent. Hepatic veins, main portal vein, SMV,\nand splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. Status post partial left nephrectomy with associated postsurgical changes.\nNo evidence of residual or recurrent disease.\n2. Bilateral renal cysts, few of which are hemorrhagic or proteinaceous in\ncontent.\n3. 0.6 cm pancreatic cystic lesion, likely side branch IPMN, unchanged since\n___.\n\nRECOMMENDATION(S): Recommend MRCP without contrast in ___ years to assess for\ninterval change in pancreatic cystic lesion." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The contours are smooth. In segment 8,\nthere is a 6 mm non-enhancing focus which is hyperintense on T2 weighted\nimages most in keeping with a biliary hamartoma. No concerning solid or\ncystic lesions.\n\nBiliary: There is a new moderate stenosis in the mid common bile duct at the\nlevel of the fiducial marker and a known pancreatic head lesion. The common\nbile duct measures up to 6 mm and there is borderline slight progression of\nvery mild central left intrahepatic duct dilation. Just distal to the\nstenosis, there appears to be a flow void on the T2 weighted images which is\nlikely a flow artifact through the stenosed segment. Patient is status post\ncholecystectomy.\n\nPancreas: The patient is status post central pancreatectomy with a Roux-en-Y\npancreaticojejunostomy. In the head of the pancreas, there is a 13 x 28 mm\nhypoenhancing soft tissue mass just posterior to the fiducial marker which\ndemonstrates restricted diffusion (series 6, image 32). Compared to the\nprevious CT exam dated ___, this lesion appears slightly larger. \nThe remnant pancreas is atrophic and hypointense on the T1 weighted images but\nenhances normally. No pancreatic duct dilation.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no concerning solid or cystic\nlesions. In the left upper pole, there is a 24 x 26 mm cystic lesion with a\ntail which may represent a calyceal diverticulum or a simple cyst. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: Oral contrast traverses past the jejunojejunostomy,\nwhich appears patent. There is no dilation of the pancreaticojejunostomy\nlimb. The GI tract is of normal caliber throughout. No mural thickening or\nabnormal enhancement is detected.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta appears patent without any\nsignificant areas of narrowing or dilatation. As seen on the previous CT\nscan, there is mild narrowing at the origin of the celiac axis with mild\npost-stenotic dilation.\n\nOsseous and Soft Tissue Structures: Non-specific oft tissue stranding\nsurrounding the celiac axis and SMA appears similar to the previous exam. The\nbone marrow demonstrates normal signal characteristics. No concerning osseous\nlesions.", "output": "1. New moderate CBD stricture at the level of a known pancreatic head mass. \nVery mild upstream central left intrahepatic bile duct dilation has minimally\nincreased since the previous MRCP, with the remaining ducts unchanged in\ncaliber. This could be assessed with ERCP.\n2. Post central pancreatectomy with a Roux-en-Y pancreaticojejunostomy from\nthe pancreatic tail section. Please note this is not a Whipple procedure.\n3. Pancreatic head mass, likely representing local recurrence, has slightly\nenlarged since the prior CT in ___. Non-specific signal intensity surrounding the celiac axis and SMA appears\nsimilar to recent cross-sectional imaging." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: There is widening of the periportal space and nodular contours\nconsistent with cirrhosis. In segment 7, there is a 5 mm T2 hyperintense\nnon-enhancing lesion in keeping with a simple cyst. Conventional hepatic\narterial anatomy. The portal and hepatic veins are patent. No free fluid.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. Sludge is noted in the neck of the gallbladder. There\nis no evidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: Splenomegaly measuring 19 cm.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid or cystic lesions. \nNo hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Although incompletely imaged, there appears to be non-enhancing\nthrombus in the superior mesenteric vein which likely presents bland thrombus\n(2:26). There are multiple large esophageal and gastric varices. Multiple\nportosystemic collaterals are noted in the upper abdomen.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. Cirrhosis with evidence of portal hypertension characterized by a\nsplenomegaly, esophageal varices and multiple portosystemic collaterals.\n2. There are no suspicious hepatic lesions. There is a 5 mm biliary\nhamartoma/ cyst in segment 7.\n3. Although incompletely imaged, there appears to be non-enhancing thrombus\nin the superior mesenteric vein which likely presents bland thrombus. \nFollow-up CT abdomen and pelvis for further evaluation is recommended.\n\nRECOMMENDATION(S): Although incompletely imaged, there appears to be\nnon-enhancing thrombus in the superior mesenteric vein which likely presents\nbland thrombus. Follow-up CT abdomen and pelvis for further evaluation is\nrecommended.\n\nNOTIFICATION: These findings were added to the dashboard critical results on\n___ @ 1728 hours" }, { "input": "Lower thorax: Trace dependent atelectasis. No pleural effusions.\n\nLiver: Homogeneous hepatic signal. Nonspherical, enhancing area in the\ninterface of the right lung base and the hepatic dome (17:12), not seen on\ncoronal T2 or DWI images, suggestive of focal atelectasis with to volume\naveraging. No discrete hepatic lesion. No ascites.\n\nBiliary: No ductal dilation. 7 mm cholelith. (5:22). No gallbladder wall\nthickening.\n\nPancreas: Pancreatic atrophy with multiple cystic lesions along the pancreas. \nNo pancreatic ductal dilation. The largest cystic lesions are in the head and\nbody measuring up to 9 mm suggestive of intraductal papillary mucinous\nneoplasms.\n\nSpleen: Homogeneous spleen without splenomegaly.\n\nAdrenal Glands: No adrenal lesion.\n\nKidneys: Left greater than right renal cortical atrophy. Simple bilateral\nrenal cysts. Sub cm hemorrhagic cyst in the left superior pole. No\nhydronephrosis.\n\nGastrointestinal Tract: No gastric wall mass. Sigmoid diverticulosis. \nUnremarkable appendix. No intestinal obstruction.\n\nPelvis: Decompressed bladder. Unremarkable uterus and adnexa.\n\nLymph Nodes: No adenopathy.\n\nVasculature: Moderate atherosclerotic disease. Patent aorta and major\nbranches. Mild SMA ostial stenosis\n\nOsseous and Soft Tissue Structures: Sacral perineural cysts. Normal bone\nmarrow signal.", "output": "1. No gastric or abdominopelvic masses.\n\n2. Multiple pancreatic IPMNs. No follow-up is recommended based on patient's\nage." }, { "input": "Lower Thorax: There is a moderate left pleural effusion (series 4, image 2). \nThere is no pericardial effusion. The heart size is normal.\n\nLiver: The liver contour is nodular, in keeping with known history of\ncirrhosis. The hepatic parenchyma demonstrates normal signal intensity on T1\nand T2 weighted sequences. No focal hepatic lesion is detected. No correlate\nis seen corresponding to the subcentimeter hypoechoic foci on the recent\nultrasound examination from ___.\n\nBiliary: There is no intra or extrahepatic bile duct dilation. The\ngallbladder is decompressed, containing multiple stones. No ductal stones are\nseen.\n\nPancreas: The pancreas demonstrates normal signal intensity and bulk, without\nduct dilation or focal lesion.\n\nSpleen: The spleen size is normal. There are no focal splenic lesions.\n\nAdrenal Glands: The adrenal glands appear normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nThere is moderate abdominal ascites.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries appear\npatent and normal in caliber. The portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. Cirrhotic liver with moderate ascites. No splenomegaly.\n2. No OPTN-5 or concerning hepatic lesion. No MR findings correlating to the\nhypoechoic foci seen on the ultrasound from ___.\n3. Moderate left pleural effusion.\n4. Cholelithiasis." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion.\n\nLiver: The liver is homogeneous in signal intensity without concerning focal\nmass lesions. Several subcentimeter T2 hyperintense foci are seen within\nliver, consistent with cysts or biliary hamartomas. Several areas of early\nenhancement are seen within hepatic segments 2, 5, and 6 (1001: 17, 75, 104,\n110), without precontrast or delayed phase correlates. The portal and hepatic\nveins are patent.\n\nBiliary: The gallbladder is surgically absent. There is no intrahepatic\nbiliary ductal dilatation.\n\nPancreas: Patient is status post pylorus-sparing Whipple procedure. The\nremaining pancreatic body and tail demonstrate normal bulk and signal\ncharacteristics. There is minimal prominence of the main pancreatic duct,\nmeasuring 4 mm. The pancreaticojejunostomy appears patent.\n\nSpleen: The spleen is normal in size and homogeneous in enhancement.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and signal characteristics. There is\na mildly prominent left extrarenal pelvis. No hydronephrosis.\n\nGastrointestinal Tract: The distal esophagus is normal appearing. The\nstomach is under-distended, but grossly normal. The small and large bowel are\nwithout evidence of wall thickening or mass lesions.\n\nLymph Nodes: No abnormal lymphadenopathy.\n\nVasculature: The major abdominal arterial structures are widely patent.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions are\nidentified.", "output": "1. Several areas of transient hepatic intensity differences are seen within\nsegments 2, 5, and 6. No concerning hepatic mass.\n2. Post Whipple. Patent hepaticojejunostomy and pancreaticojejunostomy.\n3. No MR findings correlating with reported history of chronic abdominal\npain." }, { "input": "Lower Thorax: A small to moderate right pleural effusion is present.The\nvisualized heart and pericardium are normal in size.\n\nLiver: The liver is markedly dysmorphic and nodular, consistent with\ncirrhosis. There is severe atrophy of the right lobe of the liver as seen\npreviously. Again noted is arterially hyperenhancing lesion measuring 2.5 x\n1.9 cm, with washout and pseudocapsule. This lesion is slightly larger in\nsize compared to the most recent prior study, measuring 2.4 x 1.8 cm at that\ntime. Assuming that the patient has not had a right hepatectomy, this lesion\nis likely in segment VIII, not in segment IV as previously described. The\nportal vein remains completely occluded, and there is cavernous\ntransformation. While the SMV remains patent, the splenic vein is not well\nvisualized and likely thrombosed.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is partly distended but otherwise unremarkable in appearance.\n\nPancreas: The pancreas is normal in contour and signal characteristics without\nfocal lesions or main ductal dilation.\n\nSpleen: The spleen is also markedly shrunken. Again noted are three round\narterially enhancing lesions in the spleen, stable in appearance since the\nprior CT scan, which become isointense to the spleen on later imaging phases\nand appear hyperintense on T2-WI.These may represent hamartomas and are\nunchanged.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There is normal contour corticomedullary differentiation of the\nkidneys. Left parapelvic cysts are noted.\n\nGastrointestinal Tract: The stomach and visualized loops of small bowel are\nunremarkable without any evidence of wall thickening or obstruction. Edema in\nthe wall of the ascending colon is consistent with portal colopathy. There is\ntrace ascites.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Gastroesophageal varices are again noted. The upper abdominal\naorta and major arterial branches are patent.\n\nOsseous and Soft Tissue Structures: No focal suspicious osseous lesions are\npresent peer Significant bilateral gynecomastia is again noted.", "output": "1. 2.5-cm lesion in the right lobe of the liver meeting criteria for OPTN 5B,\nwith mild interval growth but < 50% since the prior CT from ___.\n2. Chronic thrombosis of the portal vein with cavernous transformation. \nSplenic vein is no longer clearly seen and is likely thrombosed. SMV remains\npatent.\n3. Markedly cirrhotic liver with sequela of portal hypertension, including\nportal colopathy and gastroesophageal varices." }, { "input": "Pre today's MRI performed ___ demonstrated a 2.5 cm lesion within\nthe right lobe of the liver in keeping with HCC. The patient underwent TACE\non ___ with chemoembolization via the right hepatic artery.\n\nLower Thorax: Small right pleural effusion. Lower lung bases are clear. \nLower mediastinal structures are grossly normal. Again noted is bilateral\ngynecomastia.\n\nLiver: Liver demonstrates morphological features in keeping with hepatic\ncirrhosis. No evidence for hepatic steatosis. Previously seen HCC within\nsegment ___, treated in the interval with TACE, is identified on today's\nMRI. This lesion measures 2.2 x 1.8 cm and demonstrates no internal\nenhancement. No residual or recurrent HCC is identified. No new hepatic mass\nis seen. Portal venous thrombosis with cavernous transformation is again\nnoted, along with multiple collateral vessels seen within the upper abdomen. \nThe splenic vein is not identified, however the superior mesenteric vein\nremains opacified with contrast. Multiple gastric varices are again noted. \nTrace ascites.\n\nBiliary: No intra or extrahepatic ductal dilatation. Gallbladder is\nunremarkable.\n\nPancreas: Pancreas demonstrates normal signal intensity and enhancement with\nno focal mass or main duct dilatation. No peripancreatic abnormality.\n\nSpleen: Spleen is shrunken in appearance, however at least 2 nodules within\nthe left upper quadrant are again noted, as seen previously, likely reflecting\nsplenosis.\n\nAdrenal Glands: Adrenal glands bilaterally are unremarkable.\n\nKidneys: Kidneys enhance symmetrically with no focal mass or dilatation of the\ncollecting system. No perinephric abnormality.\n\nGastrointestinal Tract: Visualized gastrointestinal tract is within normal\nlimits.\n\nLymph Nodes: No retroperitoneal lymphadenopathy.\n\nVasculature: No aneurysmal dilatation of the abdominal aorta. The celiac axis,\nsuperior mesenteric artery, renal arteries bilaterally and inferior mesenteric\nartery are well opacified with contrast.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions are\ndemonstrated.", "output": "1. Post TACE of a segment ___ lesion with no evidence of residual or\nrecurrent HCC. No new concerning liver lesion.\n2. Background hepatic cirrhosis with chronic portal venous thrombosis and\ncavernous transformation, and sequela of chronic portal hypertension.\n3. New small right pleural effusion." }, { "input": "Lower Thorax: Limited views of the lung bases are unremarkable. There is no\npleural effusion.\n\nLiver: The liver is dysmorphic and nodular compatible with known cirrhosis. \nThere is no hepatic steatosis. Just superior to the margin of the previous\nTACE in the right lobe, there is a 1.3cm area with nodular arterial\nenhancement and washout highly suspicious for tumor recurrence (11:50). No\nadditional suspicious lesion is seen. Scattered areas demonstrating arterial\nhyper-enhancement, including a 1.7cm lesion adjacent to the IVC (11:33, 30)\nwithout washout are likely due to perfusional differences.\n\nThere is unchanged portal venous thrombosis with cavernous transformation with\nmultiple collateral vessels seen within the upper abdomen. The splenic vein\nis not seen, likely chronically thrombosed. The SMV is patent. Multiple\ngastroesophageal varices are again noted. There is a small amount of ascites.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is somewhat distended but otherwise unremarkable.\n\nPancreas: The pancreas demonstrates normal signal intensity and enhancement\nwithout focal lesions. There is no main duct dilatation. No peripancreatic\nabnormality is seen.\n\nSpleen: The spleen appears shrunken with at least 3 nodules compatible with\nsplenosis.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: The partially imaged kidneys are normal in contour for in size\nbilaterally. There is no hydronephrosis or perinephric abnormality. \nParapelvic cysts are identified in the left kidney.\n\nGastrointestinal Tract: The stomach and included small and large bowel are\nunremarkable. There is no bowel wall thickening or dilatation.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. The celiac axis, SMA, bilateral renal arteries, and origin of the\n___ are patent.\n\nOsseous and Soft Tissue Structures: Osseous structures are grossly\nunremarkable. Bilateral gynecomastia is noted.", "output": "1. 1.3cm nodular area of arterial hyper-enhancement and washout just superior\nto the previous TACE margin is highly suspicious for recurrent tumor as it was\nnot definitely seen on the previous post-TACE follow-up scan.\n\n2. Scattered arterially enhancing lesions without subsequent washout are\nlikely due to perfusion differences but attention on follow-up study is\nrecommended.\n\n3. Hepatic cirrhosis with chronic portal venous thrombosis and cavernous\ntransformation and sequelae of portal hypertension including small ascites and\ngastroesophageal varices." }, { "input": "Lower Thorax: Lung bases are included are clear. No suspicious pulmonary\nnodule pleural effusions are seen. Extensive gynecomastia is again\nidentified.\n\nLiver: There is increased amount of perihepatic and perisplenic ascites. \nExtensive amount of periesophageal varices are again identified. It appears\nthat the patient status post chronic portal vein thrombosis with presumably is\ncavernous transformation of the portal venous system. There is complete\ntreatment of the previously described recurrent HCC superior to this days\nabnormality. On the current study there is no enhancement identified\n(sequence 1002 image 57) there is a chronic filling defect identified within\nthe middle hepatic vein just prior to its entrance into the IVC. This most\nlikely represents a chronic thrombus. There is no evidence for new suspicious\nhepatic lesions. Few areas of transient hepatic intensity difference are\nagain identified.\n\nBiliary: There is normal appearance of the intra extrahepatic bile ducts. The\ngallbladder is unremarkable. No evidence for cholelithiasis.\n\nPancreas: The pancreas is normal in bulk and signal intensity. The main\npancreatic duct is normal in\n\nSpleen: The spleen appears hypotrophic with several nodular areas which could\nrepresent hypertrophic changes versus splenosis nodules.\n\nAdrenal Glands: The adrenals are normal in size. No focal lesions are\npresent.\n\nKidneys: There is no evidence for hydronephrosis. No suspicious renal masses\nare seen.\n\nGastrointestinal Tract: The visualized for the GI tract is unremarkable.\n\nLymph Nodes: A stable enlarged lymph node is identified in the portacaval\nspace most likely reactive in nature.\n\nVasculature: The abdominal aorta and its major branches are normal in caliber.\n\nOsseous and Soft Tissue Structures: There no suspicious bony lesions.", "output": "1. Complete treatment of the previously described recurrent HCC superior to\nthe phases zone. No evidence for recurrent or new disease. 2. Chronic\nchanges of hepatic cirrhosis with portal hypertension as described above. 3. \nHypotrophic shrunken spleen. 4. Slight increase in the amount of ascites." }, { "input": "Liver: The transplant liver is unremarkable. There are no hepatic lesions\nmeeting OPTN criteria. There scattered arterial enhancing foci without\nwashout or correlate on additional sequences, likely transient hepatic\nintensity differences. Largest located in segment VI measuring 7 mm (series\n1001, image 56).\n\nBiliary: The gallbladder is surgically absent. No biliary ductal dilatation.\n\nPancreas: There is a stable cystic lesion in the pancreatic head measuring 3\nmm, requiring no specific follow-up.\n\nSpleen: Stable multinodular appearance of the spleen with areas of\nsusceptibility, likely sequela of prior infarctions.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable aside for bilateral peripelvic renal\ncysts, most pronounced in the left kidney, as on prior.\n\nGastrointestinal Tract: No bowel obstruction or ascites\n\nLymph Nodes: There is a mildly enlarged portacaval lymph and peripancreatic\nnodes measuring 11 mm, likely reactive.\n\nVasculature: Hepatic arterial anatomy is conventional. The hepatic\nvasculature is patent.Note is made of paraesophageal and intraabdominal\nvarices sequela of portal hypertension.\n\nOsseous and Soft Tissue Structures: There is bilateral gynecomastia. No\nsuspicious bony lesions.", "output": "Unremarkable transplant liver morphology. No HCC." }, { "input": "Lower Thorax: No pleural or pericardial effusion.\n\nLiver: Evidence of orthotopic liver transplant. There are no hepatic lesions\nmeeting optn criteria.\n\nBiliary: The gallbladder is surgically absent. No biliary ductal dilatation.\n\nPancreas: Multiple small T2 hyperintense lesions most likely represent IPMNs\nand appear fairly similar compared to prior imaging with the largest lesion\nmeasuring 7 mm in diameter in the uncinate process (series 2, image 33).\n\nSpleen: Stable multinodular appearance of the spleen with areas of\nsusceptibility, likely sequela of prior infarctions.\n\nAdrenal Glands: Unremarkable\n\nKidneys: No suspicious renal lesions. No hydronephrosis. Left peripelvic\nrenal cyst.\n\nGastrointestinal Tract: Unremarkable\n\nLymph Nodes: Portacaval lymph node appears similar compared to prior imaging.\n\nVasculature: The major vasculature are patent.\n\nOsseous and Soft Tissue Structures: Marked gynecomastia.", "output": "Evidence of prior orthotopic liver transplant. No evidence of HCC.\n\nPancreatic IPMNs are subcentimeter and no follow-up recommended." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver is normal in signal and morphology. Stable 6 mm cyst/biliary\nhamartoma in segment V. No worrisome hepatic mass lesion within limitations\nof a noncontrast study.\n\nBiliary: Status post cholecystectomy. Mild prominence of the central\nintrahepatic and extrahepatic biliary ducts with the common bile duct\nmeasuring up to 8 mm. There is pneumobilia, likely related to prior\nsphincterotomy.\n\nPancreas: Mild atrophy of the pancreatic parenchyma, unchanged from prior. \nRe-visualization of mild dilatation of the main pancreatic duct with multiple\nectatic side branches, likely related to chronic pancreatitis. There are a\nfew stable T2 hyperintense cystic lesions within the pancreatic tail measuring\nup to a 6 mm (series 5, image 22 and 21). In addition a few small T2\nhyperintense cystic lesions within the uncinate process also appear grossly\nstable in size, collectively measuring 1.1 x 0.6 cm (series 5, image 31). No\nnew cystic lesions seen. No intrapancreatic ductal filling defects or\nstrictures. No peripancreatic inflammatory changes or fluid collections.\n\nSpleen: Spleen is normal in size and signal characteristics.\n\nAdrenal Glands: Adrenal glands are normal bilaterally without focal nodules.\n\nKidneys: Kidneys are symmetric in size bilaterally. There are stable\nbilateral T2 hyperintense foci most compatible with simple renal cysts. No\nsuspicious renal masses or hydronephrosis.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are within normal limits. No ascites.\n\nLymph Nodes: No suspicious retroperitoneal or mesenteric lymphadenopathy by\nsize criteria.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "1. Unchanged dilatation of the main pancreatic duct with diffuse ectatic side\nbranches consistent with chronic pancreatitis.\n\n2. Unchanged cystic lesions within the pancreas as described above most\nlikely representing side-branch IPMNs.\n\nRECOMMENDATION(S): MRCP in ___ years is recommended." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nThe hepatic parenchyma demonstrates mild signal drop-off on T1 weighted out of\nphase images in comparison to in phase sequences, denoting steatosis (series\n6, image 77). A 2.4 x 1.8 cm lesion arising from the posterior aspect of\nsegment VII demonstrates a well-circumscribed borders, macro lobulations, with\nperipheral nodular contrast enhancement on the early postcontrast phase\nfollowed by centripetal enhancement on delayed sequences, all compatible with\na hemangioma (series 4, image 18, series 1001, image 56). No concerning\nhepatic mass is detected. No correlate is seen for the a ill-defined\nhyperechoic lesion from the ___ ultrasound examination. The portal\nand hepatic veins are patent. Conventional hepatic arterial anatomy is\ndemonstrated.\n\nThe spleen, adrenal glands, kidneys, stomach, and small bowel are normal.\nThere is a moderate amount of colonic stool (series 3, image 15).\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent there is\nno mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "1. The ill-defined hyperechoic lesion seen on the ultrasound from ___ has no correlate on the current MRI examination. Given the fairly\ndiscrete appearance of this lesion on the prior ultrasound, followup\nultrasound in 6 months is recommended to reassess this area.\n2. No concerning hepatic mass detected. Unchanged segment VII hepatic\nhemangioma.\n3. Mild hepatic steatosis." }, { "input": "Liver appears normal in signal intensity without focal abnormality or evidence\nof hepatic steatosis. Surgical absence of the gallbladder. Susceptibility\nartifact at the hepatic hilum. The spleen is normal in size measuring 9.7 cm\nwith a tiny cyst measuring 5mm. Small sliding hiatal hernia. Both adrenal\nglands and pancreas are unremarkable. At the lower pole of the right kidney,\na simple cyst is present measuring 8 mm. Kidneys are otherwise unremarkable\nwithout hydronephrosis. No significant retroperitoneal or mesenteric\nadenopathy by size criteria. No ascites. Abdominal aorta is normal in\ncaliber.\n\nProbable functional follicles in both ovaries, the largest on the left\nmeasuring 2.2 x 1.5 cm.\n\nOverlying soft tissues are preserved. Bone marrow signal is age appropriate.", "output": "Limited evaluation given lack of intravenous contrast.\n1. Small sliding hiatal hernia.\n2. Status post cholecystectomy. No evidence of intrahepatic biliary ductal\ndilatation or filling defects.\n3. Tiny renal cyst at the inferior pole of the right kidney.\n4. Probable functional follicles in both ovaries." }, { "input": "Lower Thorax: Visualized lungs are clear. There is no pleural effusion.\n\nLiver/biliary:\nNormal morphology and signal intensity of the liver parenchyma. There is no\nhepatic steatosis. No suspicious focal liver lesion identified. In\nparticular, there is no MRI correlate for the ill-defined hypodensity seen on\nthe most recent CT.\n\nPatient is status post ___'s procedure. There is mild persistent\ndilatation the central intrahepatic bile ducts and mild biliary enhancement\nsegments V and VIII which is similar to the prior study. Note is also made\npersistent mild enhancement of the common bile duct. These changes are likely\nsecondary to ongoing cholangitis. There is no intrahepatic abscess.\n\nPancreas:\nStatus post ___'s procedure. The remnant pancreatic parenchyma is\natrophic. There is no upstream pancreatic duct dilation. There is no\nabnormal soft tissue mass in the surgical bed to suggest disease recurrence. \nThe previously noted fat stranding at the mesenteric root surrounding the\nceliac trunk and SMA is less conspicuous on today's examination.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: Adrenal glands are unremarkable bilaterally.\n\nKidneys: The kidneys are normal in size and symmetric and demonstrate normal\ncorticomedullary differentiation. There is no hydronephrosis.\n\nGastrointestinal Tract:\nPostsurgical changes from pancreaticojejunostomy and hepaticojejunostomy. \nVisualized bowel loops demonstrate normal caliber and enhancement. There is\nadherence of a loop of proximal jejunum, just distal to the gastrojejunostomy,\nto the left anterior abdominal wall where there is an enhancing scar and\nthinning of the subcutaneous fat. No bowel obstruction at this site.\n\nThere is moderate ascites. Note is made of loculated fluid pocket just medial\nto the liver and superior to the surgical bed, unchanged in size compared to\nprior CT. Another loculated fluid collection is seen in the perihepatic and\nsubhepatic space with the largest pocket in the subhepatic space measuring 3.6\nx 9.6 cm. This pocket demonstrates rim enhancement and has slightly increased\nin size since the prior MRI in ___.\n\nLymph Nodes: Few prominent subcentimeter periaortic nodes are comparable to\nthe prior study there are no enlarged retroperitoneal or mesenteric lymph\nnodes.\n\nVasculature: Re-demonstration of prior aortic stent graft placement. The\ninfrarenal abdominal aorta is partially included in the field of view and\nappears grossly comparable to prior CT. Note is again made arterial\nenhancement within the proximal portion of the aneurysmal sac in keeping with\npatient's known endoleak which is better assessed on the most recent CT.\n\nOsseous and Soft Tissue Structures:\nAn enhancing scar is noted in the left anterior abdominal wall within\nsubcutaneous fat, which may be a site of prior surgical port insertion.\nNo suspicious osseous or soft tissue lesion.", "output": "1. No suspicious focal liver lesion identified. In particular, no MRI\ncorrelate identified for the ill-defined hypodensity seen on most recent CT.\n2. Mild persistent central intrahepatic bile duct dilation and biliary\nenhancement in the anterior segments of the right lobe and common bile duct\nare unchanged and likely secondary to ongoing cholangitis.\n3. Moderate ascites and loculated perihepatic fluid collections as described. \nIn particular, rim enhancing perihepatic/subhepatic collection has slightly\nincreased in size since ___." }, { "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver: Normal in size. Parenchyma is normal in signal noting several\nbenign-appearing lesions which demonstrate very high T2 signal consistent with\ncysts some of which are minimally septated. There are also a few small\nbenign-appearing lesions which demonstrate moderate high T2 signal and some\namount of enhancement on the prior CT consistent with hemangiomas. There is\nno concerning liver lesion.\n\nNo evidence of hepatic steatosis on the dual-echo GRE images.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nwall is of normal caliber. No gallstone.\n\nPancreas: Normal in size. Parenchyma is normal in signal. Main pancreatic duct\nis not dilated. No mass noting limitations of non contrast exam.\n\nSpleen: Normal in size and signal. At the upper pole the spleen there is a\nsubcentimeter cyst.\n\nAdrenal Glands: Left adrenal gland is normal.\n\nRight adrenal gland contains two abutting lesions. The anterior lesion\nmeasures 1.7 x 1.0 cm and demonstrates homogenous T2 signal and diffuse loss\nof signal on the gradient echo dual echo out of phase images compared to the\ninphase images consistent with adrenal adenoma.\n\nThe posterior lesion measures 1.6 x 1.0 cm and demonstrates mildly\nheterogeneous high T2 signal and minimal loss of signal on the gradient echo\ndual echo out of phase images compared to the inphase images. It also\ndemonstrates a few foci of macroscopic fat best appreciated on the low B value\nDWI sequence (essentially a fat saturated T2 weighted image) and also verified\non the prior CT. This is consistent with an adrenal myelolipoma.\n\nKidneys: No hydronephrosis. Normal in size and signal. Several small right\nperipelvic cysts are noted. Several small left cortical and peripelvic cysts\nare noted.\n\nGastrointestinal Tract: Normal caliber loops of small bowel and colon.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber.\n\nOsseous and Soft Tissue Structures: No mass. Degenerative changes are noted\nof the visualized spine with Schmorl's nodes at the inferior endplate of the\nL1 vertebral body and the superior endplate of the L2 vertebral body. Also\nincidentally noted is lumbarization of the left S1 vertebral body.", "output": "2 abutting lesions within the right adrenal gland. The anterior lesion\nmeasuring up to 1.7 cm is consistent with an adrenal adenoma. The posterior\nlesion measuring up to 1.6 cm is consistent with a myelolipoma." }, { "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver: There are numerous liver lesions seen throughout the entirety of the\nliver which show moderately high signal on T2 weighted images, enhancement,\nand restricted diffusion consistent with metastatic disease. Comparison with\nCT from ___ is difficult and limited due to difference in\nmodality but the hepatic lesions appear grossly unchanged. When compared with\nCT from ___ the tumor burden has increased:\nIndex lesion within hepatic segment VII measures 6.5 x 6.5 cm, previously 5.0\nx 4.3 cm on ___. This lesion demonstrates central necrosis. \n15:33\nIndex lesion within hepatic segment VI currently measures 5.1 x 4.8 cm,\npreviously 3.8 x 3.3 cm. 15:36\nIndex lesion at the junction of hepatic segments ___ and ___ measures 5.3 x 5.3\ncm, previously 4.0 x 3.9 cm. 15:10\nIndex lesion within hepatic segment ___ measures 3.7 x 3.7 cm, previously 2.1\nx 2.0 cm. 15:13\nThere are numerous (approximately 20) smaller lesions throughout the liver. \nMany of these lesions are new when compared to ___ and are\nunchanged since ___.\nSeveral benign cysts are noted in the left hepatic lobe.\n\nBiliary: Intrahepatic bile ducts are mildly dilated. Gallbladder is normal\nnoting air within the lumen. No gallstone. There is a common bile duct stent\nwithin the distal common bile duct as well as a biliary stent extending into\nthe proximal right hepatic duct\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.\n\nSpleen: Normal in size, signal, and enhancement.\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement. No solid\nmass. There are several right and one left T2 hyperintense foci without\nenhancement consistent with simple cysts. The largest is at the right upper\npole and measures 4.4 x 4.5 cm.\n\nGastrointestinal Tract: No evidence of obstruction. No mass.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Portal veins and hepatic veins are\npatent noting that the left hepatic vein is somewhat attenuated by the lesion\nat the junction of hepatic segments 4a and 2.\n\nOsseous and Soft Tissue Structures: Bilateral subpectoral breast implants. \nWidespread osseous metastases throughout the vertebral bodies and visualized\npelvis as seen previously.", "output": "1. Multiple hepatic metastases which are grossly unchanged from CT from ___, with clear increase in tumor burden since ___, with\nseveral index lesions detailed above.\n2. Common bile duct stent and biliary stent extending into the proximal right\nhepatic duct. Mild intrahepatic bile duct dilation.\n3. Widespread osseous metastases throughout the vertebral bodies and\nvisualized pelvis is unchanged from prior, better visualized on CT." }, { "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: The liver is normal in signal intensity without evidence of focal mass.\n\nGallbladder and Biliary System: The gallbladder is normal with no evidence of\nstones. There is no significant intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in signal intensity.In the pancreatic neck,\nthere is a T2 hyperintense cystic lesion measuring 1.4 x 1.5 cm that has\nincreased minimally in size from previous where it measured 1.4 x 1.0 cm,\nalthough some of this increase may be technical (4:24).There is no pancreatic\nductal dilatation.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: There are subcentimetric simple appearing left renal\ncysts ___ adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "Minimal increase in size in the indeterminate pancreatic neck cystic lesion\nmeasuring 1.5 cm, which can be followed in ___ years.\n\nNOTIFICATION: These findings were entered into the critical communications\ndashboard at 16:30 on ___." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base of the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. In the left lobe, there is\nan unchanged 3 mm T2 hyperintense focus, which is likely a cyst or biliary\nhamartoma. No worrisome liver lesions are identified on this noncontrast\nexam.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The common\nbile duct measures 5 mm. The gallbladder is surgically absent.\n\nPancreas: The background pancreatic parenchyma is normal in signal. In the\npancreatic neck, there is a T2 hyperintense cystic lesion which measures 15 x\n13 mm (4, 27). Allowing for changes in measurement technique, it is not\nchanged in size. It previously measured 15 x 14 mm. Again, there is a thin\nseptation which is similar to the prior exam. It appears to be connected to\nthe duct, so may represent an IPMN. Two tiny cystic lesions in the pancreatic\nbody (6, 1), which measure 3 mm and 2 mm, respectively, are also unchanged in\nretrospect. These also likely represent side branch IPMNs. No new lesions\nare identified. There is no duct dilation.\n\nSpleen: The spleen is normal in size, measuring 11.2 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. Tiny left renal cysts are unchanged.\nThere are no worrisome renal lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. Evaluation of the vasculature is limited on this noncontrast exam.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe soft tissues are unremarkable.", "output": "1. No significant change in the indeterminate cystic lesion in the pancreatic\nneck, measuring 15 mm, as described above. A follow-up non-contrast MRCP is\nrecommended in ___ years.\n2. Tiny cystic lesions in the body of the pancreas are also unchanged, and\nmost likely side-branch IPMNs. These can be reassessed at the time of the\nnext MRCP.\n\nRECOMMENDATION(S): Noncontrast MRCP in ___ years." }, { "input": "Lower Thorax: Partially imaged lung bases are clear.\n\nLiver: Liver shows normal parenchymal morphology. Tiny subcentimeter T2\nhyperintense cystic lesion is again seen which likely represents the hepatic\ncysts versus biliary hamartoma.\n\nBiliary: The gallbladder is surgically absent. No intra or extrahepatic\nbiliary dilatation seen.\n\nPancreas: The background pancreas shows normal signal intensity. Again seen\nis the T2 hyperintense cystic lesion in the pancreatic neck showing thin\ninternal septations measuring approximately 1.4 x 1.1 x 1.3 cm (previously 1.5\nx 1.2 x 1.3 cm). Again seen are 2 tiny punctate T2 hyperintensities in the\npancreatic body. There is no evidence of mass effect. There is no evidence\nof pancreatic ductal dilatation.\n\nSpleen: Normal in size and morphology. Stable tiny cysts re-spleen.\n\nAdrenal Glands: Both adrenals are symmetric in size and shape.\n\nKidneys: Both kidneys are normal in size and appearance. Tiny subcentimeter\ncortical T2 hyperintensities are stable and likely represent tiny renal cysts.\nThere is no hydronephrosis.\n\nGastrointestinal Tract: Visualized bowel loops are normal in caliber.\n\nLymph Nodes: No significant retroperitoneal or mesenteric lymphadenopathy\n\nVasculature: Limited assessment on this noncontrast study.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal. No soft tissue\nabnormality.", "output": "Stable appearance of the pancreatic cystic lesions, likely representing\nside-branch IPMNs. Recommend follow-up MRI in ___ years time." }, { "input": "Lower Thorax: The lung bases are clear.\n\nLiver: Views of the liver are unremarkable without focal lesion. No evidence\nof ascites.\n\nBiliary: There is cholelithiasis without evidence of acute cholecystitis. No\nextrahepatic biliary duct dilation.\n\nPancreas: There is mild fatty atrophy of the pancreas. Limited views\ndemonstrate no focal lesion. There is no pancreatic duct dilation.\n\nSpleen: Spleen is normal in size. No focal splenic lesion is seen.\n\nAdrenal Glands: Limited views of the adrenal glands are unremarkable.\n\nKidneys: There is a 2.2 x 2.5 x 2.4 cm T2 hypointense lesion in the lower pole\nof the right kidney with focal areas of T2 hyperintensity (series 2, image 4;\nseries 6, image 21). This lesion demonstrates heterogeneous hyperenhancement. \nThere is minimal drop of signal on out-of-phase imaging, likely a small amount\nof intravoxel fat. This lesion abuts the renal sinus fat without involvement.\n\nThere are bilateral renal cysts measuring up to 2.9 x 2.4 cm in right midpole.\nNo additional suspicious renal lesions are seen. There is no hydronephrosis.\n\nGastrointestinal Tract: There is no hiatal hernia. Visualized small and\nlarge bowel is unremarkable.\n\nLymph Nodes: There is no retroperitoneal or mesenteric adenopathy.\n\nVasculature: There is ectasia and moderate atherosclerosis of the abdominal\naorta without aneurysmal dilation. Hepatic arterial anatomy is conventional. \nThere is an accessory left renal artery. Renal vein is unremarkable.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. There\nis no superficial soft tissue abnormality.", "output": "2.5 x 2.4 cm solid lesion in the lower pole of the right kidney which abuts\nthe renal sinus fat, highly concerning for renal cell carcinoma, likely clear\ncell variant. No evidence of renal vein involvement." }, { "input": "Limited evaluation of postcontrast imaging due to respiratory motion.\n\nLower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: There are a few T2 hyperintense hepatic cysts or biliary hamartomas. \nPartially visualized liver is otherwise homogeneous in signal intensity\nwithout suspicious mass. No imaging features suggestive of cirrhosis. No\nsignificant signal drop on out of phase imaging to suggest hepatic steatosis. \nNo ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The common\nbile duct smoothly tapers to the ampulla without obstructing stone or large\nperiampullary mass. Gallbladder is decompressed and unremarkable.\n\nPancreas: There is a 0.2 cm T2 hyperintense cystic lesion within the\npancreatic body, unchanged since ___, likely representing a side\nbranch intraductal papillary mucinous neoplasm (IPMN). (3:9 pancreas is\notherwise homogeneous in signal intensity without suspicious mass. No\npancreatic duct dilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is normal in size measuring 11 cm. Along the superior pole of\nthe spleen is a 0.4 cm mildly T2 hyperintense lesion which is unchanged since\n___ and most consistent with a small cyst or hemangioma.\n\nAdrenal Glands: Bilateral adrenal glands symmetric in size without discrete\nnodule.\n\nKidneys: Again seen within the right lower pole is a 2.6 x 2.4 x 2.1 cm\nheterogeneously T2 hypointense heterogeneously hypoenhancing (previously 2.3 x\n2.5 x 2.2 cm) cortically based mass without renal pelvic involvement. There\nare internal punctate areas of increased signal intensity on T2 weighted\nsequences within this lesion (series 3, image 11). Overall, the lesion\nappears decreased signal intensity on T2 weighted sequences in comparison to\nthe ___ examination. No intra voxel or macroscopic fat noted\nwithin this lesion. (03:12). Additionally there are bilateral T2\nhyperintense nonenhancing renal cysts.\n\nGastrointestinal Tract: Stomach, visualized small and large bowel are\nunremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes the are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and ___ are patent. Severe atherosclerotic disease is noted\nthroughout the infrarenal abdominal aorta including a focal short segment\ndissection (18:50), unchanged since ___ CT. Main portal vein and\nsplenic vein are patent. Bilateral renal veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. 2.6 cm right lower pole renal mass has slightly changed in MR signal\ncharacteristics in comparison to the ___ examination, but remains\nconcerning for RCC; clear cell subtype is favored over papillary renal cell\ncarcinoma based on the MR features from the prior study. No renal sinus or\nrenal vein involvement. No new renal mass.\n2. 0.2 cm pancreatic body cystic lesion, likely side branch IPMN, unchanged\nsince ___.\n3. Chronic short-segment dissection of the infrarenal abdominal aorta.\n\nRECOMMENDATION(S): Close attention of the pancreatic cystic lesion on\npatient's routine follow-up MR is recommended." }, { "input": "As was seen on the prior examination, there is a cluster of subcentimeter\ncysts within the pancreatic neck and head. The largest individual lesion has\ndiameter of the 7 mm additional scattered a subcentimeter cysts are also seen\nwithin the tail and body (6:2). No nodularity or concerning features are\nappreciated. The main pancreatic duct maintains normal caliber and contour.\nPancreatic parenchyma otherwise demonstrates a normal T2 appearance.\n\nThe liver is notable for a 1.3 cm T2 hyperintense lesion within segment VII,\npreviously characterized as a hemangioma. The patient is status post\ncholecystectomy. There is no abnormal bile duct dilation.\n\nThe spleen and adrenal glands are unremarkable. There are bilateral simple\nrenal cysts, without concerning features.\n\nNote is made of intramural macroscopic fat within the second portion of the\nduodenum, likely representing a lipoma. There is a tiny diverticulum of the\ngastric fundus.\n\nThe patient is status post colectomy. The residual bowel loops are\nunremarkable on this limited examination.\n\nLymph nodes within the porta hepatis are nonspecific, but had been seen on\nmultiple prior examinations.", "output": "Numerous stable subcentimeter pancreatic cystic lesions, presumably\nrepresenting side branch IPMNs. Continued imaging surveillance is recommended\nin ___ years with noncontrast MRI." }, { "input": "Atelectasis and small pleural effusion at the right lung base are unchanged. \nThere is small amount of ascites, as before. Liver is diffusely enlarged and\nheterogeneous, consistent with known diffuse disease. There is no evidence of\nbiliary dilatation. There is no bowel obstruction. A large right breast mass\nis better seen on the preceding CT.", "output": "1. The examination is extremely limited due to patient's inability to proceed\nafter only one full sequence was obtained.\n\n2. Diffuse hepatic metastatic disease. No evidence of biliary dilatation\nwithin limitations of the study.\n\n3. Small right pleural effusion and subsegmental atelectasis, better seen on\nthe preceding CT.\n\n4. Large right breast mass, better seen on the preceding CT." }, { "input": "Lower Thorax: The imaged lung bases are grossly clear. No pleural or\npericardial effusion.\n\nLiver: The imaged portion of the liver is normal in morphology. There are\nscattered subcentimeter T2 hyperintensities, consistent with cysts or biliary\nhamartomas, which are unchanged. No hepatic steatosis.\n\nBiliary: No biliary dilation. The gallbladder is normal.\n\nPancreas: Pancreatic parenchyma is mildly atrophic. No focal lesion or ductal\ndilation.\n\nSpleen: The spleen is normal.\n\nAdrenal Glands: Adrenal glands are normal.\n\nKidneys: The patient is status post partial right nephrectomy, with a surgical\ndefect in the right lower pole. There is no abnormal enhancement to suggest\nlocal disease recurrence. A punctate left lower pole hemorrhagic cyst is\nunchanged. A right upper pole cyst demonstrates decreased T2 signal compared\nto prior, but is nonenhancing is likely hemorrhagic (6:15).\n\nGastrointestinal Tract: There is a periampullary diverticulum. There is\ncolonic diverticulosis. Bowel is otherwise unremarkable\n\nLymph Nodes: Abdominal lymph nodes are not enlarged.\n\nVasculature: The abdominal aorta and major branches are patent. No abdominal\naortic aneurysm. Portal venous system is patent.\n\nOsseous and Soft Tissue Structures: There are no suspicious osseous lesions. \nThere are multilevel degenerative changes of the lumbar spine, including grade\n1 anterolisthesis of L4 on L5.", "output": "Status post partial right nephrectomy without evidence of local disease\nrecurrence or metastatic disease in the abdomen." }, { "input": "The exam is limited by motion.\n\nLower Thorax: Within the limitations of MRI, the bases of the lungs are clear.\nThere is no pleural effusion. The base of the heart is normal in size. There\nis no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is no hepatic steatosis. In the right lobe,\njust superior to the gallbladder fossa, there is a lobulated 28 x 28 mm T2\nhyperintense lesion which demonstrates peripheral nodular enhancement that\nfills in on the delayed phases. It is compatible with a hemangioma. No other\nliver lesions are identified. The hepatic arterial anatomy is difficult to\nevaluate due to motion. The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic biliary duct dilation. The common bile duct\nmeasures 8 mm, which is slightly dilated for patient of this age. There is no\nevidence of choledocholithiasis or an obstructing mass. No abnormal\nenhancement is identified around the ducts. The biliary anatomy is\nconventional. The cystic duct has a normal insertion site.\n\nGallbladder: The gallbladder is not distended. There is no pericholecystic\nfluid to suggest acute cholecystitis. There is adenomyomatosis of the\ngallbladder fundus, as well as along the body and neck of the gallbladder, and\nlikely even around the cystic duct. Multiple stones are identified localized\nin the fundus of the gallbladder, perhaps in a region of a phrygian cap\nmorphology.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is pancreatic divisum. No duct dilation or mass is\nidentified. There is no acute pancreatitis.\n\nSpleen: The spleen is normal in size, measuring 8.7 cm. There are no focal\nlesions. A 12 mm accessory spleen is noted in the left upper quadrant.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are multiple simple cysts\nbilaterally, measuring up to 9 mm. There are no worrisome renal lesions,\nhydronephrosis, or perinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is minimal atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild-to-moderate multilevel degenerative changes are noted throughout the\nspine. The soft tissues are unremarkable.", "output": "1. Cholelithiasis at the gallbladder fundus, it is difficult to determine\nwhether this represents a conglomerate of adherent gallstones or one large 1.3\ncm gallstone, and diffuse adenomyomatosis of the gallbladder particularly in\nthe region of the gallbladder fundus and neck/cystic duct, as described above.\nNo evidence of acute cholecystitis.\n2. Minimal dilation of the common bile duct to 8 mm. No choledocholithiasis\nor mass.\n3. Hepatic hemangioma.\n4. Pancreatic divisum without duct dilation or evidence of acute\npancreatitis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion. The cardiac size\nis not enlarged\n\nLiver: The liver demonstrates diffuse mild signal drop on the opposed phase\nsequences, suggestive of mild hepatic steatosis. The calculated fat fraction\nis 8.7%. Several mildly T2 hyperintense lobulated lesions in the liver\ndemonstrate peripheral discontinuous nodular arterial enhancement with\nprogressive fill-in on the delayed postcontrast sequences, compatible with\nhemangiomas. The largest lesion measures 2.0 x 2.0 x 2.5 cm (5:19 and 3:36),\nin the hepatic segment 6. A second hemangioma is seen in hepatic segment 6\nand measures 1.6 x 2.0 cm (05:26). A third hemangioma seen in hepatic segment\n5, measuring 1.0 cm (05:21). No concerning liver lesion is identified. There\nis no perihepatic ascites.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder appears unremarkable.\n\nPancreas: The pancreas is normal in signal intensity and bulk without evidence\nof focal lesion or main pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in signal intensity without focal lesion.\n\nAdrenal Glands: Bilateral adrenal glands appear normal in signal intensity\nwithout concerning lesion.\n\nKidneys: Patient is status post right nephrectomy. The left kidney appears\nnormal in signal intensity without hydronephrosis or perinephric abnormality. \nA tiny millimetric simple cyst is seen in the left interpolar kidney.\n\nGastrointestinal Tract: The visualized small and large bowel loops are normal\nin caliber without obstruction.\n\nLymph Nodes: There is no adenopathy in the visualized upper abdomen.\n\nVasculature: The abdominal aorta is normal in caliber without aneurysmal\ndilatation.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesion is\nidentified.", "output": "1. There are several hepatic hemangiomas, the largest measuring 2.5 cm in the\nhepatic 6. Otherwise, no concerning liver lesions are identified.\n2. Mild hepatic steatosis with calculated fat fraction of 8.7%.\n3. Post right nephrectomy." }, { "input": "Lower Thorax: Included lower thorax demonstrates small normal masses, trace\nbilateral pleural effusion, no pericardial effusion.\n\nLiver: Liver is cirrhotic in morphology. Within the peripheral aspect of\nsegment 6 is a heterogeneous minimally T2 hyperintense, arterially enhancing\n3.2 x 2.6 x 3.7 cm mass with washout on portal venous phase and pseudocapsule\non delayed phase consistent with an OPTN 5 criteria HCC lesion. There are\nscattered T1 hyperintense arterially enhancing nodules without washout or\npseudocapsule within the right and left hepatic lobe which are compatible with\ndysplastic nodules, a representative 1.2 cm dysplastic nodule is noted within\nsegment ___ (12:38).\n\nBiliary: 2 adjacent approximately 1 cm angular shaped stones within the cystic\nduct with distended gallbladder lumen without evidence of acute cholecystitis.\nNo intrahepatic or extrahepatic biliary dilation. The common hepatic duct\nmeasures 8 mm.\n\nPancreas: Pancreas is normal in signal intensity without focal lesions. \nPancreatic duct is normal in caliber.\n\nSpleen: Top-normal spleen size measuring 13.5 cm. No focal splenic lesions.\n\nAdrenal Glands: Adrenal glands are normal and symmetric without masses.\n\nKidneys: Kidneys are normal and symmetric in size without focal lesions. No\nhydronephrosis.\n\nGastrointestinal Tract: Imaged bowel loops are normal in caliber. No bowel\nobstruction.\n\nLymph Nodes: There is scattered prominent retroperitoneal nodes, for example\nmeasuring up to 6 mm in the aortocaval region (12:47) which are not\npathologically enlarged.\n\nVasculature: The hepatic and portal vasculature are patent. No abdominal\naortic aneurysm. Hepatic vasculature is conventional. Prominent perisplenic\nvarices are noted.\n\nOsseous and Soft Tissue Structures: No suspicious body wall soft tissue masses\nor aggressive osseous lesions. Bilateral gynecomastia is incidentally noted.", "output": "1. Cirrhotic liver containing a 3.7 cm OPTN 5B lesion within segment 6\nconsistent with a HCC lesion. Scattered dysplastic nodules also noted within\nthe liver.\n2. Patent portal and hepatic vasculature\n3. Perisplenic varices in keeping with portal hypertension.\n4. Cholelithiasis." }, { "input": "Lower Thorax: No pleural effusion. No pericardial effusion.\n\nLiver: The liver has a nodular heterogeneous contour consistent with\ncirrhosis. There is a large heterogeneous enhancing mass in the right lobe of\nliver measuring 8.3 x 8.3 x 8.6 cm (AP by TV by CC). There are adjacent\nperfusion changes surrounding lesion. There is an additional nodular lesion\nwithin hepatic segment V (series 1301, image 36) and another in segment VI\nmeasuring 2.6 cm (series 1301, image 35). These lesions do not exhibit\nwashout.\nAdjacent to the 2.6 cm lesion in segment VI is a 1.9 cm nonenhancing lesion\nwhich most likely represents a focal infarct.\n\nBiliary: The common bile duct is diffusely distended, measuring up to 1.0 cm\nin diameter. There is no suspicious mass or lesion at the ampulla. This\ncould be related to ampullary stenosis. There is a nonobstructing stone\nwithin the gallbladder measuring 1.2 cm in diameter.\n\nPancreas: The pancreas is normal size and contour. No pancreatic ductal\ndilatation.\n\nSpleen: The spleen has smooth contours and normal sized.\n\nAdrenal Glands: Symmetric and normal size.\n\nKidneys: The kidneys are symmetric and normal sized. There are few\nsubcentimeter T2 hyperintense simple cysts within the kidneys.\n\nGastrointestinal Tract: The bowel is nonobstructed.\n\nLymph Nodes: Prominent porta hepatic nodes measuring up to 1.0 cm (series 601,\nimage 19)\n\nVasculature: There is splenorenal shunting and large varices. There is\nhypoattenuation and distension of the portal vein, especially involving the\nright portal vein, concerning for tumor thrombus. There is a possible left\nsplenic artery aneurysm measuring up to 8 mm in diameter right (series 1201,\nimage 21).\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. Large, heterogeneously enhancing lesion within the right lobe of the liver\ndoes not exhibit washout, but based on size measuring up to 8.6 cm and tumor\nthrombus, meets OPTN 5X criteria.\n2. The hypoattenuation of the portal vein is concerning for tumor thrombus\ninvolving the right portal and main portal veins.\n3. Possible left splenic artery aneurysm measuring up to 8 mm in diameter.\n4. Dilatation of the common bile duct without evidence of an obstructing mass\nor lesion.\n5. Cholelithiasis without cholecystitis." }, { "input": "Lower Thorax: Limited assessment of the lung bases shows no pleural effusion.\n\nLiver: Liver is shrunken and nodular, consistent with cirrhosis. Mild drop in\nsignal on opposed phase imaging suggest hepatic steatosis.\n\nThe following hepatic lesions are suspicious:\n1. Segment ___ junction (23:21, 24:21): 2.1 cm lesion demonstrating arterial\nhyperenhancement, washout, and pseudocapsule, meeting OPTN-5B criteria for\nhepatocellular carcinoma (HCC)\n2. Segment 6 (23:30, 06:12): Approximately 1.4 cm lesion demonstrating\nheterogeneous arterial hyperenhancement, washout, and probable pseudocapsule. \nThis is seen along the inferior margin of what appears to be a treatment\ncavity, and may represent residual/recurrent tumor. However, in the absence\nof relevant clinical history and prior studies for comparison, above findings\nwould meet OPTN-5A criteria for HCC.\n\nSeveral indeterminate hepatic lesions are as follows:\n1. In the hepatic dome along the superior margin of the OPTN-5B lesion\ndescribed above, there is a heterogeneous lesion demonstrating relative\n___ and associated T2 hyperintense signal, may represent a site of\nprior treatment (23:17, 6:6).\n2. 1.2 cm nodular focus of arterial hyperenhancement along the medial margin\nof this area is nonspecific, but there is suggestion of intermediate T2\nhyperintense signal in this region, and should be followed (series 6, image\n6).\n2. Segment 7 (23:24, 21:24): A 1.4 cm lesion demonstrating intrinsic T1\nhyperintense signal and rim enhancement, but no central enhancement. This may\nrepresent a treated lesion.\n3. Segment 6 (23:33): 1.6 cm subcapsular lesion demonstrating intrinsic T1\nhyperintense signal and no definite internal enhancement, may represent a\ntreated lesion.\n\nTwo additional subcentimeter arterially hyperenhancing foci without a\ncorrelate on T2 weighted imaging or delayed postcontrast phases likely\nrepresent transient hepatic intensity differences (23:23, 23:31).\n\nBiliary: Several gallstones are noted. There is no wall thickening or\npericholecystic fluid. Extrahepatic bile ducts are mildly prominent measuring\nup to 9 mm, not significantly changed compared to ___. There is\nsmooth tapering at the level of the ampulla.\n\nPancreas: Normal intrinsic T1 hyperintense signal is demonstrated throughout\nthe pancreas. No focal lesions are identified. The main pancreatic duct is\nnot dilated.\n\nSpleen: Spleen is normal in size, without focal lesions.\n\nAdrenal Glands: Normal in size and shape..\n\nKidneys: The kidneys are normal in size and shape. Subcentimeter simple renal\ncysts are noted. There is no concerning renal mass. No hydronephrosis on\neither side.\n\nGastrointestinal Tract: Stomach is unremarkable. There is no bowel\nobstruction or ascites.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are not enlarged by\nsize criteria.\n\nVasculature: Abdominal aorta is not aneurysmal. Celiac artery, superior\nmesenteric artery, and bilateral renal arteries are patent. The portal veins\nare diminutive, but remain patent. Splenic vein is markedly engorged, with\nnote of a large splenorenal shunt. Distal paraesophageal varices are also\nnoted.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are\nidentified. Soft tissues are unremarkable.", "output": "1. 2.1 cm OPTN-5B lesion at the junction of hepatic segment ___.\n2. 1.4 cm hepatic segment 6 lesion meets OPTN-5A criteria for HCC, but is seen\nalong the inferior margin of what may represent a treatment zone (no history\non OMR to confirm this), and therefore may represent residual/recurrent tumor.\nComparisons with any prior OSH can be made if further characterization is\nrequired.\n3. Several other indeterminate hepatic lesions, including areas resembling\npost-treatment change in segments 6 and 7, and a nonspecific 1.2 cm nodular\nfocus of arterial hyperenhancement adjacent to a possible treatment zone along\nthe hepatic dome which requires continued imaging surveillance.\n4. Cholelithiasis.\n5. Mild extrahepatic biliary dilation, minimally changed compared ___, may be\ndue to ampullary stenosis/sphincter of Oddi dysfunction." }, { "input": "Lower Thorax: No visible pleural or pericardial effusion.\n\nLiver: There is diffuse mild hepatic steatosis. There are tiny biliary\nhamartomas seen measuring less than 1 cm in the peripheral liver (e.g. See\nseries 7, images 1 and 5). Nonenhancing circumscribed T2 hyperintense foci\nseen near the dome of the liver in segment II, as well as a bilobed focus in\nthe inferior aspect of segment V, likely represent simple hepatic cysts (20:4,\n6, and 47). No suspicious focal liver lesions are seen.\n\nBiliary: There is no intra- or extrahepatic biliary ductal dilation. \nGallstones layer dependently in the gallbladder lumen (7:8). Gallbladder is\notherwise unremarkable.\n\nPancreas: Centered in the anterior head of the pancreas is a 2.2 cm rim\nenhancing heterogeneously T2 hyperintense cystic mass. The mass contains an\nenhancing mural nodule at its anterior aspect measuring up to 10 mm (20:47 and\n07:19). There is a 14 mm cyst in the posterior tail of the pancreas (7:3),\nwithout internal enhancement, slightly larger since ___ (at that time\nmeasuring up to 9 mm). Closely adjacent lobulated cystic foci are seen in the\npancreatic body just proximal to this measuring up to 12 mm in aggregate\n(7:3). No main pancreatic ductal dilation. The pancreatic parenchyma\notherwise demonstrates preserved morphology and signal intensity.\n\nSpleen: There is no splenomegaly or focal splenic lesion.\n\nAdrenal Glands: There is a 2.3 cm right adrenal adenoma (5:8), slightly larger\nsince ___ at which time it measured 2.0 cm. The left adrenal gland is\nnormal.\n\nKidneys: In the upper pole cortex of the left kidney, there is a 2.4 x 2.1 x\n2.1 cm mass which demonstrates nodular internal enhancement (13:40),\ncontaining both bulk and intravoxel fat (5:7), consistent with an\nangiomyolipoma (AML). An additional fat containing 3-4 mm focus in the right\nlateral interpolar renal cortex (___) likely represents an additional small\nAML. Otherwise, elsewhere there are bilateral renal cystic cortical foci\nwithout concerning features. The background renal parenchyma enhances\nnormally and symmetrically. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. Partially\nimaged non-dilated small bowel loops are normal in course and caliber without\nevidence of wall thickening, abnormal enhancement, or obstruction. The\npartially imaged colon is unremarkable.\n\nLymph Nodes: There is a markedly enlarged and rounded left periaortic\nretroperitoneal lymph node just above the level of the left renal hilum (20:46\nand 19:30), measuring up to 3.0 cm. No additional pathologically enlarged\nretroperitoneal or mesenteric lymph nodes are seen. There is no ascites.\n\nVasculature: The abdominal aorta is normal in caliber. Major proximal\ntributaries are grossly patent. The IVC is normal in caliber and patent. \nPatent hepatic veins. Patent portal vein, splenic vein, and SMV.\n\nOsseous and Soft Tissue Structures: No suspicious foci of abnormal marrow\nsignal are seen.", "output": "1. 2.2 cm encapsulated mass in the head of the pancreas is primarily cystic\nwith an enhancing mural nodule; additionally there is an enlarged 3 cm left\nperiaortic lymph just above the level of the left renal hilum. Findings\nconcerning for cystic pancreatic neuroendocrine tumor with left periaortic\nlymph node metastasis.\n2. 2.4 cm left upper pole renal angiomyolipoma is minimally larger since\n___, at which time it measured 2.1 cm. No evidence of internal\nhemorrhage. Probable additional 3-4 mm AML in the right interpolar renal\ncortex.\n3. Multiple small simple hepatic cysts and biliary hamartomas in liver. No\nconcerning focal liver lesions.\n4. Lobulated nonenhancing pancreatic cystic foci measuring up to 14 mm in the\npancreatic tail, compatible with side duct IPMNs, slightly larger since study\nof ___. Attention to these lesions on follow-up studies is suggested.\n5. Diffuse mild hepatic steatosis. Cholelithiasis. Slight interval growth\nsince ___ of a 2.3 cm right adrenal adenoma. Other incidental findings, as\nabove.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 14:12 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "UTERUS:\nThe uterus is anteverted, measuring 10.9 (AP) x 14.6 (TV) x 19.8 (SI) cm (6:34\nand 5:18).\n(note: measurement includes the cervix and any exophytic fibroids). There is\nno scarring or deposits in the cul de sac to reflect endometriosis.\n\nEndometrium: Homogeneous, measuring 15 mm\nJunctional zone: 6 mm without focal thickening.\n\nFIBROIDS:\n\nFibroid burden: More than 15\nFibroid enhancement: Most are heterogeneous and a few are nearly homogeneous\n\nSubmucosal fibroids (all submucosal fibroids are listed below):\n1. None\n\nThe three dominant fibroids are:\n\n1. size 10.3 x 9.6 x 9.3 cm enhancement, intramural with less than 50%\nsubmucosal component, anterior left fundus (7:19 and 5:15).\n2. size 5.5 x 7.0 x 5.5 cm enhancement, intramural with more than 50%\nsubmucosal component, anterior fundus (7:17 and 5:27)\n3. size 4.1 x 4.5 x 5.3 cm enhancement, intramural with more than 50%\nsubmucosal component, right fundus (7:26 and 5:37)\n\nNo cornual or cervical fibroids are detected.\n\nVascular supply to the uterus: Uterine and ovarian arteries\n\nOVARIES:\nThe left ovary is not seen. The right ovary redemonstrates a 1.2 cm T1\nhyperintense and T2 hypointense non-enhancing lesion, likely endometrioma vs\nhemorrhagic cyst (15:85).\n\nThere is no intrapelvic free fluid.\n\nUpper Abdomen: The lung bases appear clear without focal consolidation. There\nis no pleural or pericardial effusion. The liver is normal in signal\nintensity without concerning focal lesion identified. There is no\nintrahepatic or extrahepatic biliary dilatation. The gallbladder is\nunremarkable. The adrenal glands, spleen, and pancreas appear normal in\nsignal intensity without concerning lesion.\n\nThere is no hydronephrosis or perinephric abnormality. A 0.9 cm simple cyst\nis seen in the right lower renal pole. Incidental note is made of two left\nrenal arteries. Patient is status post right colectomy and small bowel\nresection x2. Otherwise, the visualized small and large bowel loops are\nnormal in caliber without evidence of obstruction.\n\nThere is no concerning osseous lesion identified. Incidental note is made of\na 1.5 cm sacral Tarlov cysts. There is a small fat and small bowel containing\numbilical hernia.", "output": "1. Interval increase in size and number of multiple fibroids since ___. \nDetailed measurements of the largest fibroids and uterus are in the findings\nsection above. Arterial supply to the fibroids is from both uterine arteries\nand bilateral ovarian arteries.\n2. Stable appearance of a 1.2 cm endometrioma vs hemorrhagic cyst within the\nright ovary.\n3. Postsurgical changes following right colectomy and small bowel resections." }, { "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: The liver re-demonstrates a cirrhotic morphology with surface\nnodularity.\nThe right lobe demonstrates presence of thick T2 hyperintense bands of tissue\ncausing capsular retraction with associated restricted diffusion and\npersistent enhancement on the delayed postcontrast images suggestive of\nconfluent hepatic fibrosis.\nThere are two nonenhancing 3 mm T2 hyperintense foci at the margin of segment\n4 a and 8 (series 3, image 20) and in segment 2 (series 3, image 29)\ncompatible with cysts versus biliary hamartomas.\nThere are two small faint arterial enhancing foci in segment 4 a (series 12,\nimage 14) measuring 4 mm and in segment 2 measuring 3 mm (series 12, image 15)\nwhich however do not washout or demonstrate a T2 correlate/pseudo capsule or\ndiffusion restriction. These merge with the background reticular pattern of\ndiffuse hepatic fibrosis on the delayed postcontrast images.\nThere is no suspicious focal hepatic lesion corresponding to the 4 mm\nechogenic focus noted on the recent ultrasound liver.\n\nBiliary: No intrahepatic biliary ductal dilation noted. CBD is normal in\ndiameter. The gallbladder is distended with no calculi within it.\n\nPancreas: The pancreatic parenchyma demonstrates normal signal intensity\nwithout main duct dilation. No pancreas divisum. No focal pancreatic lesions\nidentified.\n\nSpleen: The spleen is not enlarged. A few punctate foci of blooming on the\ngradient sequences likely represent gamma Gandy bodies.\n\nAdrenal Glands: No adrenal nodules.\n\nKidneys: No hydronephrosis or solid enhancing renal masses seen on either\nside. Bilateral renal cortical simple cysts are again noted.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No upper abdominal lymphadenopathy.\n\nVasculature: The main portal vein and its branches, superior mesenteric and\nsplenic veins are patent. Hepatic veins are patent. There are\ngastroesophageal varices. The upper abdominal aorta and its branches are\nwidely patent.\n\nOsseous and Soft Tissue Structures: The visualized bones demonstrate normal\nmarrow signal intensity.", "output": "1. Cirrhotic morphology of the liver with confluent hepatic fibrosis involving\nthe right hepatic lobe.\n2. Two faint arterial enhancing foci measuring 4 and 3 mm respectively located\nin segment 4A and 2 without washout, restricted diffusion or T2 correlate. \nClose attention on follow-up.\n3. No suspicious focal liver lesion responding to the 4 mm abnormality noted\non the recent ultrasound.\n4. Patent portal vein, no splenomegaly or ascites, few gastroesophageal\nvarices." }, { "input": "The field of view includes abdomen from the level of the renal arteries\nthrough the pelvis. Venous structures with within the included field of view\nare patent and contrast opacified. There is no extrinsic compression of the\nvenous structures.\n\nThe visualized portions of liver are only notable for a 5 mm biliary hamartoma\nwithin segment 6 (06:12). Multiple bilateral renal cysts are noted, as well as\ncortical scarring along the posterior medial left mid kidney. Adrenal glands,\nspleen and pancreas are unremarkable.\n\nThere is no lymphadenopathy or ascites.\n\nThere is an 11mm focus within the right intertrochanteric region (7:82), which\nis T2 hypointense. In conjunction with appearance on prior CTs, this may\nrepresent a small low grade chondroid lesion, potentially an enchondroma. \nMarrow signal is otherwise unremarkable, with heterogeneity of the fat content\nwithin the sacrum.\n\nSeminal vesicles are filled with homogeneously T1 hyperintense material. This\nis symmetric and extends along the entirety of the left ductus deferens, most\nsuggestive of amyloid protein deposition.", "output": "Patent venous structures of the visualized abdomen and pelvis. No thrombus\nidentified." }, { "input": "This examination is slightly limited by motion artifact.\n\nLower Thorax: Bilateral pleural effusions with adjacent atelectasis.\n\nLiver: Liver is nodular in contour consistent with history of cirrhosis. \nThere is a 2.2 cm arterial enhancing lesion in hepatic segment ___ with\nequivocal washout (series 1103, image 44), which is intrinsically T1\nhyperintense, T2 mildly hyperintense, and demonstrates slightly restricted\ndiffusion. This has enlarged since ___. Previously seen lesion\nin segment IV from the CT examination on ___ is not well\nvisualized on the current study. Multiple cysts additionally are noted in the\nliver 1 in the left lobe with rim calcifications similar to prior. A TIPS\nshunt is in place.\n\nBiliary: No intra extrahepatic biliary ductal dilatation. The gallbladder\ndemonstrates mild wall thickening, likely related to chronic liver disease. \nNo ductal stones are detected.\n\nPancreas: The pancreas demonstrates normal signal intensity and bulk, without\nduct dilation or focal mass.\n\nSpleen: The spleen is top-normal in size, measuring 12.5 cm.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically. \nSubcentimeter renal cysts are again demonstrated (series 4, image 12, 7). \nThere is no hydronephrosis or concerning mass.\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal lesion.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy. \nProminent porta hepatis lymph nodes are likely reactive (series 1101, image\n62).\n\nVasculature: There is mild atherosclerotic plaque along the abdominal aorta. \nThere is bland portal vein thrombus adjacent to the TIPS stent along the right\nposterior portal branch (series 1104, image 81). Hepatic arterial anatomy is\nconventional.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. There is a 2.2 cm lesion in hepatic segment V/VI with arterial enhancement\nand slight washout, enlarged since ___, now meeting OPTN-5B\ncriteria.\n2. Previously-seen segment IV lesion from ___ examination is\nless conspicuous on the current study, not meeting OPTN-5 criteria.\n3. Cirrhotic liver with TIPS shunt in place with bland thrombus throughout\nthe right posterior portal branches.\n4. Top-normal spleen size." }, { "input": "Lower Thorax: A 0.9 cm right middle lobe pulmonary nodule (series 16, image 4)\nis unchanged compared to outside hospital CT ___. Other known\npulmonary nodules are not well visualized. There are bilateral atelectasis. \nNo pleural effusion.\n\nLiver: The liver demonstrate normal morphology. A 3.5 x 2.2 cm T2\nhyperintense lesion in segment ___ with heterogeneous enhancement, although\nincompletely characterized, appears similar to the right renal mass,\nconcerning for metastatic disease. No additional focal hepatic lesion. No\nsteatosis.\n\nBiliary: The gallbladder is unremarkable. No biliary ductal dilatation.\n\nPancreas: The pancreas demonstrate normal signal intensity throughout without\nfocal lesions or pancreatic ductal dilatation.\n\nSpleen: The spleen measures 15.2 cm without focal lesion.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The 16.7 x 12.8 x 14.0 cm (TV by AP by CC) exophytic mass arising\nfrom the lower pole of the right kidney demonstrates heterogeneous intrinsic\nsignal intensity with avid heterogeneous enhancement and central necrosis and\nhemorrhage. The mass appears to extend to the posterior pararenal fat and\ninto the right paraspinal musculature (series 16, image 99). There is\nenhancing tumor thrombus in the right renal vein (series 1303, image 69) with\na tail of bland thrombus extending into the IVC (series 1303, image 68). The\nright renal artery is not involved by the tumor. A large right accessory\nrenal artery is approximately 7 cm inferiorly (series 1302, image 71). There\nare additional subcentimeter cortical cysts throughout the bilateral kidneys. \nNo suspicious renal mass in the left kidney. No hydronephrosis in either\nkidney.\n\nGastrointestinal Tract: The stomach is unremarkable. The visualized small\nand large bowel demonstrate no obstruction in the abdomen. No ascites.\n\nLymph Nodes: Scattered enlarged no lymph nodes are noted. For example a\naortocaval no measures 1.1 cm (series 16, image 96). No mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta and its branches are patent with normal\ncaliber. The portal veins are patent. Single renal artery bilaterally.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. 16.7 x 12.8 x 14.0 cm heterogeneously and avidly enhancing right renal\nmass arising from the lower pole with hemorrhage and necrosis, most consistent\nwith a renal cell carcinoma. The mass extends posteriorly into the posterior\nrenal fat and probably through the body wall with early extension into the\nright paraspinal musculature.\n2. Intravascular tumor within the right renal vein with a tail of bland\nappearing thrombus extending into the IVC. The renal artery is not involved.\n3. An accessory right renal artery is seen approximately 7 cm inferiorly from\nthe main right renal artery.\n4. Incompletely characterized 3.5 x 2.2 cm hepatic segment ___ lesion with\nsimilar appearance to the renal mass, but concerning for metastasis.\n5. Right middle lobe pulmonary nodule, concerning for metastasis. Additional\nknown pulmonary nodules are better seen on outside hospital CT from ___.\n6. Splenomegaly." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: Two sites of prior RFA ablation and along the periphery of segment\nVIII, measuring 1.6 x 2.3 cm (12:11) and posterior segment VI, measuring 2.6 x\n3.4 cm (12:24), are unchanged. The adjacent liver parenchyma does not\ndemonstrate arterial hyperenhancement or delayed washout to suggest local\nrecurrence.\n\nA 1.2 x 1.3 cm focus of arterial hyperenhancement in segment ___, without\na corresponding abnormality on T2 weighted images or other postcontrast\nsequences, but less conspicuous on the prior MR study of ___ and not\nclearly seen on the CT abdomen from ___ (12:12). This lesion does\nnot meet OPTN criteria for a hepatoma.\n\nA nonenhancing curvilinear area of high T2 signal, low T1 signal along the\nperiphery of segment VII with an adjacent ill-defined area of mild T2\nhyperintensity and arterial hyperenhancement extending to the subcapsular\nregion likely represent residua of a collapsed cyst that was present in this\nregion in ___ (12:12). This region of arterial hyperenhancement\nbecomes isointense to background liver parenchyma on all subsequent phases.\n\nMore superiorly, along the posterior segment VII, there is a nonenhancing 7 mm\nfocus of high T2 signal, low T1 signal, which also corresponds to a collapsed\ncyst the was present in this region in ___ (12:11, ___. The small\ncyst is partially surrounded by an irregular rim of increased T2 signal that\nis less intense than fluid. There is no definite associated hyperenhancement\nor washout.\n\nNumerous simple cysts are present throughout the liver, largest in segment II,\nmeasuring 2.5 x 3.3 cm, unchanged.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is absent.\n\nPancreas: The pancreas demonstrate normal signal intensity and enhancement. \nThe main pancreatic duct is not dilated.\n\nSpleen: The spleen is not enlarged.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: Multiple bilateral simple renal cysts measuring up to 4.2 x 4.9 cm of\nthe right and 3.5 x 3.6 cm on the left are unchanged. The kidneys enhance\nsymmetrically and there is no evidence of a suspicious renal lesion. There is\nno hydronephrosis.\n\nGastrointestinal Tract: Partially imaged loops of small and large bowel are\nunremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: There is no bone marrow signal\nabnormality. Moderate levoscoliosis of the lumbar spine is centered at L3.", "output": "1. Stable appearance of prior RFA ablation zones in segments VIII and VI\nwithout evidence of local recurrence.\n\n2. 1.2 x 1.3 cm focus of arterial hyperenhancement in segment ___\nwithout a corresponding abnormality on T2 weighted images or other phases does\nnot meet OPTN criteria for hepatoma; however, attention on follow up is\nrecommended.\n\n3. Irregular region of mildly increased T2 signal adjacent to a collapsed\ncyst in the posterior segment VII, best appreciated on diffusion weighted\nimages, without definite arterial hyperenhancement or delayed washout, does\nnot meet OPTN criteria; however, attention on follow up is recommended." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: Two sites of prior RFA ablation and along the periphery of segment\nVIII, measuring 1.3 x 2.3 cm and posterior segment VI, measuring 2.8 x 3.0 cm\nare unchanged. The adjacent liver parenchyma does not demonstrate arterial\nhyperenhancement or delayed washout to suggest local recurrence.\n\nNo focal lesion is concerning for OPTN Class 5 criteria including arterial\nphase enhancement is present\n\nNumerous simple cysts are present throughout the liver.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The gallbladder\nis absent.\n\nPancreas: The pancreas demonstrate normal signal intensity and enhancement.\nThe main pancreatic duct is not dilated.\n\nSpleen: The spleen is not enlarged. Small lesion at the inferior aspect of\nthe spleen shows high signal on T2 weighted images and has a benign appearance\nand is likely a hemangioma, unchanged from prior MRI.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: Multiple bilateral simple renal cysts, unchanged. The kidneys\nenhance symmetrically and there is no evidence of a suspicious renal lesion.\nThere is no hydronephrosis.\n\nGastrointestinal Tract: Partially imaged loops of small and large bowel are\nnormal in caliber. There is colonic diverticulosis.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: There is no bone marrow signal\nabnormality. Moderate levoscoliosis of the lumbar spine is centered at L3. \nSmall fat-containing umbilical hernia.", "output": "1. Stable appearance of prior RFA ablation zones in segments VIII and VI\nwithout evidence of local recurrence.\n\n2. No concerning liver lesion is noted." }, { "input": "Lower Thorax: There is no pleural effusion. There is a small hiatal hernia.\n\nLiver: Two sites of prior RFA ablation and along the periphery of segment VIII\nand posterior segment VI are unchanged in appearance without evidence for\nlocal recurrence.\n\nNo suspicious hepatic lesions are seen.\n\nNumerous hepatic cysts or biliary hamartomas are present throughout the liver.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The gallbladder\nis absent.\n\nPancreas: The pancreas demonstrate normal signal intensity and enhancement.\nThe main pancreatic duct is not dilated. There are a few tiny scattered T2\nhyperintense nonenhancing foci within the pancreatic parenchyma, most likely\nrepresenting side-branch IPMNs.\n\nSpleen: The spleen is not enlarged. Small lesion at the inferior aspect of the\nspleen shows high signal on T2 weighted images and has a benign appearance and\nis likely a hemangioma, unchanged from prior MRI. There is a tiny splenule.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: Multiple bilateral simple renal cysts, unchanged. The kidneys enhance\nsymmetrically and there is no evidence of a suspicious renal lesion. There is\nno hydronephrosis.\n\nGastrointestinal Tract: Partially imaged loops of small and large bowel are\nnormal in caliber. There is colonic diverticulosis.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: There is no bone marrow signal\nabnormality. Moderate levoscoliosis of the lumbar spine is centered at L3.\nSmall fat-containing umbilical hernia.", "output": "1. Stable appearance of prior RF ablation zones in segments VIII and VI\nwithout evidence of local recurrence.\n2. No concerning liver lesion noted." }, { "input": "Lower Thorax: There is no pleural effusion. There is a small hiatal hernia.\n\nLiver: Two sites of prior RFA ablation and along the periphery of segment VIII\nand posterior segment VI are unchanged in size. Assessment for occurrence is\nvery limited as contrast enhanced images were not performed as the exam was\nterminated early at the patient's request.\n\nNumerous hepatic cysts or biliary hamartomas are present throughout the liver.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The gallbladder\nis absent.\n\nPancreas: The pancreas demonstrate normal signal intensity and enhancement. \nThe main pancreatic duct is not dilated. There are a few tiny scattered T2\nhyperintense foci within the pancreatic parenchyma, most likely representing\nside-branch IPMNs.\n\nSpleen: The spleen is not enlarged. Small lesion at the inferior aspect of the\nspleen shows high signal on T2 weighted images and has a benign appearance,\nlikely a hemangioma, unchanged from prior MRI.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: Multiple bilateral simple renal cysts, unchanged. There is no\nhydronephrosis.\n\nGastrointestinal Tract: Partially imaged loops of small and large bowel are\nnormal in caliber. There is colonic diverticulosis.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: There is no bone marrow signal\nabnormality. Moderate levoscoliosis of the lumbar spine is centered at L3. \nSmall fat containing umbilical hernia. Median laparotomy scar is noted.", "output": "1. Prior RF ablation zones in segments VIII and VI are noted and are grossly\nunchanged in size. Assessment for local recurrence is very limited as\ncontrast was not administered as the patient terminated the exam early.\n\n2. There are a few tiny scattered T2 hyperintense foci within the pancreatic\nparenchyma, most likely representing side-branch IPMNs." }, { "input": "Slightly limited evaluation due to motion degradation.\n\nLower Thorax: Limited evaluation of the lung bases is unremarkable. No\npleural or pericardial effusion.\n\nLiver: Again seen are two sites of prior RF ablation along the posterior\naspect of segment 6 and periphery of segment 8 with expected coagulation\nnecrosis. No evidence of residual or recurrent disease. No suspicious\nhepatic lesions on post-contrast imaging. Multiple scattered hepatic cysts or\nbiliary hamartomas are again noted throughout the liver. Mild signal drop on\nin phase imaging is suggestive of iron deposition.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. Gallbladder\nis surgically absent.\n\nPancreas: No pancreatic duct dilatation. No peripancreatic fat stranding. \nAgain seen are few scattered small T2 hyperintense foci within the pancreatic\nparenchyma, most likely representing side-branch IPMNs, largest measuring 0.2\ncm within the uncinate process (03:27). Otherwise homogeneous in signal\nintensity.\n\nSpleen: The spleen is nonenlarged. Stable 0.2 x 1.1 cm mildly T2 hyperintense\nlesion within the inferior aspect of the spleen (04:20) demonstrates a benign\nappearance and may represent a hemangioma, unchanged since ___. No\nnew splenic lesion.\n\nAdrenal Glands: Unremarkable. No focal lesion.\n\nKidneys: Multiple bilateral simple renal cysts are unchanged, largest\nmeasuring 4.4 x 3.7 cm within the interpolar region of the left kidney with\nmultiple thin septations and 4.8 x 3.7 cm within the interpolar region of the\nright kidney. No nodularity. No hydronephrosis. No perinephric fat\nstranding.\n\nGastrointestinal Tract: Small hiatal hernia. The stomach and visualized small\nbowel are unremarkable. Sigmoid colonic diverticulosis without evidence of\nacute diverticulitis. The colon is otherwise unremarkable. No obstruction. \nNo ascites.\n\nLymph Nodes: No retroperitoneal or mesenteric lymph node enlargement.\n\nVasculature: Tortuous aorta. No abdominal aortic aneurysm. Celiac axis, SMA,\nbilateral renal arteries, ___ are patent. Hepatic anatomy is conventional. \nHepatic veins, main portal vein, SMV, splenic vein are patent.\n\nOsseous and Soft Tissue Structures: A 1.4 x 0.5 cm mildly T2 hyperintense mid\nthoracic vertebral body hemangioma is noted. Degenerative changes of the\nlower lumbar spine with multiple small posterior disc bulges are present. \nLevoscoliosis of the lumbar ___ at L2-L3 is noted. Osseous\nstructures and soft tissues are otherwise unremarkable.", "output": "1. Slightly limited evaluation due to motion degradation.\n2. Status post RFA of segment 6 and 8 with expected coagulation necrosis. No\nevidence of residual or recurrent disease.\n3. No worrisome lesions meeting OPTN 5 criteria for HCC.\n4. Mild hepatic iron deposition.\n5. Few small pancreatic cystic lesions are statistically likely to represent\nside branch IPMNs, for which no additional follow-up is warranted.\n6. Small hiatal hernia." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: There are bilateral T2 hyperintense hepatic cysts or biliary\nhamartomas. No signal drop on out of phase imaging to suggest hepatic\nsteatosis. No evidence of large quantity iron deposition within the liver. \nNo ascites.\n\nAgain noted are radiofrequency ablation sites within segment 6, 8 with\nexpected coagulation necrosis. No abnormal enhancement to suggest residual or\nrecurrent disease at these levels.\n\nA few arterially hyperenhancing foci without correlate on initial sequences\nare consistent with transient hepatic intensity differences.\n\nWithin segment 4B is a peripherally located 1.9 x 1.6 cm (10:32) arterially\nhyperenhancing lesion which is similar to prior study and is without correlate\non additional sequences. No washout or pseudo capsule.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The common\nbile duct smoothly tapers to the level of the ampulla without obstructing\nstone. Gallbladder is surgically absent.\n\nPancreas: Again seen are few scattered T2 hyperintense pancreatic cystic\nlesions, likely side branch IPMNs, largest measures 0.3 cm within the uncinate\nprocess, for which no additional followup is warranted. No pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is normal size. Again seen is a 1.2 x 1.1 cm mildly T2\nhyperintense lesion with progressive enhancement, unchanged since ___\nand most consistent with a benign entity such as a hemangioma.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: There are bilateral T2 hyperintense renal cysts, few which are\nhemorrhagic or proteinaceous in contents. Kidneys are otherwise homogeneous\nin signal intensity without suspicious mass. No hydronephrosis or perinephric\nfat stranding\n\nGastrointestinal Tract: Distal esophagus, stomach, and visualized small bowel\nare unremarkable. Severe colonic diverticulosis noted without evidence of\nacute diverticulitis. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and ___ are patent. Hepatic anatomy is conventional. Hepatic\nveins, main portal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: There are multilevel degenerative changes\nthroughout the thoracolumbar spine with levoscoliosis centered at L3. Soft\ntissues are unremarkable.", "output": "1. Arterially hyperenhancing 1.9 cm segment 4B hepatic lesion may represent a\ntransient hepatic intensity difference. No washout or pseudo capsule. \nAttention on follow-up is recommended.\n2. Status post radiofrequency ablation of segment 6 and 8 with expected\ncoagulation necrosis. No evidence of residual or recurrent disease at these\nsites.\n3. No hepatic lesions meeting OPTN 5 criteria for HCC.\n4. Subcentimeter pancreatic cystic lesions, largest measuring 0.3 cm, likely\nside branch IPMNs are unchanged since ___ for which no additional\nfollow-up is warranted." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: Cirrhotic liver morphology is unchanged from prior study bilateral T2\nhyperintense cysts or hamartomas are similar to prior studies. There is no\nsignificant hepatic steatosis. Areas of necrosis related to prior\nradiofrequency ablation are unchanged in segment VI and segment VIII. There\nis no evidence of local recurrence adjacent to the RFA sites. An arterially\nhyperenhancing lesion measuring 1.9 x 1.6 cm in segment IVb is unchanged from\nthe prior study without correlate on delayed imaging (10:46). Millimetric\nfoci of arterial hyper enhancement similar to the prior study\nindistinguishable from background parenchyma on all other sequences, likely\ntransient hepatic intensity differences. No other suspicious lesion is\nidentified.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is not visualized.\n\nPancreas: The pancreas is normal in signal intensity and morphology without\nmain ductal dilatation. Millimetric T2 hyperintensities within the pancreatic\nparenchyma are unchanged from prior studies and require no further dedicated\nfollow-up.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: Bilateral simple cysts are present, some with a few small\nseptations. There is no suspicious renal lesion or hydronephrosis.\n\nGastrointestinal Tract: No focal abnormality.\n\nLymph Nodes: No lymphadenopathy by imaging criteria.\n\nVasculature: Arterial anatomy is conventional. There is no focal\nabnormality.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. Arterially hyperenhancing 1.9 cm segment IVb hepatic lesion is unchanged\nfrom the prior study without correlate other sequences, most likely a\ntransient hepatic intensity difference. This can be followed on subsequent\nsurveillance studies.\n2. Status post multiple radiofrequency ablations without evidence of local\nrecurrence or new suspicious liver lesion meeting OPTN criteria." }, { "input": "The exam is limited by motion artifact.\n\nLower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is shrunken and nodular consistent with cirrhotic morphology.\nThere is evidence of prior treatment of hepatic segment VI and in VIII with\nadjacent fat necrosis. There is no evidence of disease recurrence. Scattered\nfocal areas of arterial enhancement are seen without correlate on other\nsequences, measuring up to 2 x 1.6 cm in hepatic segment ___, likely\ntransient hepatic intensity differences (1001; 22, 33, 41, 55). Multiple T2\nhyperintense lesions are seen throughout the liver, likely hepatic cysts or\nbiliary hamartomas. The portal and hepatic veins are patent.\n\nBiliary: There is mild central intrahepatic and CBD prominence likely related\nto cholecystectomy status. The gallbladder is surgically absent.\n\nPancreas: Normal in signal intensity without ductal dilatation. A stable 5 mm\ncystic lesion is seen in the pancreatic tail, likely a side branch IPMN which\nrequires no dedicated follow-up (4; 16).\n\nSpleen: Normal in size. 2 mildly T2 hyperintense lesions are seen within the\nspleen which demonstrate enhancement, likely hemangiomas.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. The simple cysts are seen in bilateral\nkidneys measuring up to 4.6 cm in the lower pole of the right kidney. Small\nhemorrhagic cysts are seen in the left kidney.\n\nGastrointestinal Tract: No bowel obstruction or ascites.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Hepatic arterial anatomy is conventional.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesion. There is\nlevoconvex lumbar scoliosis. Degenerative changes are seen in the lumbar\nspine. A fat containing umbilical hernia is noted.", "output": "Cirrhotic liver morphology, status post multiple ablations, without recurrence\nor suspicious hepatic lesion meeting OPTN criteria. Given inability to\nperform optimal MRI with good breath hold, recommend follow-up surveillance\nscans with triple phase contrast-enhanced CT (provided there are no\ncontraindications to administration of CT contrast).\n\nRECOMMENDATION(S): Given inability to perform optimal MRI with good breath\nhold, recommend follow-up surveillance scans with triple phase\ncontrast-enhanced CT (provided there are no contraindications to\nadministration of CT contrast)." }, { "input": "Exam limited by motion artifact and lack of optimal breath hold.\n\nLower Thorax: No pleural effusions.\n\nLiver: The liver is cirrhotic in morphology.\nPost-treatment changes in segments VI and VIII are again noted.\nMultiple scattered T2 hyperintense hepatic cysts are again noted throughout\nthe liver.\nPost-contrast images are nondiagnostic. This limits evaluation for\nresidual/recurrent disease.\n\nBiliary: Status post cholecystectomy. Mild prominence of the extrahepatic\nduct likely related to cholecystectomy status.\n\nPancreas: Scattered less than 5 mm cystic lesions are seen throughout the\npancreas with the largest measuring 5 mm in the body of the pancreas, likely\nbranch duct IPMNs. No follow-up required. No main duct dilation.\n\nSpleen: The spleen is normal in size. Again seen are two mildly T2\nhyperintense rounded intra splenic lesions, previously characterized as\nhemangiomas.\n\nAdrenal Glands: No adrenal nodules.\n\nKidneys: There are bilateral renal simple cortical cysts with the largest at\nthe inferior pole of the left kidney measuring 4.4 cm and 4.4 cm at the\ninferior pole of the right kidney. No hydronephrosis.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No abdominal lymphadenopathy. No ascites.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: Levoconvex lumbar scoliosis again noted\nwith degenerative changes in the lower lumbar spine. Uncomplicated fat\ncontaining umbilical hernia.", "output": "1. Cirrhotic liver morphology with post treatment changes noted in segment VI\nand VIII. Post-contrast images are highly limited by motion artifact from\nlack of breath holding limiting evaluation for residual or recurrent disease.\n2. Addition incidental findings include side-branch IPMNs in the pancreas;\nbilateral renal simple cortical cysts. Please note, if intravenous CT\ncontrast can be administered, the patient would benefit from a multiphase\nliver CT, rather than an MRI.\n\nRECOMMENDATION(S): Given inability to perform optimal MRI with good breath\nhold, a multiphasic liver CT would be recommended (assuming there are no\ncontraindications to administration of IV contrast)." }, { "input": "Lower thorax: There is an area of atelectasis in the lingula associated with\ntraction bronchiectasis and some ___ infiltrates in the left lung base\nbest demonstrated on the CT scan from ___. These appearances are\nlikely to be related to mycobacterium avium complex (MAC) infection.\n\nLiver: The liver has a cirrhotic morphology. There is redemonstration of 2\nsites of previous RFA - a 3.3 x 2.5 cm cavity with intrinsic T1 hyperintensity\nin segment 6 (1003:68) and an irregularly-shaped cavity in segment 7 (3:32). \nThese are both stable in appearances when compared with the prior study with\nno evidence of local recurrence of disease.\nThere is interval development of an arterially hyperenhancing 2.1 x 2.1 cm\nlesion in a subcapsular location in segment 7 that demonstrates washout and a\npseudocapsule on delayed phase images consistent with a HCC. No other\nconcerning focal lesion is seen.\n\nThere are several T2 hyperintense nonenhancing hepatic lesions in both lobes\nof the liver consistent with cysts. The largest of these is a segment 4A\nlesion measuring 3.8 x 3.2 cm.\nThere are extensive areas of arterial hyperenhancement areas in the periphery\nof both lobes of the liver with no correlate on other sequences consistent\nwith transient hepatic intensity differences 1001: 60 40, 30 24, 10).\n\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is absent\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. There is a 0.3 cm x 10 pancreatic duct is normal\nin caliber.\n\nSpleen: The spleen is not enlarged measuring 10.3 cm. A hyperenhancing\nsplenic lesion measuring 1.3 cm likely to represent a hemangioma is stable. \nAn additional T2 hyperintense, isoenhancing lesion seen in the inferior aspect\nof the spleen (series 4, image 19) appears fairly similar compared to prior\nimaging and likely represent.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: There is mild bilateral renal cortical atrophy. There are T2\nhyperintense nonenhancing renal lesions bilaterally consistent with cysts. \nThe largest cysts are a 5 cm right lower pole cyst and a 4.4 cm left lower\npole cyst, stable since the previous MRI study. Kidneys enhance and excrete\nsymmetrically without suspicious lesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable with\nthe exception of uncomplicated sigmoid diverticulosis seen on partial views of\nthe pelvis. There is no wall thickening, adjacent inflammatory change, or\nabnormal enhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. There is levoscoliosis of the lumbar spine. Degenerative\nchanges are seen at multiple levels. Small periumbilical hernia is noted.", "output": "1. The liver has a cirrhotic morphology. No splenomegaly, varices or ascites.\n2. Interval development of a 2.1 cm arterially hyperenhancing lesion with\nwashout and a pseudocapsule fulfilling OPTN 5B criteria for an HCC.\n3. Stable splenic lesions, likely hemangioma and hamartoma.\n4. Uncomplicated sigmoid diverticulosis.\n5. A 0.3 cm cyst in the the pancreatic tail is consistent with a side branch\nIPMN.\n6. Subsegmental atelectasis and traction bronchiectasis in the lingula most\nlikely represents sequelae of Mycobacterium avium complex (MAC) infection.\n\nRECOMMENDAT" }, { "input": "Lower Thorax: Again seen are consolidative opacities in the lingula and\nanterior right middle lobe, better characterized on CT of the chest from ___. There is no pleural effusion.\n\nLiver: The liver is nodular in contour. There is no evidence of hepatic\nsteatosis. There are numerous hepatic cysts and/or biliary hamartomas, the\nlargest measuring 3.7 x 3.2 cm in the left hepatic lobe. The patient is\nstatus post interval ablation of an OPTN 5B lesion in segment VII on ___. The ablation cavity measures 4.1 x 3.7 cm, with T1 hyperintense\ncoagulative necrosis. There is a T2 isointense, linear enhancing focus within\nthe ablation cavity (series 1302, image 35), likely perfusional. There is no\nnodular enhancement to suggest residual disease. There is wedge-shaped\nhyperenhancement lateral to the ablation cavity, also perfusional. There is\nan adjacent, irregular 2 x 1.6 cm ablation cavity more superiorly in segment\nVII (series 10, image 27), and a 3.2 x 2.6 cm ablation cavity in segment VI,\nwithout evidence of residual or recurrent disease. There is heterogeneous,\nreticular hyperenhancement of the left hepatic lobe, compatible with fibrosis.\nAreas of linear and wedge-shaped arterial hyperenhancement throughout the\nperiphery of the right hepatic lobe, which normalize to background liver on\nsubsequent phases, are compatible with transient hepatic intensity\ndifferences.\n\nBiliary: The gallbladder surgically absent. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in contour and signal intensity. A 3 mm\ncystic lesion in the pancreatic tail seen on prior studies is less conspicuous\non the current exam. There is no main ductal dilatation.\n\nSpleen: The spleen is normal in size, measuring 10.7 cm in craniocaudal\ndimension. There are mildly T2 hyperintense, enhancing lesions in the spleen,\nthe largest measuring up to 1.3 cm, likely hemangiomas. There is a small\nanterior splenule.\n\nAdrenal Glands: There is thickening of the bilateral adrenal glands, stable,\nwithout discrete nodules.\n\nKidneys: The bilateral kidneys are symmetric in size, with mild diffuse\ncortical thinning. There are multiple bilateral renal cysts, the largest\nmeasuring 5 x 3.8 cm in the posterior lower pole of the right kidney and 5.1 x\n4 cm in the posterior interpolar region of the left kidney. There also a few\nsubcentimeter hemorrhagic cysts in the left kidney, which are intrinsically T1\nhyperintense. There is no hydronephrosis.\n\nGastrointestinal Tract: Small bowel loops are normal in caliber. There is\nsigmoid colonic diverticulosis seen on the large field-of-view coronal T2\nweighted images.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. Portal veins, splenic\nvein and SMV are patent.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nThere are severe degenerative changes of the lumbar spine and mild lumbar\nlevoscoliosis.", "output": "1. New 4.1 x 3.7 cm ablation cavity in segment VII, without definite evidence\nof residual disease. Linear enhancement within the ablation cavity is likely\nperfusional. Attention on follow-up is recommended.\n2. Additional ablation cavities in segments VII and VI, without evidence of\nrecurrent disease.\n3. No new suspicious hepatic lesions." }, { "input": "Lower Thorax: The imaged lung bases are clear without pleural effusion.\n\nLiver: Liver appears mildly nodular in contour with minimal high signal\nintensity within the hepatic parenchyma in segments 4A and 4B suggestive of\nfibrosis. No definite hepatic steatosis is present, and no gross focal masses\nseen.\n\nBiliary: No intra or extrahepatic biliary ductal dilatation is present. The\ngallbladder appears normal.\n\nPancreas: Pancreas is normal in signal without focal lesions or pancreatic\nductal dilatation.\n\nSpleen: Spleen is normal in size. 11 mm lobulated hyperintense lesion on T2\nweighted images within the superior aspect of the spleen appears new from the\nprior exam, but likely a benign lesion such is a cyst or hemangioma.\n\nAdrenal Glands: Again seen arising from the left adrenal gland is a 2.1 x 3.0\ncm adrenal lesion with signal loss on the out of phase sequences compared to\nthe in phase sequences which meets criteria for an adrenal adenoma. The right\nadrenal gland is normal.\n\nKidneys: Tiny simple cysts are seen in both kidneys. No hydronephrosis or\nhydroureter is identified.\n\nGastrointestinal Tract: Imaged aspect of this stomach, loops of small large\nbowel appear unremarkable. No evidence for bowel obstruction.\n\nLymph Nodes: No pathologically enlarged mesenteric or retroperitoneal lymph\nnodes are identified.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No concerning focal bone marrow signal\nabnormalities present.", "output": "1. Unchanged 3 cm left adrenal adenoma.\n2. Mildly nodular liver contour with hyperintense signal on T2 weighted\nsequences within segments 4A and 4B suggestive of fibrosis.\n3. 11 mm lobulated hyperintense lesion on T2 weighted images within the\nsuperior aspect of the spleen, likely a benign cyst or hemangioma." }, { "input": "The lung bases are clear. There is no pleural or pericardial effusion.\n\nThe liver is enlarged measuring 24 cm in craniocaudal dimension. There is drop\nof signal on opposed phase T1 images, consistent with mild steatosis\n(calculated fat fracture 10%). Delayed reticular enhancement of the liver\nparenchyma is seen, suggesting fibrosis.\n\nCorrelating to the ultrasound findings in segment VI is a rounded well-defined\nlesion measuring 1.2 cm demonstrating intrinsic T1 hyperintensity (07:46) and\nrelative ___ of the surrounding liver parenchyma (image 46 in\npost-contrast series). The lesion does not demonstrate drop of signal on the\nopposed phase T1 images (5a:18). Several arterial hyperenhancing foci\nmeasuring up to 7 mm are present in the liver (9:30, 47, 55,) without later\nphases or T2 correlates, consistent with transient arterial intensity\ndifferences. No concerning liver lesions are identified.\nThe portal and hepatic veins are patent.\nThere is a common origin of the celiac trunk and SMA from the aorta. Otherwise\nthe arterial hepatic anatomy is conventional.\n\nThe patient is post cholecystectomy. The intra and extrahepatic biliary ducts\nare normal in caliber.\nThe pancreas is normal in size and signal, without focal masses or ductal\ndilatation.\nThe spleen is normal in size.\nThe kidneys and adrenals are unremarkable.\nThere is no free fluid in the abdomen. There is no lymphadenopathy. The bone\nmarrow signal is normal.", "output": "1. Enlarged liver with mild steatosis and fibrosis, without evidence of\ncirrhosis or portal hypertension. A segment VIa 1.2 cm lesion correlating to\nthe recent US findings has MR characteristics most compatible with a\nregenerative nodule. No lesions satisfying OPTN-5 criteria for HCC. 3 month\nfollowup ultrasound or MRI is recommended to assess for stability or change.\n2. The patient complained of chest discomfort following contrast injection,\nand was evaluated by Dr ___ referred to the ED. Please refer to the\nOMR note from the same day. Future MR studies requiring contrast can be\nperformed with premedication or with an alternate agent such as MultiHance." }, { "input": "Hepatomegaly is again noted with the liver spanning 24 cm caudocranially.\nThere is mild hepatic steatosis, denoted by mild signal drop-off on T1\nweighted out of phase images in comparison to in phase sequences (series 7,\nimage 15). Focal sparing is noted within a 1 cm segment VI nodule (07:19).\nThis nodule otherwise has no post-contrast, T2, or diffusion correlate, and\nlikely represents a regenerative nodule with fatty sparing. This is unchanged\nfrom the prior examination. Numerous foci of arterial hyperenhancement are\nseen throughout the liver contrast, particularly within the periphery, likely\nare perfusional in nature given lack of pre contrast or delayed post-contrast\ncorrelates. No concerning hepatic lesion is identified.\n\nThe patient is status post cholecystectomy. The intra and extrahepatic biliary\ntree is unremarkable.\n\nThe portal venous system is widely patent and normal in caliber. There is\nborderline splenomegaly with maximum caudal cranial dimension of 13 cm. No\nascites or portosystemic venous collaterals are identified.\n\nThere is no lymphadenopathy. Pancreatic parenchyma maintains normal bulk and\nhigh intrinsic T1 signal intensity. No focal lesion or ductal abnormality is\nseen.\n\nThe kidneys and adrenal glands are unremarkable.\n\nArterial vascular anatomy is notable for common celiac and superior mesenteric\nartery trunk. Otherwise arterial anatomy is conventional.\n\nThe lung bases are clear. The osseous structures are unremarkable.", "output": "1. Mild hepatic steatosis. No MR features for cirrhosis.\n2. Unchanged 1 cm segment VI lesion most likely represents a regenerative\nnodule with fat sparing.\n3. No lesions meeting OPTN-5 criteria for hepatocellular carcinoma.\n4. Borderline splenomegaly." }, { "input": "The hepatic morphology is notable for marked atrophy of the right lobe with\nhypertrophy of the caudate lobe and the left lobe. There is scattered punctate\nfoci of arterial hyperenhancement which do not have correlates on precontrast\nor delayed post-contrast sequences and are likely perfusional in etiology.\nPreviously seen drop of signal on in-phase as compared out-of-phase chemical\nshift imaging is no longer appreciated on today's examination. In fact, there\nis currently drop of signal on the out-of-phase as compared in-phase images,\nindicative of presence of hepatic steatosis. Iron quantification sequences\nsuggests very minimal residual hepatic iron concentration. This interval\nchange likely reflects a combination of decreased hepatic iron quantity and\neither increased or uncovered hepatic steatosis.\n\nThere is cholelithiasis without evidence of cholecystitis. There intern\nextrahepatic biliary tree is normal in caliber and contour.\n\nThe pancreatic parenchyma maintains normal bulk, intrinsic hyperintense T1\nsignal and enhancement pattern. There is no evidence of pancreatic iron\ndeposition. There is a 3 mm cystic structure along the posterior aspect of the\npancreatic tail (03:24). This is unchanged from prior examination.\n\nThe spleen is normal in size and parenchymal signal. Adrenal glands and left\nkidney are unremarkable. The right kidney notable for several simple cysts,\nnone with concerning features.\n\nThere is no ascites or portal systemic venous collaterals to suggest chronic\nportal hypertension.\n\nScattered small lymph nodes are noted within the porta hepatis, presumably\nreactive in etiology. Arterial vascular anatomy is conventional. The venous\nstructures are widely patent.\n\nOsseous structures are unremarkable.", "output": "1. Cirrhosis with mildly fatty liver.\n\n2. Decreased hepatic iron concentration, now with only slight iron overload.\n\n3. No concerning hepatic lesion.\n\n4. Cholelithiasis." }, { "input": "Lower Thorax: The lung bases are essentially clear.\n\nLiver: As seen previously, there is hypertrophy of the left hepatic and\ncaudate lobes with relative atrophy of the right lobe. Hepatic contours are\nnodular, compatible the patient's history of cirrhosis. There is signal\ndropout on out of phase images, compatible with steatosis, calculated fat\nfraction of 6% (could be spuriously affected by iron deposition not quantified\non this exam).\n\nNumerous scattered foci of arterial enhancement do not demonstrate definite\ncorrelates on other sequences, and are likely small transient hepatic\nintensity differences. No specific lesion corresponding to the hypoechoic\nabnormality seen on recent ultrasound is identified.\n\nA linear artifact is noted throughout most of the left hepatic lobe (for\nexample 9:32-70) and extends outside of the liver as well.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. \nLayering gallstones are noted.\n\nPancreas: The pancreas is normal in signal intensity. There is no pancreatic\nductal dilatation or focal solid lesions. A 2 mm cystic lesion in the\nposterior pancreatic tail is most likely a side branch IPMN (07:26), and is\nunchanged since ___.\n\nSpleen: The spleen is normal in size without signal abnormality.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. No concerning solid lesions are\nidentified. Tiny parapelvic cysts are seen bilaterally. A 7 mm cortical cyst\nis seen in the lower pole of the left kidney.\n\nGastrointestinal Tract: The small and large bowel are nondilated. A tiny\nhiatal hernia is present.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. Hepatic vasculature is\npatent. Hepatic arterial anatomy is conventional.\n\nOsseous and Soft Tissue Structures: Degenerative changes are seen in the\nvisualized spine. No suspicious osseous lesions are identified.", "output": "1. No definite MR correlate for the hypoechoic lesions seen on recent\nultrasound. Numerous arterial enhancing foci likely reflecting transient\nhepatic intensity differences are present: Consider MRI follow-up in ___\nmonths given abnormal ultrasound appearance.\n2. Hepatic cirrhosis and steatosis.\n3. Cholelithiasis.\n\nRECOMMENDATION(S): Liver MRI in 6 months." }, { "input": "Lower Thorax: Limited views are unremarkable.\n\nLiver: The liver redemonstrates cirrhotic morphology with atrophy of the\nposterior segment and hypertrophy of the left hepatic lobe. There is marked\nhepatic steatosis.\n\nCorresponding to the finding on ultrasound there is a 1.8 cm mass in segments\n___ demonstrating arterial hyper enhancement, washout and pseudocapsule\nconsistent with hepatocellular carcinoma OPTN 5A (series 1102, image 52).\n\nThere is an indeterminate 0.9 cm segment 5 lesion that demonstrates arterial\nhyperenhancement with persistent enhancement in the remaining sequences\n(series 1102, image 68), slightly increased from 0.7 cm previously.\n\nBiliary: Cholelithiasis is again noted. There is no biliary ductal\ndilatation.\n\nPancreas: There is a stable 4 mm pancreatic cystic lesion in the tail on\nseries 5, image 25. The remaining visualized pancreas is unremarkable.\n\nSpleen: The spleen is unremarkable\n\nAdrenal Glands: Adrenal glands are unremarkable.\n\nKidneys: Multiple bilateral peripelvic cysts are again seen. The visualized\nenhanced kidneys are unremarkable. No hydronephrosis.\n\nGastrointestinal Tract: No intestinal obstruction or ascites in the upper\nabdomen.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes are seen. A few\nprominent peripancreatic and periportal lymph nodes measuring up to 1.1 cm are\nlikely reactive, stable.\n\nVasculature: The hepatic vasculature is patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are\ndemonstrated.", "output": "1.Cirrhotic liver morphology and steatosis. 1.8 cm hepatocellular carcinoma\nin segments ___ meeting OPTN 5A criteria, corresponding to the finding seen on\nultrasound.\n\n2. Slight increase in size of indeterminate segment 5 lesion, amenable to\ncontinued reassessment on follow-up.\n\n3. Stable 4 mm pancreatic cystic lesion likely a side-branch intraductal\npapillary mucinous neoplasm.\n\n4. Cholelithiasis." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: The liver demonstrates a nodular contour consistent with cirrhosis. \nMild hepatic steatosis is present.\n\nAgain noted is a segment II 1.8 cm arterially hyperenhancing mass with rapid\nportal venous washout and a residual pseudocapsule, consistent with an OPTN 5A\nHCC, not significantly increased in size compared to the most recent study.\n\nAt the periphery of segment V there is an arterially enhancing focus measuring\n1.0 cm, without definite washout but appearance of pseudocapsule.\n\nThe portal and hepatic veins are patent.\n\nBiliary: Multiple gallstones are noted, without a signs of inflammation. There\nis no significant intra or extrahepatic biliary ductal dilatation.\n\nPancreas: A 3-4 mm cystic lesion in the tail of the pancreas is unchanged,\npreviously characterized as a side branch IPMN. There is no ductal\ndilatation. No other focal lesions are noted.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: Bilateral peripelvic cysts are unchanged. There is no\nhydronephrosis. There is no suspicious renal lesion.\n\nGastrointestinal Tract: No focal abnormality.\n\nLymph Nodes: No lymphadenopathy by imaging criteria.\n\nVasculature: No focal abnormality.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. 1.8 cm segment II OPTN 5A lesion is unchanged since ___.\n2. 1 cm segment V arterially enhancing focus does not meet strict OPTN-5\ncriteria but is suspicious for HCC.\n3. Cholelithiasis.\n4. Unchanged 4 mm pancreatic cystic lesion, likely representing a side branch\nIPMN. This can be followed on subsequent liver surveillance studies." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Nodular contour of the liver with a cirrhotic morphology noted.\n\nThere is mild hepatic steatosis with fat fraction of 8.2%.\n\nThere is evidence of prior microwave ablation to segment II with intrinsic T1\nhyperintensity consistent with coagulation necrosis without evidence of local\ndisease recurrence.\n\nA 1.1 cm arterially hyperenhancing lesion in hepatic segment V demonstrates\nrestricted diffusion (06:11) but does not demonstrate washout, not meeting\nOPTN 5 criteria (1101; 64, 6; 29). However, this lesion has increased in size\ncompared to prior when it measured 0.7 cm on the arterial phase.\n\nThere are scattered areas of arterial hyperenhancement without correlate on\nother sequences, possibly transient hepatic intensity differences (1101; 40,\n68, 73). The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder contains gallstones.\n\nPancreas: Normal in signal intensity without ductal dilatation. Sub 5 mm\ncystic lesions are seen in the pancreatic tail (3; 28, 29).\n\nSpleen: The spleen is borderline in size, measuring 12.9 cm without focal\nlesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion. \nMultiple T2 hyperintensities in bilateral kidneys are compatible with simple\ncortical and parapelvic cysts.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: Prominent periportal and retroperitoneal lymph nodes are seen,\nminimally increased in size compared to prior (1102; 67, 75).\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. 1.1 cm segment V arterial enhancing lesion with restricted diffusion lesion\nis suspicious for HCC given interval increase in size from a prior of 0.7 cm,\nbut does not meet all OPTN criteria.\n2. Cirrhotic liver morphology post microwave ablation to segment II HCC\nwithout evidence of residual disease in the treatment bed.\n3. Interval enlargement of a left preaortic and porta hepatis lymph node, need\nclose attention on follow-up.\n4. 3-4 mm cystic pancreatic lesions, likely side-branch IPMNs. Attention on\nfollow-up exams obtained for the liver.\n5. Cholelithiasis.\n\nRECOMMENDATION(S): Short interval follow-up with MR liver in 3 months, if no\nplan of treatment in the interim." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: The liver contour is nodular, compatible with cirrhosis. Mild hepatic\nsteatosis. The patient is status post microwave ablation for a segment II\nlesion, which continues to demonstrate intrinsic T1 hyperintensity, compatible\nwith coagulation necrosis. No evidence of local recurrence.\n\nAgain seen is an approximately 1.1 cm arterially enhancing lesion in hepatic\nsegment V, demonstrating restricted diffusion, but persisting on delayed\nimaging, similar in appearance to the prior study (6:35, 1101:71). The\napparent absence of washout may likely be due to background steatosis.\n\nA linear focus of enhancement within the left hepatic lobe (1101:32) appears\nto persist on the delayed imaging, likely fibrosis following prior treatment. \nOther arterial enhancing foci do not have correlates on the other sequences,\nlikely transient hepatic intensity differences (for example, 1101: 37, 47, 68,\n72, 79).\n\nThe portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. \nMultiple gallstones are seen within a nondistended right gallbladder. No\nevidence of wall thickening or pericholecystic fluid.\n\nPancreas: The pancreas is normal in signal intensity and morphology without\nductal dilatation. A 2 mm T2 hyperintense cystic lesion within the pancreatic\ntail appears stable, likely a side branch IPMN.\n\nSpleen: The spleen is top-normal in size, measuring 13.0 cm. No focal\nlesions.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: There is no hydronephrosis. Multiple, bilateral subcentimeter T2\nhyperintense lesions are compatible with cysts.\n\nGastrointestinal Tract: No focal abnormality.\n\nLymph Nodes: Multiple prominent periportal and retroperitoneal nodes appear\nstable (1101:77, 83).\n\nVasculature: No focal abnormality.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. Stable, 1.1 cm arterially enhancing lesion within segment V, demonstrating\nrestricted diffusion, which, though not meeting OPTN-5 criteria, remains\nsuspicious for HCC.\n2. No evidence of local recurrence of a previously ablated lesion within\nsegment II.\n3. Cirrhotic liver.\n4. Unchanged prominent periportal and retroperitoneal nodes.\n5. Unchanged 2 mm cystic lesion within the pancreatic tail, likely a side\nbranch IPMN. No main pancreatic ductal dilatation. Attention on follow-up is\nrecommended on routine surveillance studies.\n6. Cholelithiasis." }, { "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: There is nodular surface of the liver, consistent with cirrhosis.\n\nThe fat fraction is 8.9%, consistent with mild steatosis.\n\nThe ablation cavity is seen in segment 2, and is unchanged, containing high T1\nsignal representing coagulative necrosis. There is no enhancement postcontrast\nto suggest recurrence.\n\nThere is redemonstration of the subcapsular arterially enhancing lesion in\nsegment 4B, seen on series 12, image 53, measuring 1.3 cm, previously 1.2 cm. \nThis lesion persists on the delayed phases. It demonstrates again abnormal\nrestricted diffusion. There is no washout.\n\nOther arterially enhancing lesions are seen, such as in segment 5, series 12,\nimage 58, but with no correlate on the other phases, likely representing\ntransient hepatic intensity differences.\n\nNo free fluid.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. The gallbladder\ncontains small gallstones.\n\nPancreas: Normal T1 appearance of the pancreas. No pancreatic duct dilatation.\nAt least 2 cystic lesions are seen in the body/tail of the pancreas, measuring\nup to 3 mm, stable compared to previously. These most likely represent side\nbranch intraductal papillary mucinous neoplasms.\n\nSpleen: The spleen measures 13.6 cm and is mildly enlarged.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: A few peripelvic cysts are seen. No hydronephrosis.\n\nGastrointestinal Tract: Unremarkable, except for a few colonic diverticula.\n\nLymph Nodes: No size significant lymph nodes. A 0.9 cm porta hepatis lymph\nnode is seen, likely reactive.\n\nVasculature: Unremarkable. The portal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: Unremarkable.", "output": "1. Cirrhotic morphology of the liver, with a stable 1.3 cm arterially\nenhancing lesion in segment 4B of the liver, with restricted diffusion, not\nmeeting criteria for OPTN 5. However, this remains suspicious.\n\n2. Unchanged appearance of the ablation cavity in segment 2 of the liver, with\nno evidence of recurrence.\n\n3. Mild hepatosteatosis.\n\n4. Uncomplicated cholelithiasis.\n\n5. Stable 3 mm cystic lesions within the pancreas, likely side-branch IPMNs." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion\n\nLiver: There is cirrhotic liver morphology with hypertrophy of the caudate and\nleft lobe of the liver. There has been interval ablation of segment 4B HCC\nwith post ablation changes extending to the overlying right abdominal wall. \nThere is mild arterial hyperenhancement around the ablation cavity without\nwashout, likely reflecting posttreatment changes. There is unremarkable\nappearance of the segment 2 ablation cavity without evidence of residual or\nrecurrent disease. There is a new 1.3 cm area of arterial hyperenhancement at\nthe dome of the liver without evidence of washout or pseudo capsule (11:96),\nbut suggestion of correlate on diffusion sequence (05:31). Additional focus\nof hyperenhancement in the dome of the liver is also without evidence of\nwashout and pseudo capsule in is unchanged from prior (11:98). Mild signal\ndropout on out of phase images suggests mild hepatic steatosis.\n\nBiliary: Gallbladder contains gallstones, but is otherwise unremarkable. No\nintrahepatic or extrahepatic biliary dilation.\n\nPancreas: Unremarkable. No ductal dilation. No focal lesions.\n\nSpleen: Spleen is mildly enlarged measuring up to 13.7 cm without evidence of\nfocal lesions.\n\nAdrenal Glands: Adrenal glands are unremarkable.\n\nKidneys: Visualized portions of the kidneys are unremarkable. No\nhydronephrosis. No focal lesions. Simple cyst arises from the lower pole\nleft kidney, unchanged.\n\nGastrointestinal Tract: Visualized small and large bowel loops in the upper\nabdomen are unremarkable.\n\nLymph Nodes: Mildly prominent porta hepatis lymph nodes are likely reactive in\nthe setting of cirrhosis. No retroperitoneal and mesenteric lymphadenopathy\nin the upper abdomen.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions.", "output": "1. Interval ablation of segment 4B HCC with mild surrounding peripheral\narterial hyperenhancement, likely reflecting posttreatment changes. Recommend\ncontinued attention on follow-up.\n2. New 1.3 cm arterially hyperenhancing lesion at the dome of the liver does\nnot meet OPTN criteria for HCC, but remains concerning. Recommend continued\nattention on follow-up.\n3. Stable segment 2 ablation cavity without evidence of recurrent disease." }, { "input": "Lower Thorax: The visualized segments of the lower lungs are unremarkable. No\npleural or pericardial effusion.\n\nLiver: Redemonstration of a cirrhotic liver with to post treatment cavities T2\nhypointense with no contrast enhancement, the largest in segment ___ measuring\n4.0 x 3.6 cm (06:21) and the smallest in segment 5 measuring 2.7 x 2.2 cm\n(06:23). There is mild hepatic steatosis. No new nodules are identified. \nThere is a T1 hyperintense nodule (10:36) with no contrast enhancement and no\nrepresentation in all other sequences, likely representing a regenerative\nnodule.\n\nBiliary: The gallbladder is filled with biliary sludge and small calculi\n(06:25, 28). The intra and extrahepatic biliary tree is not dilated.\n\nPancreas: The pancreas is normal in size and shape, with normal signal\nthroughout. The pancreatic duct is within normal limits.\n\nSpleen: The spleen is top-normal in size, with normal signal throughout and no\nfocal lesions.\n2 post treatment cavities\nAdrenal Glands: Both adrenal glands are unremarkable.\n\nKidneys: The kidneys are of normal in symmetric size, with symmetric\nnephrogram. There are bilateral small simple cysts, the largest in the left\ninferior pole (04:32) measuring 1.0 cm.\n\nGastrointestinal Tract: The stomach, duodenum and visualized segments of\nsmall and large bowel are unremarkable.\n\nLymph Nodes: At least 2 left periaortic lymph nodes measuring up to 0.8 cm\n(1202:90), unchanged from prior study.\n\nVasculature: The aorta and its branches are normal in caliber throughout with\nno aneurysmal dilations. Mild atherosclerotic burden. The portal and hepatic\nveins are unremarkable.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions in the\nvisualized skeleton.", "output": "Unchanged appearance post ablation cavities in the cirrhotic liver with no new\nnodules suspicious for hepatocellular carcinoma.\nCholelithiasis with no evidence of cholecystitis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver:\n\nCirrhotic liver morphology. There is mild hepatic steatosis with a fat\nfraction 9.1%. The portal and hepatic veins are patent.\n\nAblation cavities are again seen in hepatic segment ___ measuring 4.0 x 3.6\ncm, and in hepatic segment 5 measuring 2.7 x 2 cm. Peripheral enhancement is\nnoted along the inferior margin of the ablation cavity in hepatic segment 5,\nunchanged compared to prior (1001: 66).\nThere are scattered foci of arterial enhancement throughout the liver, most of\nwhich are similar to prior, with a few foci increased in size or conspicuity\n(for example 1001: 29, 35, 62). Some of the arterially enhancing foci\ndemonstrate intrinsic T1 hyperintensity and mildly restricted diffusion\nwithout evidence of washout, suggestive of regenerative/dysplastic nodules in\na background of cirrhosis (8: 29, 32, 37, 5:28).\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder contains gallstones.\n\nPancreas: Normal in signal intensity without ductal dilatation. A 2 mm cystic\nlesion is seen in the pancreatic head (3:28).\n\nSpleen: Borderline enlarged measuring 13.2 cm without focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion. A 5\nmm simple cyst and a 4 mm hemorrhagic/proteinaceous cyst are seen in the upper\npole of the right kidney.\n\nGastrointestinal Tract: Grossly unremarkable.\n\nLymph Nodes: Small para-aortic lymph nodes are unchanged measuring up to 8 mm\n(1003:85)\n\nVasculature: Mild atherosclerotic disease.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. Cirrhotic liver morphology with stable appearance of two ablation cavities.\nNo focal lesions suspicious for HCC.\n2. Multiple arterial enhancing foci associated with T1 intrinsic\nhyperintensity and mildly restricted diffusion, similar to prior, and\nsuggestive of regenerating/dysplastic nodules. Recommend attention on\nfollow-up.\n3. Cholelithiasis.\n4. 2 mm pancreatic head cystic lesion, likely a side branch IPMN. Follow-up\ncan be performed on subsequent liver MRIs." }, { "input": "Lower Thorax: The visualized lung bases are unremarkable. No pericardial or\npleural effusions.\n\nLiver:\nIn segment III/ IV B and segment V are ablation cavities which measure 2.9 x\n3.1 cm and 1.7 x 2.1 cm,, (series 5, image 19) previously 4.2 x 3.7 and 2.3 x\n1.8 cm. The ablation cavities demonstrate mild T1 hyperintensity which\nrepresent coagulation necrosis. There is nodular enhancement along the\nsuperolateral aspect of the ablation cavity in segment III/IV B, (series 1203\nimage 51). Additionally along the inferior aspect of the ablation cavity in\nsegment V is 1.6 cm nodular area of T1 hyperintensity and arterial\nhyperenhancement which demonstrates no washout of pseudo capsule (series 1203,\nimage 63). The aforementioned areas are concerning for disease recurrence. \nMultiple scattered foci of arterial enhancement through the liver, are similar\nin size when compared to prior (series 1201 images 38, 39 and 63). Some areas\ndemonstrate intrinsic high signal intensity on T1 weighted images and mild\nrestricted diffusion which may reflect regenerative/dysplastic nodules in the\nsetting of cirrhosis. No evidence of focal hepatic lesions meeting OPTN 5\ncriteria for hepatocellular carcinoma.\nMorphologically cirrhotic for with atrophy of the posterior segment of the\nright hepatic lobe and hypertrophy of the left hepatic lobe. There is a\nsignificant drop of signal intensity on out of phase imaging when compared to\nin phase imaging consistent with hepatic steatosis. The calculated fat\nfraction is 10.1% consistent with mild steatosis.\n\n\nBiliary: No intrahepatic or extrahepatic bile duct dilation. Cholelithiasis\nis again demonstrated without gallbladder wall thickening or pericholecystic\nfluid.\n\nPancreas: The pancreas demonstrates normal signal intensity, morphology and\nbulk on pre T1 in post-contrast images. A 2 mm cystic, T2 hyperintense lesion\nin the pancreatic head is again demonstrated, (series 5, image 38). No main\npancreatic duct dilation or peripancreatic abnormality.\n\nSpleen: The spleen measures up to 13.6 cm, unchanged from prior. However, it\ndemonstrates normal signal intensity. No focal splenic lesions.\n\nAdrenal Glands: The left and right adrenal glands demonstrate normal\nmorphology and size.\n\nKidneys: The kidneys are symmetric in size and demonstrate symmetric\nnephrograms. A few sub 4 mm simple renal cysts are demonstrated within the\ninterpolar region of the right kidney. No suspicious renal lesions are\ndemonstrated within the visualized kidneys. No hydronephrosis or perinephric\nabnormality.\n\nGastrointestinal Tract: The stomach walls are mildly thickened which may\nreflect sequela of a collapsed state, otherwise unremarkable. The visualized\nsmall bowel demonstrates normal luminal caliber and wall enhancement. The\nvisualized large bowel demonstrates no bowel obstruction.\n\nLymph Nodes: A left periaortic lymph node measures 8 mm in short axis, (series\n1204 image 83), unchanged from prior. No mesenteric or retroperitoneal\nlymphadenopathy.\n\nVasculature: No evidence of abdominal aortic aneurysm. The hepatic\nvasculature demonstrates conventional anatomy. The main portal vein, superior\nmesenteric vein and splenic vein are patent\nMild atherosclerosis is demonstrated.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Cirrhotic liver morphology with moderate interval decrease in size of two\nablation cavities.\n2. Nodular enhancement along the ablation cavities in III/ IVB and V is\nconcerning for possible disease recurrence. Close follow-up is recommended.\n3. Multiple arterial enhancing foci associated with T1 hyperintensity and mild\nrestricted diffusion, similar to prior in suggestive of\nregenerative/dysplastic nodules.\n4. No focal hepatic lesions meeting OPTN 5 criteria for hepatocellular\ncarcinoma.\n5. Cholelithiasis.\n6. Mild hepatic steatosis with a calculated fat fraction of 10.1%.\n7. A 2 mm cystic, T2 hyperintense lesion in the pancreatic head likely\nrepresents a side branch IPMN.\n\n\nRECOMMENDATION(S): For management of pancreatic cyst(s) up to 5 mm in\npatients in less than ___ years of age, a non-contrast MRCP follow-up is\nrecommended in ___ years. If remaining no larger than 5 mm at that point no\nsubsequent followup is needed.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Lower thorax: No obvious pulmonary mass on limited images of the partially\nvisualized lower lungs. No pleural effusion or pericardial effusion.\n\nLiver: The liver is normal in size and surface contour. The hepatic\nparenchyma demonstrates diffuse signal drop out on out of phase images\nrelative to in phase images within the limitation of a higher flip angle of 80\ndegrees (series 8a, image 21; series 8b, image 22). The calculated hepatic\nfat fraction is 14% and the the calculated hepatic fat percentage is 15.8%,\ncorresponding to mild-to-moderate hepatosteatosis. A 7-mm focal lesion that\ndoes not enhance near the surgical resection bed is unchanged since ___, likely representing post-surgical change such as fat necrosis (series\n13, image 82; series 1502, image 80). No concerning focal hepatic lesion. No\nascites.\n\nBiliary: The patient is status-post cholecystectomy. No intrahepatic biliary\nductal dilatation.\n\nPancreas: There is fatty replacement of the pancreas. No focal pancreatic\nmass, peripancreatic fat stranding, or main pancreatic duct dilatation.\n\nSpleen: The spleen is normal in size without signal abnormality or focal\nmass.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration. No\nevidence of an adrenal mass.\n\nKidneys: The kidneys are normal in size and symmetric. Multiple bilateral\ncortical cysts are unchanged and tiny. No suspicious focal renal mass. No\nhydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: Visualized bowel loops are unremarkable. No bowel\nwall thickening, obstruction, or wall edema.\n\nPelvis: No free fluid in the pelvis. An approximately 2-cm periuretheral\ndiverticulum is similar to the CT in ___ (series 16, image 150; series 11,\nimage 47; series 6, image 33).\n\nLymph Nodes: No retroperitoneal, mesenteric, or pelvic side wall\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber with moderate-to-severe\natherosclerosis. The SMA, celiac axis, and renal arteries appear patent. The\nportal vein, splenic vein, and SMV appear patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion for\nmalignancy.", "output": "1. Mild-to-moderate hepatosteatosis.\n\n2. Post-surgical changes in the liver and gallbladder fossa, stable since\n___. No MR evidence to suggest disease recurrence.\n\n3. No specific MR finding to explain the patient's symptoms.\n\n4. Periurethral diverticulum, unchanged since ___.\n\n5. Please refer to the dedicated CT chest report from the same day for\npossible thoracic findings not detected on MR." }, { "input": "MR Abdomen: There is a 3.8 x 3.5 cm mass encasing the celiac axis and\nnarrowing the origins of the common hepatic and splenic arteries (14:49). \nThough indistinct, this appears to the connect to a 2.3 x 1.1 cm soft tissue\nmass in the pancreatic neck (14:60). There is also soft tissue encircling the\nSMA. The main pancreatic duct is dilated to 6 mm in the distal body and tail\nwith a sharp transition near the base of the mass. These findings are new\nwhen compared to CT of ___. There is mild intra and extrahepatic\nbiliary ductal dilatation and the common bile duct measures 11 mm. Allowing\nfor differences in technique, this is stable since ___.\n\nThere are several tiny T1 hyperintensities in the left lobe of liver that\nlikely represent biliary hamartomas (14:41,47). There is no enhancing mass.\nThe hepatic and portal veins are patent. Hepatic arterial anatomy is\nconventional. The gallbladder and adrenals are normal. 9 mm T2 hyperintensity\nin the spleen is likely a simple cyst or hemangioma. The stomach and\nvisualized bowel are unremarkable. There are numerous simple cysts in the\nkidneys. There is no ascites.", "output": "Ill-defined mass encasing the celiac axis and SMA along with new pancreatic\nductal dilatation to the neck are highly suspicious for pancreatic malignancy.\nThis study is not dedicated to evaluate extent of pancreatic lesions and\nconsideration can be given to performing pancreatic CTA or endoscopic\nultrasound to evaluate the pancreas in the region of ductal caliber\ntransition.\n\nNo findings to suggest high grade arterial mesenteric vascular compromise.\n\nNOTIFICATION: Findings were discussed by Dr. ___ with Dr.\n___ by phone at 3:32 p.m. on ___." }, { "input": "Lower Thorax: The visualized lower lungs are unremarkable. No pericardial or\npleural effusions. Heart is normal in size.\n\nLiver: The liver is normal in morphology. No evidence of hepatic steatosis. \nSignal and enhancement are homogeneous throughout. There is a 1.3 cm nodule\nin the tip of segment 6 (3:39) with moderately T2 hyperintense signal and\nperipheral nodular progressive contrast enhancement compatible with a\nhemangioma.\nThere is heterogeneous enhancement in segment 3 (17:79), with no underlying\nmass, likely representing a perfusion abnormality.\nThere are 2 subcentimeter T2 hyperintense cystic structures with no contrast\nenhancement, either cysts or biliary hamartomas (2:22, 17:47, 68).\n\nBiliary: Status post cholecystectomy. No intra or extrahepatic biliary\ndilation. No choledocholithiasis.\n\nPancreas: The pancreas is normal in bulk with homogeneous signal and\nenhancement throughout. No focal lesions. No pancreatic duct dilation.\n\nSpleen: The spleen is normal in morphology with homogeneous signal and\nenhancement throughout. No focal lesions.\n\nAdrenal Glands: Both adrenal glands are unremarkable.\n\nKidneys: The kidneys are of normal and symmetric size, shape, nephrogram and\ncontrast excretion. No worrisome solid lesions or hydronephrosis bilaterally.\nThere is simple cortical cysts bilaterally measuring up to 1.0 cm.\n\nGastrointestinal Tract: The lower esophagus, stomach, duodenum and visualized\nsegments of small and large bowel are unremarkable and not distended.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Major vessels in the abdomen are patent and normal in caliber\nthroughout.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions or acute\nfractures. Unremarkable appearance of the superficial soft tissues of the\nabdominal wall.", "output": "1. 1.3 cm hepatic hemangioma in segment 6 and subcentimeter scattered\ncysts/biliary hamartomas. No worrisome hepatic lesions.\n2. Unremarkable postoperative appearance of recent cholecystectomy." }, { "input": "Lower Thorax: The lung bases are clear. The visualized heart is normal in\nsize, there is no pericardial effusion.\n\nLiver: The liver is nodular, consistent with cirrhosis. There is no drop\nsignal on the out of phase images to suggest steatosis. A round arterially\nenhancing lesion in segment 6 which persists on the portal venous phase and\nbecomes isointense to the liver on delayed phase, without T2 correlate, is not\nconcerning for ___. Several additional arterially enhancing lesions without\ncorrelates on other sequences are consistent with THIDs (series 901, images\n46, 70). Delayed enhancement in the liver dome is consistent with fibrosis. A\nlarge splenorenal shunt is present, as well as a recannulized paraumbilical\nvein.\n\nBiliary: Cholelithiasis is present without evidence of cholecystitis. There\nis no intrahepatic or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas maintains normal morphology without focal lesions main\npancreatic ductal dilation.\n\nSpleen: The spleen is enlarged, measuring 14.5 cm.\n\nAdrenal Glands: The adrenal glands are normal.\n\nKidneys: The kidneys maintain normal corticomedullary differentiation without\nhydronephrosis. The left kidney is anteriorly displaced due to the spleen. \nSub centimeter cysts are present in the right kidney.\n\nGastrointestinal Tract: The stomach and visualized loops of small and large\nbowel are unremarkable without any evidence of wall thickening or obstruction.\n\nLymph Nodes: Porta hepatis and gastrohepatic ligament lymph nodes are\nborderline enlarged but likely related to patient's cirrhosis. There is no\nretroperitoneal lymphadenopathy.\n\nVasculature: The upper abdominal aorta maintains normal contour without\nevidence of aneurysm. The major branches are patent. Mild to moderate\natherosclerotic disease present. There is the appearance of three left renal\narteries.\n\nOsseous and Soft Tissue Structures: The visualized osseous structures soft\ntissues maintain normal signal without evidence focal lesions.", "output": "1. Cirrhosis with sequela of portal hypertension, including splenomegaly and\nlarge splenorenal shunt. No concerning focal liver lesions.\n2. Cholelithiasis." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver demonstrates normal morphology and signal characteristics. Few\nT2 hyperintense subcentimeter lesions scattered throughout the liver\ncompatible with cysts/biliary hamartomas. No worrisome hepatic mass lesions\nwithin limitations of a noncontrast study.\n\nBiliary: Gallbladder is present without gallstones. No gallbladder wall\nthickening or pericholecystic fluid. No intrahepatic or extrahepatic biliary\nduct dilatation. The common bile duct tapers normally towards the ampulla\nwithout obstructing filling defects or choledocholithiasis.\n\nPancreas: Re-demonstration of a 9 x 11 mm multilocular cystic lesion within\nthe pancreatic tail (series 8, image 20 and series 3, image 23) most likely\nrepresenting side-branch IPMN. It appears grossly stable in size when\ncompared to prior. The main pancreatic duct is not dilated. No\nperipancreatic inflammatory changes or fluid collections.\n\nSpleen: Spleen is normal in size and signal characteristics.\n\nAdrenal Glands: Adrenal glands are normal bilaterally without focal nodules.\n\nKidneys: Mild atrophy of the kidneys bilaterally. Multiple T2 hyperintense\nrenal cysts some of which contain thin septations, the majority of which\nappear grossly stable in size when compared to prior, however few appear to\nhave minimally increased in size. No suspicious renal masses or\nhydronephrosis.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are within normal limits. No ascites.\n\nLymph Nodes: No suspicious mesenteric or retroperitoneal lymphadenopathy by\nsize criteria.\n\nVasculature: Stable appearance of infrarenal abdominal aortic aneurysm\nmeasuring 3 cm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "1. stable 11 mm cystic lesion within the pancreatic tail most likely\nrepresenting side-branch IPMN. No dilatation of the main pancreatic duct. \nPer departmental protocol, this can be followed up with MRCP in ___ years.\n\n2. Stable infrarenal abdominal aortic aneurysm measuring 3 cm.\n\nRECOMMENDATION(S): MRCP in ___ years." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver is shrunken with nodular contours compatible with known liver\ncirrhosis. There is diffuse reticular progressive enhancement of the liver\nparenchyma compatible with liver fibrosis. A more focal area of capsular\nretraction at segment IV with progressive delayed enhancement compatible with\nconfluent hepatic fibrosis corresponding to the heterogeneous area seen on\nprior ultrasound. There is no focal enhancing hepatic mass lesions suspicious\nfor HCC.\n\nBiliary: Gallbladder is present containing few gallstones. No gallbladder\nwall thickening or pericholecystic fluid. Focal mild intrahepatic biliary\nduct prominence within segment IV (series 17, images 26 and 30) likely related\nto adjacent confluent hepatic fibrosis. The remainder intrahepatic biliary\nducts are normal. There is no extrahepatic biliary duct dilatation. The\ncommon bile duct tapers normally towards the ampulla without obstructing\nfilling defects or choledocholithiasis.\n\nPancreas: Pancreas demonstrates normal signal intensity on the T1 weighted\nimages and enhances homogeneously. No suspicious solid or cystic mass\nlesions. The main pancreatic duct is not dilated. No peripancreatic\ninflammatory changes or fluid collections.\n\nSpleen: Moderate splenomegaly measuring 17 cm in maximal craniocaudal\ndimension. It otherwise enhances homogeneously without focal mass lesions.\n\nAdrenal Glands: Adrenal glands are normal bilaterally without focal nodules.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There is adequate excretion of contrast on\nthe more delayed phases. No suspicious renal masses or hydronephrosis.\n\nGastrointestinal Tract: There is a small hiatal hernia. The remainder\nstomach, small bowel and colon in the upper abdomen are within normal limits.\n\nLymph Nodes: No suspicious mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta is normal in caliber and its major branches are\npatent. Hepatic arterial anatomy is conventional. There is slight\nattenuation of the posterior branch of the right portal vein (series 13, image\n33), however no occlusion or thrombosis. The main portal and left portal\nveins are patent. The splenic vein, SMV and hepatic veins are patent. Small\nparaesophageal varices.\n\nOsseous and Soft Tissue Structures: T1 and T2 hyperintense lesion within L5\nvertebral body compatible with an intraosseous hemangioma. No suspicious\nosseous or soft tissue mass lesions.", "output": "1. Cirrhotic liver morphology. There is confluent hepatic fibrosis with a\nmore focal area of capsular retraction with progressive delayed enhancement in\nsegment IV- likely corresponding to the abnormality seen on the ultrasound. \nThere are no focal enhancing hepatic mass lesions suspicious for HCC.\n2. Stigmata of portal hypertension including splenomegaly and small\nparaesophageal varices.\n3. Slight attenuation of the posterior branch of the right portal vein due to\ncompression from the adjacent liver parenchyma without thrombosis.\n4. Cholelithiasis." }, { "input": "The liver is visualized and is of normal signal intensity. A\nsubcentimeter area of high signal intensity is seen in the liver in segment VI\nand does not demonstrate enhancement post administration of contrast. The\nappearance is consistent with a simple cyst. The spleen is visualized and is\nnormal. The right adrenal is normal. The left adrenal demonstrates some\nnodularity and measures 9 mm in maximum length with drop in signal on the out-\nof-phase imaging consistent with intravoxel fat and an adenoma. The\nappearance is unchanged when compared with the previous MR from ___. The\nright kidney demonstrates multiple subcentimeter cysts and is otherwise\nunremarkable.\n\nThe left kidney again demonstrates a left interpolar cyst measuring 3.3 cm in\ntransverse x 2.8 cm in AP x 2.9 cm in craniocaudal ___. The wall\nremains thickened though less so than ___. No focal mass lesion identified\nwithin this cyst. Post-administration of contrast it demonstrates wall\nenhancement, though comparison is somewhat limited due to nonbreathhold\ntechnique.\n\nThe pancreas is visualized and is normal. No evidence of any lymphadenopathy.\nThe gallbladder is unremarkable. No evidence of any intrahepatic or\nextrahepatic bile duct dilatation.\n\nNo evidence of any free fluid. The osseous structures where visualized are\nnormal.\n\nNote is made of some atelectasis in the left base.", "output": "1. Unchanged interpolar cyst in the left kidney which demonstrates some rim\nenhancement along the wall but is unchanged since ___.\n2. Nodularity in the left adrenal which is unchanged and likely represents an\nadenoma.\n3. Subcentimeter hepatic cyst." }, { "input": "Lower Thorax: The lung bases are clear. Heart size is normal.\n\nLiver: The liver is normal in morphology. Corresponding to the lesion on\nultrasound is a lobulated T2 hyperintense lesion in segment IV/VIII a segment\nmeasuring 1.7 x 1.3 x 1.4 cm demonstrating peripheral nodular arterial\nenhancement and progressive fill-in, consistent with a hemangioma. No\nadditional lesions are seen. There is no ascites.\n\nBiliary: The gallbladder is unremarkable without evidence of stones. There is\nno intra or extrahepatic biliary duct dilation. There is no ductal filling\ndefect.\n\nPancreas: The pancreas is normal in morphology and signal intensity. Note is\nmade of pancreas divisum. No focal pancreatic lesion is seen. There is no\npancreatic duct dilation.\n\nSpleen: The spleen is normal in size. There is drop of signal on the spleen\non in-phase-imaging consistent with iron deposition.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. There is a subc entimeter cyst in\nthe lower pole of the left kidney measuring up to 0.5 cm. There is no\nhydronephrosis.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. There is a single renal artery bilaterally.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. \nThere is multilevel degenerative change of the lumbar spine.", "output": "1. Lesion seen on ultrasound corresponds to a hepatic hemangioma. No\nsuspicious liver lesions.\n2. Iron deposition within the spleen.\n3. Pancreas divisum." }, { "input": "Lower Thorax: Right subsegment atelectasis.\n\nLiver: Redemonstration of cirrhotic hepatic configuration.\n\nBiliary: No biliary ductal dilatation. Unremarkable gallbladder.\n\nPancreas: Stable size and morphology 1 cm side-branch IPMN of the pancreatic\nhead since ___. No main pancreatic ductal dilatation.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: No hydronephrosis. Renal cortical cysts and left peripelvic cyst. \nThe unenhanced kidneys are otherwise unremarkable.\n\nGastrointestinal Tract: No bowel obstruction. No ascites.\n\nLymph Nodes: No abdominal adenopathy.\n\nVasculature: Normal caliber abdominal aorta.\n\nOsseous and Soft Tissue Structures: T2 hyperintense lesions likely\nrepresenting hemangiomas.", "output": "Stable pancreatic head side-branch IPMN since ___.\n\nRECOMMENDATION(S): Continue follow-up with MRCP ___ years." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Note, study is markedly degraded by motion. A nodular liver contour is\ncompatible with cirrhosis. The portal vein is patent. In segment IV-A, an 8\nmm hypodense focus most apparent on delayed phase post-contrast images (for\nexample see series 6, image 9) is compatible with post treatment change\nfollowing TACE to the segment IV-A hepatic artery branch. In segment VIII near\nthe liver dome, again seen is a 17 x 12 mm arterially enhancing lesion (series\n15, image 6) is not appreciably changed since ___. In segment III, a\n12 x 7 mm focus of hypoenhancing hepatic parenchyma (series 16 and 18, image\n13) in the region of previously identified arterially-enhancing 15 mm lesion\ndoes not have appear to have an arterial phase or T2 correlate. An additional\n14 mm focus arterial enhancement high in segment VII (series 15, image 6) is\nidentified. An 8 mm focus of hypoenhancement in segment IV-A is compatible\nwith post-TACE treatment change. Note, OPTN criteria are unable to be\nassessed due to the lack of breath-holding sequences.\n\nBiliary: There is no intra- or extrahepatic biliary ductal dilation. The\ngallbladder is unremarkable.\n\nPancreas: A 17 mm circumscribed T2 hyperintense cystic structure in the\nanterior pancreatic tail (series 10, image 13) does not enhance, statistically\nlikely side-branch IPMN. An additional smaller, approximately 3 mm T2\nhyperintense cystic focus seen in the anterior pancreatic body (series 10,\nimage 31) is also likely a side-branch IPMN. These are unchanged in\ncomparison to outside hospital MRI from ___. Otherwise, the\nbackground pancreatic parenchyma demonstrates normal homogeneous signal\nintensity. There is no main pancreatic ductal dilation.\n\nSpleen: There is mild splenomegaly with a craniocaudal diameter 15.0 cm. \nThere is no focal splenic lesion.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration.\n\nKidneys: Adjacent simple cysts in the left lower renal pole measure 14 and 11\nmm (series 7, image 41). Otherwise, the kidneys display normal symmetric\nenhancement and signal intensity characteristics. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. Partially\nimaged non-dilated small bowel loops are normal in course and caliber without\nevidence of wall thickening, mural or mucosal hyperenhancement, or\nobstruction. There is descending rectosigmoid colonic diverticulosis. The\npartially imaged colon is otherwise unremarkable.\n\nLymph Nodes: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVasculature: The partially imaged abdominal aorta is normal in caliber without\nevidence of aneurysm or dilation. Major proximal tributaries appear patent.\n\nOsseous and Soft Tissue Structures: No suspicious foci of abnormal marrow\nsignal are seen.", "output": "1. Note, study is severely degraded by motion and patient inability to sustain\nbreath-holds.\n2. At least two (2) arterially-hyperenhancing hepatic lesions and segments VII\nand VIII. The largest lesion in segment VIII measures 17 x 12 mm, and is\ngenerally unchanged in appearance since ___. An additional 14 mm\narterially enhancing lesion in segment VII was not seen clearly on prior. \nBreath-holding sequences were unable to obtained, and thus OPTN criteria\nassessment is unable to be applied. Recommend multiphasic CT abdomen and\npelvis for further characterization.\n3. 8 mm focus of hypoenhancement in segment IV-A likely represents post-TACE\ntreatment change.\n4. 12 mm hypoenhancing hepatic focus in segment III at site of known lesion no\nlonger demonstrates arterial enhancement.\n5. Stable pancreatic cystic foci measuring up to 17 mm, likely side branch\nIPMNs. Attention on followup.\n6. Cirrhosis. Splenomegaly. Descending rectosigmoid colonic diverticulosis. \nOther incidental findings as above.\n\nRECOMMENDATION(S): Multiphasic CT abdomen for further characterization, and\nfor future follow-up studies." }, { "input": "Lower Thorax: Limited evaluation of the lung bases is notable for fluid\ncontaining right Bochdalek diaphragmatic hernia, unchanged from ___.\n0.9 cm enhancing left lower lobe pulmonary nodule is unchanged(03:10). No\npleural effusion.\n\nLiver: The liver is shrunken and nodular in contour consistent with cirrhosis.\nSmall volume perihepatic free fluid noted. No signal drop on out of phase\nimaging to suggest hepatic steatosis.\n\nStatus post segment 8 TACE and coiling of an arterioportal fistula. (10:26.) \nAlong the lateral portion of the ablation cavity there is a 0.4 cm area of the\narterial hyper enhancement which may be an area of early recurrence (10:28).\n\nAdditional 1.5 x 1.4 cm arterially hyperenhancing lesion within segment 3\ndemonstrates washout with possible pseudo capsule unchanged since prior\n(10:62).\n\n1.2 x 1 cm arterial hyperenhancing lesion within segment 3 demonstrates\nwashout and no definite pseudocapsule, unchanged since ___ (10:70).\n\nA 4.6 x 2.8 cm ablation cavity is noted within segment 4B/5. There is an\nill-defined 7.2 x 6.5 cm (previously 6.1 x 4.1 cm) arterially hyperenhancing\nlesion within segment ___ which demonstrates washout and multiple thin\nseptations (10:62). No definite pseudo capsule. The right anterior portal\nveins and segmental peripheral branches of the posterior right portal vein\ndemonstrate arterial hyper enhancement and washout consistent with tumor\nwithin the vein, which is new since prior study (16:46).\n\nA 1.2 x 1.2 cm and adjacent 1.8 x 1.4 cm arterially hyperenhancing lesions\nwith washout are noted within segment 4A, which have slightly increased in\nsize ___ were both lesions measured 1.1 cm in maximal diameter\n(10:31). No pseudo capsule.\n\nThere is a 0.8 x 0.6 cm arterially hyperenhancing focus within segment 8\n(10:33) which demonstrates washout and pseudo capsule, similar in appearance\nto ___.\n\nNo interval change in 0.6 cm segment 8 arterially hyperenhancing lesion\nwithout correlate on additional sequences and remains nonspecific (10:34)\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. No\ncholedocholithiasis. Gallstones noted. Gallbladder is otherwise\nunremarkable.\n\nPancreas: Few T2 hyperintense nonenhancing pancreatic cystic lesions noted,\nlargest measuring 1.5 x 1.4 cm within the tail which is unchanged since ___ (03:22).\n\nSpleen: Spleen is enlarged measuring 17.2 cm. No suspicious mass. Trace\nperisplenic free fluid noted.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: Bilateral kidneys are mildly atrophic. A 3.3 cm left lower pole\nrenal cyst noted. No suspicious mass. No hydronephrosis or perinephric fat\nstranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, and visualized small bowel\nare unremarkable. Transverse and ascending colonic diverticulosis noted\nwithout evidence of acute diverticulitis. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries are patent. Hepatic anatomy is notable for a common hepatic artery\narising off of the SMA. Hepatic veins, main portal vein, SMV, and splenic\nvein are patent. The right anterior portal veins and segmental branches of\nthe posterior right portal vein demonstrate arterial hyper enhancement and\nwashout consistent with tumor within the vein, which is new since prior study\n(16:46). Paraesophageal varices noted. There is early filling of the middle\nhepatic vein consistent with an arterial hepatic fistula, unchanged since\nprior examination.\n\nOsseous and Soft Tissue Structures: Soft tissues are unremarkable. 0.6cm\nslightly T2 hyperintense upper thoracic vertebral body lesion is unchanged\nsince ___ (2: 37).", "output": "1. Progression of multifocal HCC involving both right and left hepatic lobes.\nLargest lesion measures 7.2 cm within segment ___ with tumor extension within\nthe right anterior portal veins and segmental branches of the right posterior\nportal veins.\n2. Cirrhosis with small volume ascites and splenomegaly.\n3. 0.9 cm left lower lobe pulmonary nodule, unchanged." }, { "input": "Limited evaluation due to absence of intravenous contrast\n\nLower Thorax: Limited evaluation of the lung bases is notable for bilateral\natelectasis. Trace right pleural effusion noted. No left pleural effusion.\n\nLiver: The liver is nodular in contour consistent with history of cirrhosis. \nAgain noted is T2 hyperintense signal within segment 5 and 8 which has overall\nincreased in bulk since ___, worrisome for disease progression in\na patient with known infiltrative hepatocellular carcinoma. Definitive\nevaluation is limited due to absence of intravenous contrast. No hemorrhage\nnoted within this area.\n\nThere are multiple additional T2 hyperintense lesions which demonstrate\nrestricted diffusion throughout the liver. Representative lesions are as\nfollows: 1.8 x 1.7 cm and 1.4 x 1.4 cm mildly T2 hyperintense lesions within\nsegment 4A which have mildly increased in conspicuity and size since ___. Additional 1.3 and 1 cm T2 hyperintense lesions within segment\n3 are unchanged since prior examination.\n\nStatus post segment 8 TACE as well as radiofrequency ablation of segment 4B/5\nwith expected posttreatment changes including coagulation necrosis at the RFA\nsite. Moderate volume ascites noted.\n\nBiliary: Gallbladder is top normal with few small gallstones. No gallbladder\nwall edema. No central or intrahepatic biliary duct dilation. The common bile\nduct is normal in caliber without obstructing stone or large periampullary\nmass.\n\nPancreas: Pancreas is notable for 1.9 x 1.5 cm cystic lesion within the\npancreatic tail, unchanged since ___, minimally increased in size\nsince ___. Pancreas is otherwise homogeneous in signal intensity\nwithout suspicious mass. No pancreatic duct dilatation or peripancreatic fat\nstranding.\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: Bilateral renal cysts noted. There is mild bilateral renal cortical\natrophy, unchanged since prior. Kidneys are otherwise homogeneous in signal\nintensity without suspicious mass.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. Findings worrisome for disease progression predominately involving segment\n___ in a patient with known multifocal hepatocellular carcinoma.\n2. Status post tace and radiofrequency ablation with expected changes.\n3. No biliary duct dilatation. No choledocholithiasis.\n4. Top-normal gallbladder with gallstones. No additional signs of acute\ncholecystitis.\n5. Minimal increase size 1.9 cm pancreatic tail cystic lesion, likely IPMN. \nClose attention on follow-up is recommended." }, { "input": "Lower Thorax: The lung bases are clear. There is no pleural effusion. There\nis no pericardial effusion.\n\nLiver: The liver demonstrate normal morphology without suspicious focal\nlesion. There is no steatosis. Portal vein is patent.\n\nBiliary: The gallbladder is within normal limits. There is no intrahepatic or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas demonstrate normal morphology enhancement without focal\nlesion or pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size enhancement without focal lesion. Signal\ndropout in the out of phase images is consistent with iron deposition.\n\nAdrenal Glands: The adrenal glands are normal bilaterally.\n\nKidneys: There is a 2.8 x 2.3 x 2.7 cm mass in the medial aspect of the upper\npole of the left kidney (Series 3, image 17 and series 5, image 17)\ncorresponding to the biopsy-proven clear cell renal cell carcinoma. The mass\nis mildly T2 hyperintense and T1 isointense to the cortex with heterogeneous\nenhancement on postcontrast images. The mass demonstrates signal dropout on\nout of phase images consistent with intravoxel fat, which can be seen in clear\ncell renal cell carcinoma. There is no restricted diffusion. When compared\nto CT dated ___, the mass grossly unchanged. There are bilateral\nparapelvic cysts. Multiple T2 hyperintense cystic lesions throughout the\nbilateral kidneys measuring up to 1.9 cm in the left upper pole are consistent\nwith simple renal cysts. There is no additional suspicious lesion in either\nkidney. Bilateral renal veins and arteries are patent. There is no\nperinephric abnormality.\n\nGastrointestinal Tract: There is a large hiatal hernia. The visualized small\nand large bowel demonstrate no obstruction or wall thickening. No ascites.\n\nLymph Nodes: There is no lymphadenopathy.\n\nVasculature: The abdominal aorta and its branches are patent normal caliber.\n\nOsseous and Soft Tissue Structures: Partially imaged heterogeneous T1 and T2\nhyperintense area in the right rectus sheath (series 3, image 38) is\nconsistent with evolving known rectus sheath hematoma better evaluated on\nprior CT dated ___.\n\nNo suspicious osseous lesions.", "output": "1. 2.8 x 2.3 x 2.7 cm mildly T2 hypointense and T1 isointense mass in the\nmedial aspect of the upper pole of the left kidney with heterogeneous\nenhancement and intravoxel fat consistent with known clear cell renal cell\ncarcinoma which is similar to ___. Patent bilateral renal\nvasculature. No additional suspicious renal mass.\n2. Partially imaged involving right rectus sheath hematoma, better evaluated\non prior CT.\n3. Large hiatal hernia." }, { "input": "Limited assessment of the lung bases are clear. No pleural effusion.\nVisualized heart is unremarkable without pericardial effusion.\n\nThe liver is homogeneous in signal intensity and smooth in contour. Mild\nsignal drop of the hepatic parenchyma is seen on T1-weighted out of phase\nimaging in comparison to the in phase sequence, consistent with steatosis. No\nconcerning hepatic lesion is identified. No intra or extrahepatic biliary duct\ndilatation. The gallbladder is within normal limits without filling defects to\nsuggest gallstones. The portal vein, SMV, and splenic vein are patent. The\nspleen and adrenal glands are unremarkable.\n\nA 1.7 x 1.6 cm T2 hyperintense, nonenhancing, ovoid, pancreatic head cystic\nlesion with a thin septum or pseudo-septation is noted (12 b: 27). An\nadditional 0.4 x 0.3 cm nonenhancing cystic lesion is seen within the\npancreatic body (12b: 36). No enhancing nodular components are detected. The\npancreas is otherwise normal in signal intensity without pancreatic ductal\ndilatation or enhancing lesion. Few subcentimeter renal cysts identified\nlargest measuring 0.7 x 0.8 cm (03:20) within the interpolar region of the\nleft kidney as well as a 0.8 x 0.7 cm (03:27) cyst within the upper pole of\nthe right kidney. No hydronephrosis or obstructing stones.\n\nLimited assessment of the esophagus is unremarkable without hiatal hernia.\nVisualized stomach, small bowel, and colon are within normal limits. No\nascites. No retroperitoneal or mesenteric lymph node enlargement. Visualized\naorta is normal in caliber without aneurysmal dilatation. The celiac axis and\nSMA are patent. Mild prominence of the left gonadal vein is noted. The bone\nmarrow signal is notable for a 0.9 x 0.6 cm (903: 77) enhancing round lesion\nwithin the inferior aspect of L1 vertebral body without T2 correlate and may\nreflect a varix. No compression fracture.", "output": "1. 1.7 cm pancreatic head cystic lesion with thin septation or pseudo\nseptation as well as a 0.4 cm pancreatic body cystic lesion are statistically\nlikely side branch IPMN. Followup MRCP recommended in 6 months per department\nguidelines. Alternatively, gastroenterology consultation could also be\nconsidered for EUS.\n2. 0.9 cm enhancing round lesion within the L1 vertebral body without T2\ncorrelate is likely to represent a varix or prominent vessel. No aggressive\nfeatures seen. Correlate with any prior history of malignancy; if history is\nconcerning, a lumbar spine MR could be considered.\n3. Renal cysts.\n4. Mild hepatic steatosis." }, { "input": "Lower Thorax: There are no pleural or pericardial effusions.\n\nLiver: The liver is normal in morphology and signal intensity, without\nevidence of focal lesion.\n\nBiliary: There is no intra or extrahepatic biliary duct dilatation. \nGallbladder is unremarkable.\n\nPancreas: The pancreas is normal in signal intensity. There are few\nsubcentimeter cystic lesions in the pancreas, measuring up to 4 mm in the\npancreatic head, stable, likely representing side-branch IPMNs. Pancreatic\nduct is not dilated.\n\nSpleen: The spleen is not enlarged.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There are bilateral cortical renal cysts, measuring up to 1.1 cm at\nthe upper pole of the left kidney.\n\nGastrointestinal Tract: The visualized bowel loops in the upper abdomen are\nunremarkable, without evidence of obstruction.\n\nLymph Nodes: There is no size significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions.", "output": "Stability of subcentimeter cystic lesions in the pancreas, likely representing\nside-branch IPMNs.\n\nRECOMMENDATION(S): Follow-up MRCP in ___ years is recommended." }, { "input": "ABDOMEN:\n\nLIVER: The partially imaged liver is normal in signal intensity. No hepatic\nsteatosis. No focal concerning lesions.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation. There\nis sludge or concentrated bile within the gallbladder. No gallbladder wall\nedema. Gallbladder distention is mild.\n\nPANCREAS: The pancreas normal in signal intensity. No concerning lesions. No\nmain pancreatic duct dilatation. No evidence of peripancreatic inflammation.\n\nSPLEEN: The partially imaged spleen is normal size and signal intensity. No\nfocal concerning lesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Small bowel loops are\nborderline dilated with a diameter of approximately 3 cm, some containing\nfluid and some partially fecalized, tapering toward the J-pouch. There is a\nshort segment of narrowing near the prior obstruction which could reflect\nperistalsis or a small stricture (series 4, image 15). Distal loops are not\ncollapsed. There is no transition point. Patient is status-post colectomy.\n\nPELVIS: The urinary bladder is unremarkable. The uterus is arcuate morphology.\nEndometrial contents are compatible with an early gestation pregnancy, better\nassessed on pelvic ultrasound. There's a 2 centimeter left ovarian\nhemorrhagic cyst. No adnexal mass. There is trace abdominopelvic ascites.\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: No concerning soft tissue lesions. There are postoperative\nchanges in the anterior pelvic wall.", "output": "1. Borderline dilated small bowel loops containing fluid and some fecal\nmaterial tapering toward the J-pouch without a transition point to suggest\nobstruction. Findings could reflect an ileus.\n2. Short segment of narrowing near the prior obstruction which could reflect\nperistalsis or a small stricture.\n3. Trace abdominopelvic ascites.\n4. An intrauterine pregnancy is better assessed on same day pelvic ultrasound.\n5. Arcuate uterus." }, { "input": "Lower Thorax: Of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nLiver: The hepatic parenchyma demonstrates normal signal intensity on T1 and\nT2 weighted sequences. There are multiple hepatic cystic lesions involving\nall segments, demonstrating low signal intensity on T1 weighted precontrast\nimages, and high uniform signal intensity on T2 weighted sequences. There are\nclusters of cysts or cyst demonstrating thin internal septations, particularly\nalong the anterior left lobe (series 4, image 24). The largest of the\nsimple-appearing cysts measures 8.8 x 10.6 x 10.3 cm, arising from the\ninferior right hepatic lobe (series 4, image 14, series 3, image 18). The\nsecond largest cyst, located at the dome, measures 8.9 x 9.3 x 8.2 cm,\ndemonstrating thin internal septations (series 3, image 16, 20). A central\nsegment VI cyst demonstrates intermediate signal intensity on T1 weighted\nimages, with high signal intensity on T2 weighted sequences, measuring 5.1 x\n6.2 x 5.0 cm (series 4, image 21, series 9, image 85), compatible with\nproteinaceous or hemorrhagic material. There are no solid enhancing\ncomponents.\n\nBiliary: Moderately dilated intrahepatic bile ducts along segment III are\nunchanged in comparison to the ___ examination (series 13, image\n61), likely due to mass effect from adjacent cystic lesions. No ductal\nfilling defects are demonstrated. The gallbladder appears normal.\n\nPancreas: The pancreas demonstrates normal signal intensity and bulk, without\nduct dilation or focal lesion.\n\nSpleen: The spleen size is within normal limits. There are no focal splenic\nlesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. There is slight malrotation of the right kidney (series 4,\nimage 43). A punctate T2 hyperintense nonenhancing right lower pole renal\ncyst is present (series 14, image 6, series 4, image 46).\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal lesion.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy, and no\nascites.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries are\npatent and normal in caliber. The portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. Moderate segment III intrahepatic bile duct dilation is unchanged since the\nreference CT examination from ___, possibly from mass effect from\na cluster of adjacent hepatic cysts. No obstructing solid mass or stone\nidentified.\n2. Additional simple and minimally complex hepatic cysts, one demonstrating\nhemorrhagic or proteinaceous contents, do not demonstrate concerning features." }, { "input": "Lower Thorax: Visualized lung bases are clear. No pleural or pericardial\neffusion.\n\nLiver: Liver contour is normal. There are innumerable hypoenhancing mildly T2\nhyperintense lesions scattered throughout the liver, concerning for diffuse\nmetastases in the setting of a large right renal and ureteral mass. The\nlargest, in segment V, measures 1.4 x 1.3 cm (___).\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. \nCholelithiasis without evidence of wall thickening or pericholecystic fluid.\n\nPancreas: Normal in bulk and signal intensity without focal lesion. The main\npancreatic duct is not dilated.\n\nSpleen: The spleen is normal in size and signal intensity without focal\nlesion.\n\nAdrenal Glands: The right adrenal gland appears bulky on axial images but not\nclearly so on coronal images, possibly due to volume averaging. The left\nadrenal gland is unremarkable.\n\nKidneys:\nRight kidney: There is a 5.2 x 5.3 x 6.3 cm diffusion restricting mass\ncentrally within the right renal pelvis (120___, ___. Peripheral to the\nmass, there are a few foci of intrinsic T1 hyperintensity, possibly\nrepresenting upstream hemorrhage in the calyces. There is diffuse\nheterogeneous soft tissue expanding or surrounding the entire length of the\nright ureter (difficult to distinguish), measuring up to 3 cm diameter,\nconcerning for florid ureteral and periureteral involvement.\n\nThere is a 2.0 cm cystic lesion in the lower pole with layering\nhemorrhagic/proteinaceous contents (___).\n\nLeft kidney: There are multiple tiny T2 hyperintense lesions, compatible with\nsimple cysts. No hydronephrosis or suspicious renal lesion.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are\nnondilated.\n\nLymph Nodes: There are multiple abnormal appearing retroperitoneal and\nretrocrural lymph nodes. Some enlarged lymph nodes, which track adjacent to\nthe right ureter, have central necrosis. Representative nodes:\n-1.9 x 1.2 cm left para-aortic (___)\n-1.2 x 1.2 cm aortocaval (___)\n-1.7 x 1.5 cm aortocaval (___)\n\nVasculature: Aorta is normal in caliber with moderate atherosclerosis. The\nright renal vein is not well visualized, but there is adjacent mass effect on\nthe IVC, concerning for venous involvement by the mass. The left renal vein is\nunremarkable. There are 2 right renal arteries. There are 3 left renal\narteries. Incidentally noted left hepatic artery.\n\nOsseous and Soft Tissue Structures: Innumerable round lesions throughout the\npelvic bones, concerning for osseous metastases. Incidentally noted Tarlov\ncysts. Small fat containing umbilical hernia.", "output": "1. 5.2 x 5.3 x 6.3 cm diffusion restricting mass in the right renal pelvis\nwith upstream hemorrhage and diffuse heterogeneous soft tissue surrounding the\nentire length of the right ureter, measuring up to 3 cm, concerning for florid\nureteral and periureteral involvement, although it is difficult to determine\nif the lesion is within the ureter or surrounds it. The right renal vein is\nnot well visualized, but there is adjacent mass effect on the IVC, concerning\nfor venous involvement by the mass. These findings are concerning for an\naggressive urothelial neoplasm.\n2. Diffuse hypoenhancing mildly T2 hyperintense lesions scattered throughout\nthe liver, concerning for diffuse metastases in the setting of a large right\nrenal mass.\n3. Diffuse round lesions throughout the pelvic bones, also concerning for\nosseous metastases.\n4. Diffuse retroperitoneal and retrocrural lymphadenopathy, some with central\nnecrosis, concerning for metastases.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 9:40 am, 5 minutes after discovery of the\nfindings." }, { "input": "Lower Thorax: There is a moderate right and small left pleural effusion. \nThere is bibasilar right greater than left atelectasis.\n\nLiver: The liver is cirrhotic. There is infiltrative T2 hyperintense tumor\nwith arterial enhancement and areas of washout replacing the near entirety of\nthe right lobe and most of the left lateral lobe with relative sparing of\nsegment VI and portions of segment VII. An additional more discrete enhancing\nmass with washout and a pseudocapsule measures 3.1 cm in segment VII (series\n1101, image 70). There is small to moderate volume ascites.\n\nBiliary: The gallbladder is unremarkable. There is no intra or extrahepatic\nbiliary duct dilation.\n\nPancreas: The pancreas is unremarkable. There is no main pancreatic duct\ndilation.\n\nSpleen: The spleen is again noted to be enlarged measuring 17.0 cm.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable. There is no hydronephrosis.\n\nGastrointestinal Tract: There is no bowel obstruction.\n\nLymph Nodes: There are prominent porta hepatic and crural lymph nodes more\nconspicuous on MRI these measure up to 1.2 cm (series 1101, image 70).\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. Note is made of multiple collateral venous branches at the\nhepatic hilum.\n\nThe portal vein is thrombosed containing areas of both bland and tumor\nthrombus. There is a small sliver of patent proximal main portal vein and\nright posterior portal vein noted. Bland T1 hyperintense thrombus is seen in\nthe central portal vessels the peripheral portal veins demonstrating tumor\nthrombus. Tumor thrombus is also noted in the infra/supra hepatic IV as well\nas the right hepatic vein. The middle and the left hepatic veins are not well\nseen and also thrombosed.\n\nOsseous and Soft Tissue Structures: There is mild anasarca. Likely hemangioma\nnoted in the L4 vertebral body.", "output": "1. Extensive infiltrative hepatocellular carcinoma involving the majority of\nthe right lobe of as well as much of the lateral left lobe of the liver.\n2. Bland and tumor thrombus in the portal veins as well as tumor thrombus in\nthe infra/suprahepatic IVC and hepatic veins.\n3. Prominent peripancreatic and periportal lymph nodes measuring up to 1.2 cm." }, { "input": "The patient is status post hysterectomy and bilateral salpingo-\nOophorectomy. Post radiotherapy changes are present in the pre sacral area,\nevident by mildly restricted diffusion (6b:59).\nA big circumferential mass involving the mid rectum and extending down to the\nlevel of the anus is seen. Anteriorly the mass is well defined. The right\nmargin of the mass is ill-defined extending to the mesorectal fat (09:12).\nPosteriorly no definite separation can be made between the mass and the\nfibrotic changes in the presacral area (11:28), thus posterior minute\nextension of the mass cannot be ruled out. The mesorectal fascia is not\nclearly involved. There is no evidence of extramural vascular invasion.\nSeveral lymph nodes less than 5 mm in size are present in the mesorectal fat,\nnot meeting the criteria for malignant involvement.\nSmall amount of free fluid is present in the pelvis.\nThe urinary bladder is unremarkable. There vaginal stump is unremarkable.\nThe bone marrow signal is normal.", "output": "Rectal mass extending from the mid rectum to the level of the anus, with mild\nextension into the mesorectal fat on the right and suspected minute posterior\nextension, compatible with early T3 stage. No nodal disease" }, { "input": "Lower Thorax: Evaluation of the lower thorax and lung bases is limited,\nhowever linear T2 hyperintense bands are seen in the lung periphery, query\nfibrotic or atelectatic changes, nonspecific on MRI. Please refer to recently\nperformed CT chest for further characterization of these findings.\n\nLiver: The liver demonstrates mild steatosis. No suspicious focal hepatic\nlesions are identified.\n\nBiliary: Visualized gallbladder and biliary tree is within normal limits.\n\nPancreas: The pancreas is mildly fatty replaced, otherwise the signal is\nwithin normal limits. No suspicious pancreatic mass or main pancreatic ductal\ndilation.\n\nSpleen: Unfortunately, evaluation of the splenic lesions is limited by motion\nartifact. Several T2 hyperintense splenic lesions are identified, largest\nbeing a 1.1 cm lesion near the splenic hilum. The diffusion-weighted images\nare not reliable because of extensive motion and misregistration. On\npostcontrast images, the lesions appear to fill in progressively. These are\nmost likely related to splenic hemangiomas. They have not changed in size\nwhen compared to the CT scan performed yesterday. If there is persistent\nconcern for splenic microabscesses repeat CT scan can be performed to assess\nfor any size progression or increase in number.\n\nAdrenal Glands: Visualized adrenal glands are within normal limits with no\nsuspicious focal lesions seen.\n\nKidneys: Kidneys demonstrate several cortical and parapelvic cysts, none of\nwhich appear suspicious. There are no suspicious renal lesions seen.\n\nGastrointestinal Tract: A moderate hiatus hernia is seen. Remainder of the\npartially visualized small and large bowel loops are unremarkable.\n\nLymph Nodes: No size significant lymphadenopathy is identified in the upper\nabdomen or retroperitoneum.\n\nVasculature: Visualized vascular structures are within normal limits, in\nparticular the aorta is of normal caliber.\n\nOsseous and Soft Tissue Structures: Limited evaluation of the bony and soft\ntissue structures demonstrate no significant abnormality.", "output": "1. Evaluation of the splenic hypodensities seen on CT is significantly limited\nby motion artifact. Several T2 hyperintense lesions correspond to the\nabnormality seen on CT. Most of these demonstrate progressive fill-in on\npostcontrast images, and are likely compatible with hemangiomas. If clinical\nconcern persists, a repeat CT in follow up can be performed to evaluate for\nany change in number or size of the previously documented splenic lesions." }, { "input": "Lower Thorax: There is mild subsegmental atelectasis within the lower lobes\nbilaterally. (Series 1301, image 24 and 28). Otherwise, the partially\nvisualized lower lung fields are clear. No pleural or pericardial effusion.\n\nLiver: The contour of the liver is smooth. The liver parenchyma enhances\nhomogeneously, however it is slightly T2 hypointense, which may represent\nearly mild hemosiderin deposition. There are a few scattered punctate T2\nhyperintensities, which likely represent biliary hamartomas (series 4, image ___\nand 24). No enhancing liver lesions. No evidence of portal vein thrombosis.\n\nBiliary: No intra or extrahepatic biliary dilatation. The gallbladder is\ncontracted.\n\nPancreas: There is mild pancreatic parenchymal atrophy. No focal lesions. No\npancreatic ductal dilatation. No peripancreatic stranding.\n\nSpleen: Multiple T1 hypointense T2 hyperintense lesions within the spleen\n(series 4, image 10, 11, 21), which are stable in size and distribution\ncompared to the MR dated ___, and appear to demonstrate\nprogressive peripheral enhancement on the delayed images, consistent with\nmultiple hemangiomas. No new splenic lesions. Borderline splenomegaly.\n\nAdrenal Glands: The adrenal glands are normal in size and shape bilaterally.\n\nKidneys: There are numerous parapelvic and cortical renal simple cyst cysts\nbilaterally. Otherwise, the kidneys enhance symmetrically. No enhancing\nrenal lesions. No evidence of hydronephrosis. No perinephric stranding.\n\nGastrointestinal Tract: There is a moderate-sized hiatal hernia. Otherwise,\nthe partially visualized stomach, small and large bowel are within normal\nlimits.\n\nLymph Nodes: No visualize mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: A right chest wall lipoma is re-\ndemonstrated, stable in size. There is a round T2 hyperintensity within the\nL3 vertebral body measuring approximately 1.4 x 1.1 cm (series 3, image 27),\nwhich likely represents a hemangioma. No suspicious osseous or soft tissue\nlesions.", "output": "1. No evidence of biliary dilatation or focal liver lesions to explain\nelevation in liver function tests.\n2. Stable splenic hemangiomas.\n3. 1.4 cm L3 vertebral body hemangioma.\n4. Hiatal hernia.\n5. Stable right chest wall lipoma." }, { "input": "Lower Thorax: No pleural or pericardial effusion. The heart appears enlarged.\n\nLiver: Liver is shrunken and nodular in contour compatible with known history\nof cirrhosis. The parenchyma is heterogeneous in signal without significant\nsteatosis. In hepatic segment 2, a 9 mm a well-circumscribed focus\ndemonstrating hyperintense signal on T2 weighted images is nonenhancing\ncompatible with a cyst or biliary hamartoma. Similarly, a peripheral punctate\nT2 hyperintense focus in hepatic segment 5 compatible with a cyst or biliary\nhamartoma. No arterially hyperenhancing lesions or lesions meeting OPTN 5\ncriteria for HCC are demonstrated.\n\nBiliary: The gallbladder contains stones. There is slight pericholecystic\nfluid likely due to third spacing from underlying liver disease. No evidence\nof intrahepatic or extrahepatic biliary dilation.\n\nPancreas: Normal parenchymal signal. No ductal dilation or focal lesions.\n\nSpleen: The spleen is enlarged measuring 16.5 cm in AP dimension. No focal\nlesions.\n\nAdrenal Glands: Normal in size and shape bilaterally.\n\nKidneys: Normal symmetric size. No focal lesions or hydronephrosis.\n\nGastrointestinal Tract: Unremarkable stomach. No evidence of obstruction.\nTrace ascites.\n\nLymph Nodes: No abnormally enlarged lymph nodes noted in the upper abdomen.\n\nVasculature: Replaced right hepatic artery from the SMA. Patent celiac axis,\nSMA, ___, and single renal arteries bilaterally. Patent portal vein,\nSMV, splenic vein, hepatic veins, and IVC. Patent paraumbilical vein,\nesophageal varices, and gastric varices compatible with portal hypertension.\n\nOsseous and Soft Tissue Structures: No concerning abnormalities.", "output": "1. Cirrhotic liver without suspicious lesions or lesions meeting OPTN-5\ncriteria for HCC.\n2. Trace ascites. Splenomegaly and varices compatible with portal\nhypertension.\n3. Cholelithiasis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver demonstrates a shrunken, nodular contour, compatible with\nknown history of cirrhosis. No significant steatosis. A 0.8 cm\nwell-circumscribed T2 hyperintense lesion does not enhance and is compatible\nwith a stable cyst or biliary hamartoma. A 0.4 cm T2 hyperintense lesion at\nthe periphery of hepatic segment VIII is compatible with a cyst or biliary\nhamartoma and is unchanged from prior. There is a focal area of parenchymal\nenhancement within hepatic segment ___, likely related to fibrosis with\nassociated portal-hepatic venous shunting. There is no suspicious lesion. The\nportal and hepatic veins are patent, with small distal portal venous\nvasculature consistent with cirrhosis.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder contains stones. Trace pericholecystic fluid and wall edema\nare likely sequela of chronic liver disease.\n\nPancreas: Normal in signal intensity without ductal dilatation. There is no\nfocal lesion.\n\nSpleen: Stable splenomegaly up to 16.3 cm in AP dimension, otherwise without\nfocal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Replaced right hepatic artery from the SMA. Patent celiac axis,\nSMA, ___ aeration and single renal arteries bilaterally. The portal venous\nvasculature is patent, as is the splenic vein, hepatic veins and IVC. There\nis a patent paraumbilical vein with prominent esophageal and gastric varices\ncompatible with portal venous hypertension.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. No suspicious lesions or lesions meeting OPTN 5 criteria for HCC. Cirrhotic\nliver with patent portal venous vasculature. Stable splenomegaly and\nprominent esophageal and gastric varices consistent with portal venous\nhypertension. No ascites.\n2. Cholelithiasis." }, { "input": "Lower Thorax: The lower lung bases are unremarkable. No evidence of\npericardial or pleural effusion.\n\nLiver: Re-demonstrated is a heterogenous and nodular hepatic morphology\nconsistent with cirrhosis. No steatosis. Multiple T2 hyperintensities seen\nagain within the liver, the largest measuring 0.8 cm in the left lobe,\nunchanged from prior (series 5, image 8), likely cysts or biliary hamartomas. \n9 mm focus of arterial hyperenhancement without correlate on T2/DWI or washout\nin segment 8 likely represents a transient hepatic intensity difference\n(series 1201, image 33). No evidence of concerning liver lesion. No acsites.\n\nBiliary: No evidence of intra or extrahepatic biliary duct dilation. \nCholelithiasis without evidence of cholecystitis. Gallbladder wall edema is\nlikely due to underlying liver disease.\n\nPancreas: The pancreatic parenchyma demonstrates normal T1 signal intensity. \nNo evidence of pancreatic duct dilation.\n\nSpleen: The spleen is enlarged measuring 17.8 cm without evidence of\nconcerning lesion.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: No evidence of hydronephrosis or renal mass.\n\nGastrointestinal Tract: Small and large bowel are normal in caliber.\n\nLymph Nodes: No evidence of mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: No evidence of aortic aneurysm. Recanalized umbilical vein is\nnoted again noted. Re-demonstrated is a replaced right hepatic artery from\nthe SMA.\n\nOsseous and Soft Tissue Structures: Gynecomastia is noted. No evidence of\nconcerning osseous lesion.", "output": "1. Cirrhotic liver without evidence of hepatic lesions meeting OPTN 5\ncriteria. 9 mm arterial hyperenhancing focus in segment 8 has no correlate on\nT2 weighted imaging or diffusion weighted imaging and does not demonstrate\nwashout, likely a transient hepatic intensity difference.\n2. Sequelae of portal hypertension including splenomegaly and patent umbilical\nvein.\n3. Cholelithiasis." }, { "input": "Lower Thorax: Within limits of evaluation by MRI, the bilateral lung bases are\ngrossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is no\nevidence of hepatic steatosis. There are scattered hepatic cysts or biliary\nhamartomas, the largest measuring 1.1 x 0.8 cm in the hepatic dome. There is\na 1.1 x 0.7 cm arterially hyperenhancing focus on segment VIII (series 10,\nimage 25), without correlate on the T2 weighted images or DWI, and normalizing\non the more delayed phases, compatible with a transient hepatic intensity\ndifference. There also four scattered T2 hyperintense, enhancing lesions in\nthe liver, measuring 1.1 x 0.8 cm in segment III (series 3, image 23), 0.5 x\n0.5 cm in segment VII (series 3, image 13), 0.8 x 0.6 cm in the lateral aspect\nof segment VI (series 3, image 27) and 0.6 x 0.6 cm in the medial aspect of\nsegment VI (series 3, image 26), compatible with hemangiomas, some of which\ndemonstrate surrounding perfusion alteration. No suspicious hepatic lesion is\nidentified.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is mild\ndiffuse prominence of the pancreatic duct, measuring up to 4 mm, unchanged. \nThere is no focal pancreatic lesion.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are normal in size and\nshape.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. There is no focal renal lesion or\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is within normal limits. The known\nperiampullary mass identified on endoscopy is not discretely visualized on\nMRI. Upper abdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Hepatic arterial anatomy is conventional. The portal and hepatic\nveins are patent. There is no abdominal aortic aneurysm. The major\nmesenteric branch vessels are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. The abdominal wall is within normal limits.\n\nOther: There are multiple fibroids in the uterus seen on the large\nfield-of-view coronal images.", "output": "1. No suspicious hepatic lesion. Combination of cysts versus biliary\nhamartomas and hemangiomas in the liver, as described. 1.1 x 0.7 cm arterially\nhyperenhancing focus in segment VIII, compatible with a transient hepatic\nintensity difference.\n2. Known periampullary mass is not discretely visualized on MRI.\n3. No abdominal lymphadenopathy." }, { "input": "Lower Thorax: The metastatic disease in the chest is better assessed on recent\nPET.\n\nLiver: The liver is unremarkable except for mild diffuse steatosis. No liver\nlesions are seen. The FDG avidity adjacent to the right hepatic dome appears\nto be extrahepatic and pleural based.\n\nBiliary: Cholelithiasis is again seen. No biliary ductal dilatation.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable except for a few cysts, the largest 2.5\ncm on the right.\n\nGastrointestinal Tract: There is no intestinal obstruction or ascites in the\nupper abdomen.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes are demonstrated.\n\nVasculature: The hepatic vasculature is patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are seen.", "output": "No findings of metastatic disease in the upper abdomen." }, { "input": "Lower thorax: The lung bases are clear.\n\nLiver: The liver is homogeneous in morphology. There is a 8 mm simple cyst in\nsegment VII. There is heterogeneous hyperenhancement along the periphery of\nthe liver on arterial phase, likely a transient hepatic intensity difference. \nNo suspicious focal liver lesions are seen. The gallbladder is decompressed.\n\nBiliary: Again seen, is mild-to-moderate intrahepatic biliary duct dilation. \nAt the porta hepatis and involving the hepatoduodenal ligament, there is\nabnormal enhancing soft tissue encasing the common bile duct with associated\nlong segment narrowing of a still patent duct (series 11, image 26 through 32;\nseries ___, image 74 through 78).\n\nPancreas: The pancreas is mildly atrophic. No focal pancreatic lesion is\nseen. Pancreatic duct is not dilated.\n\nSpleen: Spleen is normal in size. No splenic lesions are seen.\n\nAdrenal Glands: The right adrenal gland is unremarkable. There is a 2.6 x 1.8\ncm left adrenal lesion which demonstrates dropout of signal on out of phase\nimaging and is consistent with an adenoma.\n\nKidneys: There are bilateral simple renal cysts with the largest\nmultilobulated thinly septated cyst measuring 4.4 cm in the left mid pole. \nThere is mild bilateral hydronephrosis with normal ureteral caliber.\n\nGastrointestinal Tract: The stomach is decompressed however, there is\nabnormal mural thickening and enhancement involving the lesser curvature and\ngastric antrum. There is no small or large bowel obstruction. Limited views\nof the remainder of the bowel are normal. Again seen, is diffuse\nretroperitoneal soft tissue stranding and enhancement.\n\nPelvis: The bladder is decompressed, limiting evaluation. There is no pelvic\nsidewall or inguinal adenopathy. There is trace pelvic free fluid.\n\nLymph Nodes: There are no pathologically enlarged retroperitoneal or\nmesenteric lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. The main portal vein is attenuated, but patent.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. The\nsuperficial soft tissues are unremarkable.", "output": "1. Multi-system disease with enhancing soft tissue in the porta hepatis\nencasing and narrowing the common bile duct, thickening and gastric mural\nheterogeneous enhancement, and diffuse retroperitoneal enhancing soft tissue\nstranding, in the setting of known lobular breast cancer, findings are highly\nconcerning for metastatic disease. Alternative less likely differential\nincludes IgG4 mediated disease. Consider EUS with both gastric and porta\nhepatic biopsies for tissue diagnosis.\n2. Bilateral UPJ obstruction, likely a result of the same process.\n3. Chronic findings of renal cysts and left adrenal adenoma.\n\nRECOMMENDATION(S): EUS with porta hepatic and gastric biopsies." }, { "input": "Liver: There is no evidence of hepatic steatosis. 9 mm simple cyst again\nnoted in segment VII. Heterogeneous areas of enhancement in the periphery of\nthe liver in the left lobe and right posterior segments become isointense to\nbackground parenchyma in the portal venous and delayed phases and likely\nrepresent transient hepatic intensity differences. No suspicious focal liver\nlesion seen.\n\nBiliary: The gallbladder is unremarkable. There is stable mild intrahepatic\nbile duct dilatation. There is mild persistent delayed enhancement in the\nporta hepatis and encasing the distal common bile duct which appears improved\ncompared to the prior study. Common bile duct remains patent. There is no\nmeasurable focal soft tissue lesion.\n\nPancreas: Pancreas is again noted to be mildly atrophic. Main pancreatic duct\nis normal in caliber.\n\nSpleen: Spleen is unremarkable.\n\nAdrenal Glands: 2.2 cm left adrenal adenoma is stable. Right adrenal gland is\nunremarkable.\n\nKidneys: Bilateral simple renal cysts are unchanged. Bilateral caliectasis\nand peripelvic cysts are again noted and unchanged.\n\nPoorly defined stranding and delayed enhancement within the retroperitoneum\nhas improved in the interval. This finding is most notable in the anterior\nperiaortic region below the SMA. There is no vascular displacement or\nnarrowing of the IVC. No restricted diffusion is seen in this location.\n\nGastrointestinal Tract: There has been significant improvement in previously\nseen gastric wall thickening and enhancement. No bowel obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Abdominal aorta and main mesenteric branch vessels are normal in\ncaliber.\n\nOsseous and Soft Tissue Structures: Aggressive osseous lesions.", "output": "1. Interval improvement in enhancement in the porta hepatis encasing the\ndistal common bile duct as well as improvement of retroperitoneal stranding\nand enhancement. Previously seen gastric wall thickening and enhancement has\nsignificantly improved. These findings may be secondary to treatment\nresponse. Differential diagnosis is unchanged and again includes metastatic\ndisease or IgG4 mediated disease.\n2. Mild bilateral caliectasis and peripelvic cysts, unchanged.\n3. Stable left adrenal adenoma." }, { "input": "Lower Thorax: A 0.6 cm left lower lobe pulmonary nodular opacity is grossly\nunchanged (series 6, image 2).\n\nLiver: The liver is normal in morphology and signal intensity. In segment\nVII, there is a 1.0 x 0.7 cm T2 intermediate intensity lesion with peripheral\nnodular enhancement and progressive fill-in, consistent with a hemangioma\n(series 6, image 18). No additional focal liver lesions are seen. There is\nno ascites.\n\nBiliary: Gallbladder is without evidence of stones. There is stable mild\nintrahepatic biliary duct dilation.\n\nThere has been interval improvement of minimal remaining soft tissue density\nin the porta hepatis which demonstrates very low level enhancement (series 6,\nimage 22). There remains mild thickening without abnormal enhancement of the\ncommon bile duct. There is persistent mild central intrahepatic duct\nirregularity with linear periductal enhancement along a single intrahepatic\nbile ducts supplying segment VI, unchanged from prior (series 1201, image 66).\nThere is no extrahepatic biliary duct dilation.\n\nPancreas: The pancreas is normal in morphology and signal intensity. No focal\npancreatic lesions are seen. There is no evidence of pancreas divisum.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: There is mild thickening of the right adrenal gland without\ndiscrete nodularity. There is an unchanged 2.4 x 2.1 cm left adrenal nodule\nwith diffuse drop of signal on out-of-phase imaging consistent with an\nadenoma.\n\nKidneys: Mild bilateral hydronephrosis is unchanged. There is no ureteral\ndilation. Bilateral cortical cysts are also noted with the largest bilobed\ncyst in the interpolar are left kidney measuring 3.7 x 2.1 cm.\n\nGastrointestinal Tract: There is no hiatal hernia. Note is made of two\nduodenal diverticula. Views of the small and large bowel are grossly\nunremarkable.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. The portal vein is patent.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. \nPatient is post bilateral mastectomy.", "output": "1. Interval improvement in porta hepatic soft tissue when compared to prior\nMRI from ___.\n2. Stable persistent mild intrahepatic bile duct dilation with focal\nperiductal enhancement involving a single duct in segment VI, suggesting\nsubclinical cholangitis.\n3. Bilateral mild hydronephrosis is unchanged.\n4. Stable left adrenal adenoma.\n5. Unchanged 0.6 cm left lower lobe nodular opacity." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: There is a right hepatic lobe hemangioma (03:20). Otherwise, hepatic\ncontours are unremarkable with no abnormal signal. There are no new\nsuspicious masses.\n\nBiliary: There is no biliary ductal dilatation. Gallbladder is unremarkable.\n\nPancreas: Pancreatic contours are unremarkable with no pancreatic ductal\ndilatation or suspicious mass lesions.\n\nSpleen: There is no splenomegaly.\n\nAdrenal Glands: There is a stable left adrenal adenoma. Right adrenal gland\nis unremarkable.\n\nKidneys: Bilateral caliectasis is unchanged. There unchanged renal cortical\ncysts bilaterally.\n\nGastrointestinal Tract: There is a small hiatal hernia. There is no small\nbowel obstruction. There is no ascites.\n\nLymph Nodes: There is no adenopathy.\n\nVasculature: Abdominal aorta is normal in caliber with patent intra-abdominal\nbranches.\n\nOsseous and Soft Tissue Structures: There are no acute osseous abnormalities\nor suspicious osseous lesions.", "output": "No evidence of metastatic disease in the abdomen." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: Again noted is cirrhotic morphology of the liver with hypertrophy of\nthe left lateral segment. No significant signal drop on out of phase imaging\nto suggest hepatic steatosis. Patient is status post segment 7 ablation with\nablation cavity measuring 2.8 x 2.3 cm with intrinsic T1 hyperintense signal\nconsistent with coagulation necrosis (100: 53). There is triangular-shaped\nmildly T2 hyperintense area of progressive enhancement within segment 7\nadjacent to the ablation cavity, consistent with fibrosis. No abnormal\nenhancement to suggest residual or recurrent disease. Few scattered\narterially hyperenhancing foci without correlate on additional sequences and\nconsistent transient hepatic intensity differences. No suspicious mass.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The\ngallbladder is notable for cholelithiasis. No gallbladder wall thickening or\npericholecystic free fluid.\n\nPancreas: Pancreatic parenchyma is homogeneous in signal intensity without\nsuspicious mass. No pancreatic duct dilatation. No peripancreatic fat\nstranding.\n\nSpleen: Normal in size without suspicious mass.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Homogeneous in signal intensity without suspicious mass. No\nhydronephrosis.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: No retroperitoneal or mesenteric lymph node enlargement.\n\nVasculature: No diabetic aneurysm. Celiac axis, SMA, bilateral renal arteries\nare patent. Hepatic anatomy is notable for an accessory left hepatic artery\narising off of the left gastric artery. Hepatic veins, main portal vein, SMV,\nand splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. Status post segment 7 ablation with expected posttreatment changes. No\nevidence of residual or recurrent disease.\n2. No hepatic lesions meeting OPTN 5 criteria for HCC.\n3. Cholelithiasis without evidence of acute cholecystitis." }, { "input": "Lower Thorax: Stable 0.8 cm right internal mammary lymph node.\n\nLiver: Cirrhotic liver morphology is redemonstrated. A treatment cavity\nwithin segment VII measures 2.9 x 2.5 cm, previously 3.1 x 2.7 cm. No\nfindings of recurrence. Stable linear scarring and fibrosis adjacent to the\ntreatment cavity. A few punctate arterial hyperenhancing lesions without\ncorrelate on additional sequences are nonspecific, possibly perfusional\n(series 1401, image 33 and 66). No new hepatic lesions meeting OPTN criteria\nare seen.\n\nBiliary: No biliary ductal dilatation. Cholelithiasis is redemonstrated.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable\n\nKidneys: The kidneys are unremarkable except for a stable cysts. No\nhydronephrosis\n\nGastrointestinal Tract: There is no intestinal obstruction or ascites in the\nupper abdomen.\n\nLymph Nodes: No enlarged abdominal lymph nodes.\n\nVasculature: The hepatic vasculature is patent.\n\nOsseous and Soft Tissue Structures: No aggressive appearing osseous lesions", "output": "Cirrhotic liver. No findings of new or recurrent HCC.\n\nCholelithiasis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Again seen in segment VII peripherally is a 2.6 x 2.2 cm ablation zone\nwith internal coagulative necrosis. There is no evidence for recurrent or\nresidual disease. Slightly T2 hyperintense band like progressive enhancement\nposterior to the ablation zone is unchanged (for example see series 7, images\n13 and 14 as well as 1504:33), compatible with fibrosis. There is ill-defined\nnon masslike 8 mm focus of enhancement inferior to this in segment VI\n(1501:53) without T2 correlate or persistence, less conspicuous than on prior,\npossibly transient hepatic intensity difference or perfusional anomaly. \nOtherwise, there are no concerning focal liver lesions.\n\nBiliary: No intra- or extrahepatic biliary ductal dilation. Gallstones layer\ndependently in the gallbladder lumen. The gallbladder is otherwise\nunremarkable.\n\nPancreas: The pancreas demonstrates normal homogeneous signal intensity. \nThere is no main pancreatic ductal dilation.\n\nSpleen: There is no splenomegaly or focal splenic lesion.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration.\n\nKidneys: There are bilateral renal cortical cysts without suspicious features\nmeasuring up to 8 mm in the right kidney. The renal parenchyma otherwise\ndemonstrates normal, symmetric enhancement and signal bilaterally. No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. Partially\nimaged non-dilated small bowel loops are normal in course and caliber without\nevidence of wall thickening, abnormal enhancement, or obstruction. The\npartially imaged colon is unremarkable.\n\nLymph Nodes: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. Major proximal tributaries are patent. The IVC is\nnormal in caliber and patent. The hepatic veins are patent. Patent portal\nvein, SMV, and splenic vein.\n\nOsseous and Soft Tissue Structures: No suspicious foci of abnormal marrow\nsignal are seen.", "output": "1. Unchanged 2.6 cm ablation zone in segment VII with posteriorly adjacent\nband like focal fibrosis. No evidence of recurrent/residual or new HCC in the\nliver.\n2. Cholelithiasis. Other incidental findings, as above." }, { "input": "Slightly limited evaluation due to respiratory motion.\n\nLower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: There is a 2.2 x 2.5 cm ablation cavity within segment 7 with expected\nT1 hyperintense coagulation necrosis. No nodular enhancement to suggest\nresidual or recurrent disease at this level (12:35). Again seen is a mildly\nT2 hyperintense band like area of progressive enhancement posterior to the\nablation zone which is unchanged since prior examination consistent with\nfibrosis (16:57). There is a 0.7 x 0.5 cm area of arterial hyper enhancement\nadjacent to this band like area fibrosis, which is unchanged since prior\nexamination which is without correlate on additional sequences, suggestive of\na transient hepatic intensity difference. (12:54).\n\nThere is mild hypertrophy of the left lateral segment suggestive of early\ncirrhosis. No signal drop on out of phase imaging to suggest hepatic\nsteatosis. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The common\nbile duct smoothly tapers to the level of the ampulla without without\nobstructing stone or large periampullary mass. Gallbladder is notable for few\ngallstones and is otherwise unremarkable.\n\nPancreas: Pancreas is homogeneous in signal intensity without suspicious mass.\nNo pancreatic duct dilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: 0.3 cm right lower pole simple renal cyst noted.Bilateral kidneys are\notherwise homogeneous in signal intensity without suspicious mass. No\nhydronephrosis.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: Slightly limited evaluation due to respiratory motion. No\nabdominal aortic aneurysm. Celiac axis, SMA, bilateral renal arteries, and\nproximal ___ are patent. Hepatic anatomy is conventional. Hepatic veins,\nmain portal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Small fat\ncontaining umbilical hernia noted. Soft tissues are otherwise unremarkable.", "output": "1. Slightly limited evaluation due to respiratory motion.\n2. No hepatic lesions suspicious for HCC.\n3. 0.7 cm hepatic segment 6 area of arterial hyper enhancement is unchanged,\nand is suggestive of transient hepatic intensity difference.\n4. Hepatic segment 7 ablation with expected coagulation necrosis. No\nevidence of residual or recurrent disease.\n5. Early cirrhosis. No ascites.\n6. Cholelithiasis without evidence of acute cholecystitis.\n\nRECOMMENDATION(S): Close attention on routine follow-up is recommended of the\nsegment 6 area of arterial hyper enhancement." }, { "input": "Lower Thorax: No pleural effusion. Please refer to separate CT chest done the\nsame day for further details of thoracic findings.\n\nLiver: Status post liver transplant. The transplant liver is not cirrhotic. \nThere is no hepatic steatosis. No focal lesion meeting OPTN 5 criteria. \nThere are few arterially enhancing foci throughout the liver with no\ncorrelation on other sequences as seen on images 23, 38 and 78 of series 1101.\nThese may represent small perfusional variations.\n\nBiliary: Status post cholecystectomy. No intrahepatic or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is homogeneous with no focal lesion. No main duct\ndilatation.\n\nSpleen: The spleen is homogeneous and measures 12 cm.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Normal post contrast enhancement of the kidneys. There is a 4 mm\nsimple cyst at the left interpolar kidney. No hydronephrosis.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No abdominal lymphadenopathy. No ascites.\n\nVasculature: No abdominal aortic aneurysm. The arterial anatomy is\nconventional. The portal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No concerning bone lesion.", "output": "Status post liver transplant. No focal liver lesion meeting OPTN 5 criteria." }, { "input": "Lower Thorax: Limited assessment of the bilateral lungs appear unremarkable. \nThere is no pleural effusion. No pericardial effusion.\n\nLiver: Status post liver transplant. The transplanted liver is smooth in\ncontour. There is no drop on out of phase imaging to suggest hepatic\nsteatosis. There is redemonstration of the 1.2 cm arterially enhancing lesion\nin segment VIII without T2 correlate or correlate on delayed imaging, likely\nperfusional change (1001; 30).\n\nThere is a 0.7 cm hypoenhancing T2 intermediate segment III lesion, which\nappears to drop in signal on out of phase imaging, likely representing focal\nfatty change versus prior surgical change (1003; 67), similar to prior.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder surgically resected.\n\nPancreas: The pancreas is normal in signal intensity without main pancreatic\nductal dilatation or focal lesion.\n\nSpleen: The spleen is normal in signal intensity and size without focal\nlesion, similar to prior.\n\nAdrenal Glands: The adrenal glands appear unremarkable bilaterally.\n\nKidneys: The kidneys are symmetric in size and nephrogram. There is no\nhydronephrosis. T2 hyperintense nonenhancing 0.7 cm cyst is noted in the right\nlower pole (4; 40), similar to prior.\n\nGastrointestinal Tract: The visualized small and large bowel appear normal in\ncaliber without evidence of obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The hepatic arterial anastomosis appears unremarkable. \nPostsurgical changes of the IVC are again noted with bifurcation of the IVC,\none of which drains the right renal vein and the other drains the left renal\nvein. The abdominal aorta is normal in caliber. The hepatic veins, portal\nvein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. There is a fat containing umbilical and in the fat containing\nsupraumbilical midline incisional hernia (3; 3).", "output": "Status post liver transplant with no suspicious hepatic lesions meeting OPTN 5\ncriteria for HCC is identified." }, { "input": "Lower Thorax: There is a small right pleural effusion with an associated\nconsolidation, unchanged from the recent CT. The consolidation most likely\nrepresents atelectasis. Within the limitations of MRI, the lung bases are\notherwise clear. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is no hepatic steatosis. Corresponding to the\nabnormality seen on CT in segment ___, there is a small 6 mm rim enhancing\nlesion (10, 33). Peripheral to this lesion, there is a wedge-shaped area of\narterial hyperenhancement (10, 32). A similar 7 mm lesion is present in\nsegment 4B (10, 39), as well as a similar 6 mm lesion in segment 6 (10, 57). \nFinally, there is a 5 mm lesion in segment 6 that is not in the periphery and\nhas no surrounding perfusional abnormality (10, 52). Additionally, there are\nother wedge-shaped areas of peripheral hyperenhancement without apparent rim\nenhancing lesions, including three areas around the gallbladder fossa and a\nsmall 3 mm focus in segment 5 (10, 51). These most likely represent areas of\ncholangitis with phlegmon/developing abscesses, though it is difficult to\nexclude small metastases. These lesions do not demonstrate restricted\ndiffusion. The hepatic arterial anatomy is conventional. The portal and\nhepatic veins are patent.\n\nBiliary: There is pneumobilia in the left lobe of the liver, in keeping with a\npatent common bile duct stent. The stent is poorly evaluated by MRI, though\nappears grossly unchanged in position. There is minimal prominence of the\nintrahepatic bile ducts. The common bile duct is normal in diameter. Mild\nperibiliary enhancement is noted, particularly in the left lobe (10, 29), and\nis in keeping with cholangitis. Mild enhancement around the distal common\nbile duct is likely reactive to the stent. There is no evidence of\ncholedocholithiasis.\n\nThe gallbladder is not distended. There is no MRI evidence of cholecystitis. \nSeveral small stones are identified in the gallbladder.\n\nPancreas: Again, there is a hypoenhancing mass in the head of the pancreas\nadjacent to the common bile duct measuring 16 x 13 mm (12, 52). Allowing for\nchanges in measurement technique and distortion from artifact from the\nadjacent fiducial markers, it appears unchanged from the prior CTA. There is\nassociated upstream atrophy of the pancreatic parenchyma, as well as severe\nduct dilation. This is also unchanged.\n\nThe vascular involvement was better assessed on the recent CTA. Again, there\nis persistent contact for greater than 180 degrees around the GDA. The mass\nis abutting and attenuating the main portal vein at its confluence. There is\nno encasement. No thrombus is identified.\n\nSpleen: The spleen is normal in size, measuring 12.7 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There is a 22 mm simple cyst in the\nlower pole of the left kidney. There are other punctate simple cysts\nbilaterally. There is no worrisome renal lesion, hydronephrosis, or\nperinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is trace perihepatic ascites.\n\nLymph Nodes: There are borderline enlarged periportal and peripancreatic lymph\nnodes, unchanged from the prior CT. None have overtly concerning\nmorphologies. There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is minimal atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild multilevel degenerative changes are noted throughout the spine. The soft\ntissues are unremarkable.", "output": "1. Multiple small subcentimeter rim enhancing lesions within the liver, as\ndescribed above. Given the clinical history of fevers, as well as the\nassociated peribiliary enhancement and perfusional abnormalities in the\nadjacent liver parenchyma, these most likely represent small areas of phlegmon\nor developing abscesses related background cholangitis. Metastases cannot be\ncompletely excluded. A feasibility ultrasound is recommended for possible\ntissue sampling.\n2. Unchanged appearance of the mass in the pancreatic head with upstream\natrophy and duct dilation. There is encasement of the GDA and abutment and\ndeformity of the portal vein at its confluence by the mass.\n3. Unchanged borderline enlarged periportal and peripancreatic lymph nodes.\n4. Cholelithiasis.\n\nRECOMMENDATION(S): Feasibility ultrasound for possible tissue sampling of the\nliver lesions." }, { "input": "Lower Thorax: Visualized lungs are clear. There is no pleural effusion.\n\nLiver: Nodular appearance of the liver contour in keeping with cirrhosis. \nThere is no hepatic steatosis. There is no suspicious arterially enhancing\nlesion in the liver.\n\nBiliary: Few small stones are noted in the gallbladder lumen. The gallbladder\nis otherwise unremarkable. There is no intra or extrahepatic biliary duct\ndilatation.\n\nPancreas: The pancreas is normal in morphology and signal intensity. There is\nno focal pancreatic lesion. Main pancreatic duct is normal in caliber.\n\nSpleen: The spleen is mildly enlarged measuring 14.3 cm in craniocaudal\nlength. There is no focal splenic lesion.\n\nAdrenal Glands: Adrenal glands are unremarkable bilaterally.\n\nKidneys: The kidneys are normal in size and symmetric and demonstrate normal\ncorticomedullary differentiation. There is no hydronephrosis. There is a 5\nmm simple cyst in the left kidney.\n\nGastrointestinal Tract: Visualized small and large bowel loops are normal in\ncaliber.\n\nLymph Nodes: Note is made of a 6 mm right costophrenic lymph node which is\nlikely reactive. No other enlarged lymph nodes seen in the upper abdomen.\n\nVasculature: Abdominal aorta is normal in caliber. Main mesenteric branch\nvessels are patent. Hepatic arterial anatomy is conventional. The portal\nvein, SMV and splenic vein are patent. A few gastroesophageal varices are\nnoted. There is an IVC filter in place below the renal vein insertion.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "1. Cirrhotic morphology with mild splenomegaly and gastroesophageal varices.\n2. No arterially enhancing lesion in the liver concerning for HCC.\n3. Cholelithiasis" }, { "input": "Lower Thorax: There is trace pleural fluid bilaterally. Indistinct airspace\nopacities, predominantly within the right lower lobe are consistent with known\nunderlying interstitial lung disease.\n\nLiver: Patient is status post liver transplant. Hepatic morphology is within\nnormal limits. There is no focal lesion within the confines of a noncontrast\nstudy.\n\nBiliary: Patient is status post hepaticojejunostomy with expected pneumobilia.\nThere is no intrahepatic biliary ductal dilatation. The common bile duct\nremains in situ, blind-ending and top normal in caliber. The gallbladder is\nsurgically absent.\n\nPancreas: Pancreas is normal in signal intensity and morphology without ductal\ndilatation or focal lesion\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: No suspicious renal lesion or hydronephrosis.\n\nGastrointestinal Tract: The visualized loops of large and small bowel are\nunremarkable.\n\nLymph Nodes: No suspicious lymphadenopathy.\n\nVasculature: Abdominal varices are noted. Intra-abdominal vasculature is\notherwise unremarkable.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion.", "output": "Status post hepaticojejunostomy with no intrahepatic biliary ductal\ndilatation. Pneumobilia confirms patency of the unremarkable anastomosis." }, { "input": "Lower Thorax: Subsegmental atelectasis in the right lung base. No pleural or\npericardial effusion.\n\nLiver: Liver demonstrates slightly nodular contours with hypertrophy of the\nleft lobe. There is no significant drop of signal on the out of phase imaging\nas compared to the in-phase imaging to suggest hepatic steatosis. 8 mm T2\nhyperintense area within segment VII (series 7, image 8) that demonstrates\nenhancement on the arterial phase that persists on the more delayed phases\nwithout washout, most likely a small hemangioma. There is a 13 mm T2\nhyperintense lesion peripherally within segment V/VI (series 7, image 30) with\nslight capsular retraction. There is no enhancement on the postcontrast\nimages, most likely representing a sclerosing hemangioma. No suspicious\nenhancing hepatic mass lesions meeting OPTN Class 5 criteria for HCC.\n\nBiliary: Gallbladder is present without gallstones. No gallbladder wall\nthickening or pericholecystic fluid. There is no intrahepatic or extrahepatic\nbiliary duct dilatation. The common bile duct tapers normally towards the\nampulla without obstructing filling defects.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. No suspicious solid or cystic mass lesion. Note\nis made of pancreas divisum. No dilatation of the main pancreatic duct. No\nperipancreatic inflammatory changes or fluid collections.\n\nSpleen: Spleen is not visualized. There is a 2.3 cm accessory spleen in left\nupper quadrant.\n\nAdrenal Glands: Normal bilaterally without focal nodules.\n\nKidneys: The left kidney appears slightly smaller as compared to the right. \nThey otherwise demonstrate good corticomedullary differentiation with adequate\nexcretion of contrast on the more delayed phases. Bilateral millimetric renal\ncysts. No suspicious renal masses or hydronephrosis. No perinephric\nabnormality.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are within normal limits. No ascites.\n\nLymph Nodes: Slightly prominent periportal lymph nodes, likely reactive to\nunderlying chronic liver disease. No suspicious mesenteric or retroperitoneal\nlymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta is normal in caliber and its major branches are\npatent. Hepatic arterial anatomy is conventional. The SMV, portal vein and\nhepatic veins are patent. There is recanalization of the paraumbilical vein.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "1. Morphological signs of liver cirrhosis with portal hypertension and\nrecanalization of the paraumbilical vein. Two focal hepatic mass lesions as\ndescribed above representing a hemangioma while the other most likely\nrepresenting a sclerosing hemangioma. This can be followed up on surveillance\nimaging.\n\n2. No suspicious enhancing hepatic mass lesions meeting OPTN Class 5 criteria\nfor HCC.\n\n3. Pancreas divisum." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, bilateral lung bases\ngrossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is nodular and shrunken in contour compatible with cirrhosis.\nA TIPS appears patent. There is no hepatic steatosis.\nA 4 mm focus of arterial enhancement in segment ___ of the liver (1102:62) is\nindeterminate. Scattered T2 hyperintense cystic lesions measuring up to 1.0\ncm at the liver dome are compatible with cysts/biliary hamartomas.\n\nThe total liver volume is 512 cm3.\n\nBiliary: There is no evidence of intra or extrahepatic biliary dilation. The\ngallbladder contains sludge and stones. Focal adenomyomatosis is again noted\nat the gallbladder fundus. Mild gallbladder wall edema is likely secondary to\nchronic liver disease.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nductal dilation. No focal pancreatic lesions are seen.\n\nSpleen: The spleen is borderline enlarged measuring 13.1 cm.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral kidneys demonstrate normal signal intensity. Multiple\nsubcentimeter T2 hyperintense cysts are seen in bilateral kidneys. No\nsuspicious renal lesions are noted. No hydronephrosis. There is no perinephric\nabnormality.\n\nGI: The stomach and intra-abdominal loops of small and large bowel are within\nnormal limits.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Patent TIPS. Recanalized umbilical vein is again noted. \nSusceptibility artifact from embolization coils are noted in the left upper\nabdomen (07:20). Gastric wall varices noted. The abdominal aorta is normal\nin caliber without evidence of aneurysm or dilation. The major visualized\nbranches of the aorta are patent.\n\nOsseous and Soft Tissue Structures: No bone marrow signal abnormalities\ndetected. No suspicious osseous or soft tissue lesions detected.", "output": "1. Cirrhotic liver with patent TIPS. 4 mm arterially enhancing focus in\nhepatic segment ___ does not meet OPTN criteria for HCC. Attention on\nfollow-up is recommended.\n2. Gallbladder sludge and stones. Mild gallbladder wall edema likely\nsecondary to chronic liver disease.\n3. Borderline splenomegaly.\n4. Total liver volume: 512 cm3." }, { "input": "Lower thorax: Bibasilar atelectasis. Lung bases, visualized pleural spaces,\nand lower mediastinal structures otherwise unremarkable\n\nLiver: Atrophic, grossly cirrhotic liver. No liver steatosis. Scattered\nsimple liver cysts. Millimetric focus of arterial phase enhancement seen in\nsegment VI/VII on the MRI performed ___ is unchanged in appearance\nand size (series 1101, image 46). This finding does not fill OPTN criteria\nfor HCC and remains indeterminate. Additional scattered wedge-shaped foci of\nenhancement throughout the liver parenchyma are consistent with transient\nperfusion differences. No new discrete arterially enhancing lesions.\n\nBiliary: Sludge and stones in the gallbladder lumen. Fundal and infundibular\nadenomyomatosis. No findings of cholecystitis. No intrahepatic bile duct\ndilatation. Minimal prominence of the CBD with normal tapering to the level\nof the ampulla.\n\nPancreas: Pancreatic parenchyma slightly atrophic. No focal parenchymal\nlesions. No main pancreatic duct dilatation.\n\nSpleen: Spleen is bulky and measures up to 13 cm in longest diameter.\n\nAdrenals: Adrenal glands normal.\n\nKidneys: Bilateral renal cortical cysts. No enhancing renal lesions. No\nhydronephrosis.\n\nBowel: Grossly unremarkable partially visualized loops of large and small\nbowel.\n\nVasculature: Abdominal aorta is normal in caliber. There is stenosis at the\norigin of the celiac axis. Major branch vessels are otherwise patent. A\npatent TIPS is in-situ. IVC and portal vein are patent. Portal confluence,\nsplenic vein, and SMV are patent. Hepatic veins are attenuated but remain\npatent.\n\nLymph nodes: Scattered small mesenteric lymph nodes. No lymphadenopathy.\n\nOsseous/Soft Tissue: No marrow replacing/focal destructive osseous lesions.\n\nPeritoneum: No free fluid.", "output": "Cirrhotic liver. A patent TIPS is in situ. NO arterially enhancing lesions\nwhich fill OPTN criteria for HCC." }, { "input": "The study is severely motion degraded.\n\nLower Thorax: No pericardial or pleural effusion.\n\nLiver: Redemonstration of cirrhotic liver morphology. Numerous siderotic\nnodules have increased in number and severity. No evidence of steatosis. \nAgain seen are several scattered simple hepatic cysts measuring up to 9 mm.\n\nEvaluation for hepatic lesions is severely limited due to motion. Several\nareas of apparent rim enhancement on delayed phase images are incompletely\nevaluated, given severe motion degradation of early phase images, and unclear\nif this represents fibrosis, cirrhotic nodules, or a capsule and a lesion that\nis demonstrating washout.\n\nBiliary: The gallbladder contains stones, without gallbladder-wall thickening.\nFundal and infundibular adenomyomatosis is again noted. No intrahepatic or\nextrahepatic biliary dilatation.\n\nPancreas: The pancreas demonstrates hypointense signal on inphase imaging,\nconsistent with is fine deposition. This is significantly worsened compared\nto the prior MR examinations from ___ and ___. No focal\npancreatic lesions. No peripancreatic edema.\n\nSpleen: The spleen is homogeneous in signal intensity and top-normal in size\nat 12.5 cm.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are symmetric in size and nephrogram. Bilateral renal\ncortical cysts are again present. No suspicious renal lesions. No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. The partially imaged\nsmall and large bowel is normal in signal and caliber.\n\nLymph Nodes: No lymphadenopathy by size criteria.\n\nVasculature: No abdominal aortic aneurysm. The portal vein is patent. The\nTIPS stent appears patent.\n\nOsseous and Soft Tissue Structures: No suspicious soft tissue lesion. \nBilateral gynecomastia is noted. No marrow replacing osseous lesion.", "output": "1. The study is severely motion degraded and non-diagnostic for HCC screening.\nSeveral areas of apparent rim enhancement on delayed phase images are\nincompletely characterized given severe motion degradation of early phase\nimages, and is unclear if this represents fibrosis, siderotic nodules, or a\npseudocapsule of a lesion that is demonstrating washout. Recommend\nmultiphasic CT abdomen for further evaluation.\n2. Findings consistent with hemochromatosis, with larger hepatic cirrhotic\nnodules with increased iron content, as well as extensive iron deposition\nwithin the pancreas which has significantly worsened from the prior studies. \nNo evidence of iron deposition within the partially imaged heart, though this\ncould be further evaluated with dedicated testing as clinically indicated.\n3. Cholelithiasis without evidence of acute cholecystitis.\n4. The TIPS stent appears patent.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:17 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Evaluation is severely limited secondary to motion artifact.\n\nLower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is shrunken and nodular consistent with cirrhosis. Numerous\nsiderotic nodules are seen throughout the liver. Mild T2 hyperintensity and\nrestricted diffusion with progressive enhancement in hepatic segment 6 is\nconsistent with fibrosis (5:19, 6:43).\nA 2.8 cm T1 and T2 hyperintense lesion in hepatic segment VII is noted (3:22,\n8:10). Evaluation for arterial enhancement and delayed washout is severely\nlimited secondary to motion artifact. In retrospect this lesion is visualized\non the in and out of phase sequences and measured 1.2 cm, however the lesion\nis not seen on diffusion weighted imaging, T2, or on the post-contrast images\ngiven significant motion artifact (6:20 from ___. The additional\nhepatic segment V lesion identified ultrasound is not visualized, likely\nsecondary to significant motion artifact. Scattered hepatic cysts are noted\nmeasuring up to 1.2 cm at the hepatic dome (4:10). The patient is status post\nTIPS which appears patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nCholelithiasis. Gallbladder adenomyomatosis is noted.\n\nPancreas: The pancreas is atrophic and demonstrates low T1 signal consistent\nwith iron deposition. There is no ductal dilatation. There is no focal\nlesion.\n\nSpleen: Enlarged measuring 14.7 cm.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion. \nBilateral simple cortical cysts are noted.\n\nGastrointestinal Tract: No evidence of obstruction.\n\nLymph Nodes: No abdominal aortic aneurysm.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. Non-diagnostic liver MRI secondary to respiratory motion. Recommend\nmultiphase abdominal CT for further evaluation.\n2. Suspicious 2.8 cm hepatic segment VII lesion. Recommend further evaluation\nwith multiphase CT.\n3. Stable findings consistent with hemochromatosis including numerous\nsiderotic hepatic nodules and iron deposition within the pancreas.\n4. Cholelithiasis.\n\n\nRECOMMENDATION(S): Multiphase CT of the abdomen\n\nNOTIFICATION: The findings were discussed by ___, M.D. with ___\n___ M.D. on the telephoneon ___ at 3:30 pm, 2 minutes after discovery of\nthe findings." }, { "input": "Lower Thorax: The lung bases are essentially clear.\n\nLiver: Nodular hepatic contour is in keeping with cirrhosis. Multiple\nscattered foci of signal dropout on the in phase sequences are compatible with\nsiderotic nodules. Patient is status post microwave ablation of a segment\nVIII lesion. The ablation cavity demonstrates predominantly T1 hyperintense\nsignal compatible with coagulative necrosis and measures 3.2 x 3.0 cm (series\n8, image 53). Scattered hepatic cysts appear essentially unchanged. \nEvaluation is markedly limited due to respiratory motion, however no overtly\nsuspicious liver lesion is identified meeting OPTN 5 criteria for HCC. \nPatient is status post TIPS placement.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. Fundal\ngallbladder adenomyomatosis is again noted. Small layering gallstones are\npresent.\n\nPancreas: The pancreas demonstrates normal morphology. No evidence of\npancreatic ductal dilatation. No focal pancreatic lesions are identified.\n\nSpleen: The spleen is enlarged up to 13.8 cm. No focal splenic lesions are\nidentified.\n\nAdrenal Glands: Adrenal glands are symmetric in size and signal intensity. No\ndiscrete lesions are identified.\n\nKidneys: No suspicious renal lesions are identified. Bilateral simple renal\ncysts are again noted. No hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. No evidence of bowel\nobstruction.\n\nLymph Nodes: No abdominal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Perisplenic splenic varices are\nagain seen.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nabnormality is present.", "output": "1. Markedly limited examination as patient did not follow breath hold\ntechnique, perhaps due to language barrier. Within this limitation, no\ndefinite suspicious liver lesion is present meeting OPTN 5 criteria for\nhepatocellular carcinoma. If respiratory motion is expected to be an ongoing\nproblem, future follow-up with CT examinations rather than MRI may be\nconsidered.\n2. Status post microwave ablation of a segment VIII lesion.\n3. Cirrhotic liver morphology with stable siderotic nodules.\n4. Splenomegaly.\n5. Cholelithiasis and gallbladder adenomyomatosis." }, { "input": "Lower Thorax: Lower lung bases, pleural spaces and lower mediastinal\nstructures are grossly normal.\n\nLiver: Liver demonstrates marked T2 signal hypointensity, given the concurrent\ninvolvement of the spleen, most in keeping with hemosiderosis. No obvious\nliver lesions.\n\nInvolving the uncinate process of the pancreas and the posterior aspect of the\npancreatic head is a solid mass lesion demonstrating ill-defined T2 signal\nhypointensity and markedly restricted diffusion (series 10, image 41),\nmeasuring 3.6 x 3.3 cm. This mass extends medially and makes contact with the\nsuperior mesenteric artery, and appears to abut the superior mesenteric vein. \nThis lesion abuts the portal venous confluence, however no direct invasion is\nidentified. The lesion does appear to invade the third portion of the\nduodenum. The degree of distension of the stomach and proximal duodenum has\nsignificantly improved from the comparison CT scan performed ___.\n\nBiliary: There is prominence of the central intrahepatic biliary tree as well\nas common bile duct, measuring up to 8 mm, with abrupt cut off at the mass\nlesion.\n\nPancreas: There is prominence of the main pancreatic duct, measuring up to 4\nmm with a similar abrupt cut off at the level of the pancreatic head mass\n(double duct sign). The pancreatic tail, body and neck region maintain normal\nbulk.\n\nSpleen: Spleen is incompletely visualized, however demonstrates marked T2\nsignal hypointensity in keeping with underlying hemosiderosis.\n\nAdrenal Glands: The adrenal glands bilaterally are within normal limits.\n\nKidneys: No dilatation of the renal collecting system. A few small cortical\ncysts are noted.\n\nGastrointestinal Tract: Remainder of the visualized gastrointestinal tract is\nwithin normal limits. A duodenal diverticulum along the second portion is\nnoted (series 4, image 17), engulfed by the pancreatic head mass. Colonic\ndiverticulosis.\n\nLymph Nodes: No obvious lymphadenopathy within the retroperitoneum or upper\nabdomen.\n\nVasculature: Limited diagnostic assessment given the lack of intravenous\ncontrast. No aneurysmal dilatation of the abdominal aorta. Vessels involved\nby the pancreatic mass lesion or described above.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions.", "output": "3.6 x 3.3 cm infiltrating posterior pancreatic head uncinate process\nspiculated mass. There is limited diagnostic assessment and staging of this\nlesion given the lack of intravenous contrast (due to patient's acute renal\nfailure at the time of imaging), however the mass does make contact with the\nsuperior mesenteric artery, and appears to invade the third portion of the\nduodenum. No obvious lymphadenopathy. Complete staging with a multiphasic\nCTA pancreas is recommended, as the patient's creatinine has normalized.\n\nRECOMMENDATION(S): CTA pancreas." }, { "input": "Lower Thorax: Lower lung bases and pleural spaces are clear.\n\nLiver: Liver demonstrates homogeneous attenuation with hepatic steatosis. On\nthe opposed phase study there is artifact seen in the right upper quadrant,\nlimiting diagnostic assessment of this area. However there is a focal area of\nT1 signal hyperintensity which does not drop out in signal on the out of\nphase, most in keeping with focal fatty sparing (series 4 a, 4B, image 29,\n30). This corresponds in location to the hypoechoic region seen on the\nrecently performed abdominal ultrasound. On the post gad images no hepatic\nmass lesion is identified. Hepatic vasculature is patent.\n\nBiliary: No intra or extrahepatic ductal dilatation.\n\nPancreas: Pancreas enhances homogeneously with no pancreatic ductal dilatation\nor peripancreatic abnormality.\n\nSpleen: Spleen is not enlarged with no focal mass lesion.\n\nAdrenal Glands: Adrenal glands bilaterally are unremarkable.\n\nKidneys: No dilatation of the renal collecting system.\n\nGastrointestinal Tract: Visualized loops of small large bowel are\nunremarkable with no bowel wall thickening. The appendix is identified,\nretrocecal and coursing superiorly along the bare area of the liver.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Hepatic vasculature is patent.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions are\ndemonstrated.", "output": "Small focus of hypo echogenicity seen within the liver on recently performed\nabdominal ultrasound likely reflects an area of focal fatty sparing on a\nbackground of hepatic steatosis. No worrisome hepatic mass lesion is\nidentified on today's MRI examination." }, { "input": "A cyst is seen in segment ___ of the liver and measures 10 mm\n(series 5, image 5). No other focal lesion identified. The spleen is\nvisualized and is normal. The adrenals and kidneys where visualized are\nnormal. The pancreas is normal.\n\nThis study was tailored for the evaluation of the aorta and its branches.\nThere is mild narrowing of the celiac artery at its origin. It is patent\nbeyond this narrowing. The SMA is widely patent. The ___ is widely patent.\nThe renal arteries are patent.\n\nThe bowel where visualized is normal. No evidence of any free fluid. The\nbones where visualized are normal.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series.", "output": "1. Mild narrowing of the celiac artery at its origin.\n2. Simple hepatic cyst." }, { "input": "Liver: Innumerable cysts are seen throughout the liver, consistent with\npolycystic liver disease. These range in size from several millimeters to the\nlargest having maximal diameter of 9.2 cm. The distribution is predominantly\nright-sided. The contents of the cysts are predominantly T2 hyperintense, T1\nhypointense and nonenhancing. Several cysts 2 contain T1 hyperintense\nmaterial, presumably representing hemorrhage. No discrete nodularity or\ninternal enhancement is identified. There is no single cyst which\ndemonstrates restricted diffusion of contents are surrounding hyperenhancement\nto suggest superimposed infection.\n\nThe biliary: There is minimal dilation of the left lateral segment bile ducts\n(04:15). Extrahepatic biliary tree is normal in caliber without filling\ndefect.\n\nPancreas: Pancreatic parenchyma maintains normal bulk, intrinsic hyperintense\nT1 signal and enhancement pattern. There is no focal pancreatic lesion or\nductal abnormality.\n\nSpleen: Normal.\n\nAdrenal glands: The left adrenal gland is normal. The right adrenal gland is\nobliterated with infiltrative soft tissue. This material is surrounds the\ninfrahepatic and intrahepatic IVC. No intervening fat plane is seen\nseparating this abnormal soft tissue from the medial margin of the liver or\nthe superior pole of the kidney. The material is T2 hypointense, T1\nisointense to skeletal muscle, restricted in diffusion and progressively,\nhomogeneously enhancing. While there is drop in signal on out of phase\nchemical shift imaging as compared to in phase, this is thought to be on the\nbasis of tumor infiltrating retroperitoneal fat, rather than intralesional\nfat.\n\nThe right and renal artery and vein course through this soft tissue, and while\nmay be slightly narrowed, remain patent and contrast opacified.\n\nKidneys: There are multiple a simple renal cysts identified on the left. \nEach is T2 hyperintense, T1 hypointense and nonenhancing. A left ureteral\nstent is known to be present, within a relatively decompressed collecting\nsystem.\n\nOn the right, there is moderate hydroureteronephrosis despite a well\npositioned ureteral stent. The level of obstruction appears to be along the\nright pelvic wall (16:70), where hyperenhancing soft tissue was present within\nthe ureter, highly concerning for ureteral metastatic disease. This has not\nbeen well visualized since stent placement, although caliber change and lack\nof contrast flowing around the stent at this level is noted.\n\nThere is a delayed right-sided nephrogram. The etiology is likely\nmultifactorial on the basis of vascular encasement by tumor and urinary\noutflow obstruction.\n\nLymph nodes: None pathologically enlarged.\n\nBowel: Unremarkable.\n\nVessels: The IVC remains patent, although is narrowed both on the basis of\nmass effect from hepatic cysts and the infrahepatic retroperitoneal mass. The\nrenal vein and artery course through this mass but remain patent at this time.\n\nOsseous structures: Innumerable osseous metastases are seen throughout the\nspine and pelvis. No encroachment into the spinal canal or neural foramina is\nnoted. No arterial anatomic variant is identified.\n\nOther: There are small bilateral pleural effusions with associated adjacent\nairspace opacities, likely on the basis of compression atelectasis. The\npatient is status post right mastectomy.", "output": "1. Large infiltrative mass, almost certainly representing metastatic\ninvolvement, within the right suprarenal retroperitoneal space, obliterating\nthe adrenal gland. This abuts the medial margin of the liver, the superior\npole of the kidney, the infrahepatic IVC and surrounds the renal artery and\nvein. Although vascular structures remain patent, tumor progression may\nresult in clinically significant venous compression of the right renal vein\nand IVC for which prophylactic stenting may be a consideration.\n\n2. Delayed nephrogram on the right, likely multifactorial in the setting of\nvascular encasement and persistent right hydroureteronephrosis, despite a well\npositioned ureteral stent. The ureteral caliber change appears to be within\nthe right hemipelvis, where a ureteral metastasis is suspected, particularly\nbased on CT imaging prior to stent placement. There is also likely left\npelvic ureteral abnormality as well that could be metastasis.\n\n3. Extensive osseous metastatic disease.\n\n4. Polycystic liver disease." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Patient is status post segment 4B resection and cholecystectomy for\ncholangiocarcinoma. There is mild arterial hyperenhancement along the margin\nof the resection cavity which appears non-masslike in configuration and is\nlikely perfusional or related to postoperative change. No definite local\nrecurrence. 5.3 cm nonenhancing fluid collection at the surgical margin,\nlikely postoperative.\n\nGeographic areas of signal drop on the in phase gradient echo T1 images are in\nkeeping with heterogeneous iron deposition, consistent with surgical pathology\nresults showing moderate iron. Areas of relatively increased signal on DWI\nwith progressive enhancement on post contrast T1 images likely correspond to\nareas of more normal liver parenchyma with decreased iron content, though some\ncomponent of ongoing inflammation/fibrosis cannot be entirely excluded.\n\nBiliary: The gallbladder is surgically absent. Common bile duct is prominent\nmeasuring up to 10 mm, likely post cholecystectomy. No intrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is unremarkable. No pancreatic ductal dilatation.\n\nSpleen: Spleen is not enlarged.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: Subcentimeter cysts in the interpolar region of the right kidney. No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. The small and large\nbowel are nondistended.\n\nLymph Nodes: No retroperitoneal or mesenteric adenopathy.\n\nVasculature: No abdominal aortic aneurysm. Patent arterial anatomy is\nconventional. The hepatic and portal venous systems are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion. Postsurgical changes are noted within the anterior abdominal wall.", "output": "1. Postsurgical changes from segment 4B resection and cholecystectomy with\npostoperative fluid collection at the surgical margin, likely seroma. No\ndefinite evidence of locally recurrent disease.\n2. Heterogeneous iron deposition within the liver parenchyma. Geographic\nareas of relatively higher signal intensity on T2-weighted imaging with\nprogressive enhancement are favored to represent areas of more normal\nparenchyma with lower iron content, but some component of ongoing\ninflammation/fibrosis cannot be excluded." }, { "input": "Liver: Liver is homogeneous in signal intensity without worrisome lesion. \nMild hepatic steatosis (fat fraction 5%). No ascites.\n\nBiliary: Top normal biliary duct dilatation is expected post cholecystectomy.\n\nPancreas: 0.4 x 0.4 cm T2 hyperintense nonenhancing pancreatic tail cystic\nlesion, statistically likely to represent side branch IPMN (05:18) unchanged\nsince ___. Otherwise unremarkable. No pancreatic duct dilatation.\n\nSpleen: Unremarkable. 0.6 cm accessory spleen noted.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Innumerable bilateral renal cysts, many of which are hemorrhagic or\nproteinaceous. No worrisome renal lesions. No hydronephrosis.\n\nGastrointestinal Tract: Mild mucosal hyperenhancement and wall thickening of\nthe sigmoid colon with prominence of the pericolonic vasculature involving the\nsigmoid colon concerning for mild colitis, possibly related to radiation in\nthis setting (18: 83). No fat stranding. No obstruction.\n\nPelvis: Status post hysterectomy and bilateral salpingo-oophorectomy. No\npelvic free fluid.\n\nLymph Nodes: No enlarged abdominal or pelvic lymph nodes.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, renal arteries, SMA,\nand ___ are patent. Hepatic anatomy is conventional. Hepatic veins, main\nportal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No aggressive appearing osseous lesions. \nThe bone marrow signal change in the pelvis is presumably related to\nradiation.", "output": "1. No metastatic disease in the abdomen or pelvis.\n2. Mild rectosigmoid colitis, possibly related to radiation.\n3. Unchanged 0.4 cm pancreatic tail cystic lesion, likely to representing a\nside branch IPMN.\n\nRECOMMENDATION(S): Pancreatic tail cystic lesion can be followed on routine\noncologic imaging if these will be performed. If not, MRI in ___ year is\nrecommended for follow-up." }, { "input": "The pancreatic parenchyma maintains normal bulk, intrinsic hyperintense T1\nsignal and enhancement pattern. There is no focal parenchymal lesion. The\nstructure in question on the prior CT scan appears to reside just above the\npancreatic neck and likely represented edematous fat. The main pancreatic\nduct is normal in caliber without anatomic variation.\n\nLiver is normal in size and contour. There is no evidence of hepatic\nsteatosis. There are innumerable lesions scattered throughout the liver\nvarying in size from several mm up to 1 cm. These are best seen on arterial\npost contrast imaging (16:35). The larger lesions are, however, seen as very\nsubtly T2 hyperintense and T1 hypointense on precontrast sequences. These are\neither iso or hyperenhancing on delayed post contrast sequences. Although the\nimaging appearance of each would be compatible with focal nodular hyperplasia,\nthe multiplicity would be quite unusual. The appearance is otherwise\nnonspecific and differential broad, including inflammatory, storage or\nmetabolic processes. Infectious etiologies could be considered in the setting\nof fever, but would typically result in splenic involvement as well, which is\nnot seen.\n\nThere is cholelithiasis without evidence of cholecystitis. Intra and\nextrahepatic bile ducts are normal in caliber and contour.\n\nThe spleen, adrenal glands and kidneys are normal in appearance.\n\nThere is an arterial anatomic variant of hepatic artery originating from the\nsuperior mesenteric artery. Venous structures are patent.\n\nThere is a single portacaval node is noted, with axial ___ of 10 x 17\nmm. Otherwise no lymphadenopathy is appreciated.\n\nThere is no ascites.\n\nOsseous structures are unremarkable.", "output": "Innumerable subcentimeter hepatic lesions. Each lesion individually would be\ncompatible with focal nodular hyperplasia, although the multiplicity makes\nthis very unlikely. In the setting of fever, infection cannot be excluded\nbut typically would be hepatosplenic. Inflammatory, metabolic and storage\ndisease, potentially amyloidosis, should be considered. Given the nonspecific\nimaging appearance, in the absence of a clinical diagnosis, random ultrasound\nguided percutaneous liver biopsy is recommended.\n\nNo pancreatic lesion." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Liver is normal in signal intensity and morphology without focal lesion\nwithin the confines of IV contrast study.\n\nBiliary: There is no intrahepatic or extrahepatic biliary duct dilatation. \nThe gallbladder contains multiple gallstones and is otherwise unremarkable\nwithout wall thickening or pericholecystic inflammatory change.\n\nPancreas: Pancreas is normal in signal intensity and morphology without focal\nlesion or ductal dilatation.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: No suspicious lesion or hydronephrosis.\n\nGastrointestinal Tract: Stomach is decompressed and otherwise unremarkable. \nThere is mild focal dilatation of a single loop of small bowel in the mid\nabdomen in the region of large rectus diastasis without frank obstruction. \nThe large bowel is unremarkable. The appendix is normal.\n\nLymph Nodes: No suspicious lymphadenopathy.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. There is\nventral diastasis recti.", "output": "1. Nonspecific mild gaseous distension of a single loop of small bowel in the\nmidabdomen without high grade obstruction, an adhesion cannot be excluded in\nthe setting of prior surgery.\n2. Normal appendix.\n3. Cholelithiasis without cholecystitis.\n4. Diastasis recti." }, { "input": "The kidneys are normal in size. There is no solid, enhancing renal mass. There\nare multiple tiny subcentimeter cysts as well as a dominant cyst at the\njunction of the superior and middle thirds of the posterolateral left kidney. \nThis structure has maximum diameter of 2.3cm with internal T2 hyperintensity\nand T1 hypointensity, although not the intensity of simple fluid. There is no\nnodularity, septation, or enhancement. There is no excretion of contrast into\nthe structure to suggest calyceal diverticulum.\n\nThe liver is normal in size, contour, signal and enhancement. There is no\nfocal hepatic lesion. There are several scattered simple hepatic cysts.\nBiliary tree and hepatic vasculature is unremarkable.\n\nThe spleen, and adrenal glands are unremarkable. There is mild pancreatic\natrophy and fatty replacement. There is a small hiatal hernia. Mild\natherosclerotic disease is seen with irregularity of along the course of the\nabdominal aorta. Diverticulosis coli is noted of the visualized colon without\nassociated inflammatory change.\n\nThere is dextroscoliosis of the thoracolumbar junction with associated\ndegenerative changes. Severe degenerative changes are also noted at the right\nhip. The patient is status post left total hip arthroplasty.", "output": "Left renal lesion indeterminate by CT is confirmed by MRI to represent a cyst,\nlikely with some internal hemorrhagic or proteinaceous material. There are no\nconcerning features.\n\nMultiple additional punctate and simple renal and hepatic cysts. Other\nincidental findings as detailed above." }, { "input": "Limited evaluation due to patient motion and susceptibility artifact along the\nleft anterior chest due to pacemaker. 3D MRCP images could not be obtained.\n\nLower Thorax: Limited evaluation of the lung bases are notable for moderate\nbilateral pleural effusions with associated compressive atelectasis. Heart is\nmildly enlarged. No large pericardial effusion.\n\nLiver: Somewhat limited evaluation of the lateral segment of the left hepatic\nlobe secondary to pacemaker artifact. Given this limitation the visualized\nliver is homogeneous in signal intensity without suspicious mass. Trace\nperihepatic free fluid noted.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. There is no\nrestricted diffusion of the surrounding hepatic parenchyma to suggest active\ncholangitis. The common bile duct is normal in caliber measuring 0.6 cm and\nsmoothly tapers at the ampulla. There is no definite evidence of\ncholedocholithiasis. Gallbladder sludge noted. No gallbladder wall edema or\npericholecystic free fluid.\n\nPancreas: Limited evaluation is notable for pancreatic atrophy. No pancreatic\nduct dilatation. No peripancreatic fat stranding. No fluid collection.\n\nSpleen: Spleen is partially obscured due to susceptibility artifact. The\nspleen is normal in size and signal intensity.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: A 1.3 x 0.7 cm lesion within the interpolar region of the left kidney\ndemonstrates a T2 hyperintense/T2 hypointense fluid/fluid level most\nconsistent with a hemorrhagic or proteinaceous cyst. Kidneys are otherwise\nhomogeneous in signal intensity without suspicious mass. No hydronephrosis or\nperinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, and visualized small bowel\nare unremarkable. Descending colonic diverticulosis noted without evidence\nacute diverticulitis. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: Median sternotomy changes noted. No\nsuspicious osseous lesions. Soft tissues are unremarkable.", "output": "1. Limited evaluation due to incomplete study, patient motion, absence of\nintravenous contrast, and pacemaker artifact which partially obscures the\nlateral segment of the left hepatic lobe. No evidence of intra- or\nextrahepatic biliary duct dilatation. No restricted diffusion of the\nsurrounding hepatic parenchyma to indicate suggest cholangitis.\n2. Gallbladder sludge without additional features of acute cholecystitis. No\ndefinite evidence of choledocholithiasis.\n3. Moderate bilateral pleural effusions with compressive atelectasis." }, { "input": "Motion artifact limits the diagnostic quality of the study.\n\nLower Thorax: No effusions\n\nLiver: At least 4 hepatic lesions are again noted: 1 in segment 4 A, 3 in\nsegment 7, the largest in segment 7 of the liver measuring 10 mm in diameter. \nThese lesions are mildly hyperintense on T2 (similar signal intensity compared\nto the spleen which is concerning) and demonstrates mild delayed enhancement\non postcontrast imaging.\n\nBiliary: No intra or extrahepatic bile duct dilatation.\n\nPancreas: 13 x 8 mm cystic lesion which appears to communicate with the\npancreatic duct in the pancreatic head statistically most likely represents a\nside branch IPMN.\n\nSpleen: No focal abnormality\n\nAdrenal Glands: Slightly bulky appearance of the left adrenal, but no\nsuspicious focal lesion. The right adrenal appears in good\n\nKidneys: No masses or hydronephrosis\n\nGastrointestinal Tract: Previously noted wall thickening involving the\nascending colon just above the level of the ileocecal valve is again noted,\nbut incompletely evaluated and correlation with colonoscopy is advised\n\nLymph Nodes: No upper abdominal adenopathy\n\nVasculature: No aneurysm. Atherosclerotic changes at the bifurcation of the\ndistal abdominal aorta.\n\nOsseous and Soft Tissue Structures: Mild spinal curvature. Degenerative\nchanges of the thoracolumbar spine. No suspicious bony lesions.", "output": "At least 4 hepatic lesions the largest measuring 10 mm in diameter in segment\n7 of the liver. These lesion is concerning for metastasis.\n\nPreviously noted colonic wall thickening involving the ascending colon just\nabove the level of the ileocecal valve is again, but incompletely evaluated\nnoted and correlation with colonoscopy is advised.\n\nSuspected side branch IPMN in the head of the pancreas, for which six-month\nfollow-up MRI is advised.\n\nFor findings on rectal MRI reference is made to study done ___." }, { "input": "There is no pleural or pericardial effusion. The lung bases are grossly clear.\n\nThe liver is normal in size and morphology. The signal characteristics of the\nliver parenchyma are normal on T1 and T2 WI. In segment VIII centrally there\nis mildly T2 hyperintense lesion (05:12), with restricted diffusion (06:23).\nThe lesion demonstrates hyperenhancing center and peripheral rim of arterial\nhyper enhancement (1001:32), and is concerning for metastases. There is 4 mm\nT2 hyperintense, nonenhancing hepatic lesion in segment VIII, consistent with\ncyst or biliary hamartoma (05:15). There is conventional arterial hepatic\nanatomy. The portal and hepatic veins are patent.\n\nCholelithiasis is present, without signs of acute cholecystitis. The intra and\nextrahepatic biliary ducts are normal in caliber.\n\nThe pancreas is normal in size and signal, without focal masses or ductal\ndilatation.\n\nThe spleen is normal in size.\n\nWithin the pelvis of the right kidney there is an intraluminal soft tissue\nmass at 2 x 2.4 cm in size, with intermediate signal intensity on T2 and T1 WI\n(05:32, 07:24), restricted diffusion (06:33) and heterogeneous enhancement\n(1002:90). There is abnormal appearance of the of the upper pole of the right\nkidney (03:20); unclear if this is infiltrative or representing changes from\nobstruction. The lesion is progressively enlarging on serial imaging since\n___ and is concerning for renal pelvis TCC.\n\nCortical cysts are present in both kidneys, 1 of them in the upper pole of the\nright kidney is hyperintense on T1 WI, consistent with proteinaceous contents\n(7:85).\n\n\nThere is a single renal artery present bilaterally.\nThe adrenals are normal.\n\nThere is no retroperitoneal or mesenteric lymphadenopathy.\nThere is no free fluid in the abdomen.\nBone marrow signal is normal. Bone hemangioma is present in a lower thoracic\nvertebral body (1002:17).", "output": "1. Hepatic lesion in segment VIII does not have signal and enhancing\ncharacteristics of a benign lesion and is concerning for metastasis. Advise\nurologic evaluation.\n2. Progressively enlarging soft tissue mass in the right renal pelvis is\nconcerning for urothelial neoplasm.\n3. Cholelithiasis." }, { "input": "Lower Thorax: The lower thorax is unremarkable. There is no pericardial or\npleural effusion.\n\nLiver: The liver is shrunken and nodular with a cirrhotic morphology. Again\nseen is either atrophy or surgical absence of the left hepatic lobe. There is\nno evidence of signal dropout on out of phase imaging to suggest diffuse\nhepatic steatosis. 1.9 x 1.7 cm T2 hyperintense arterially enhancing lesion\nbetween the portal vein and IVC (06:24) with diffusion restriction. Washout\ncannot be assessed due to non breath hold technique.The main portal vein, SMV,\nand splenic vein are patent. Moderate ascites is present.\n\nBiliary: Cholelithiasis. There is no intrahepatic or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity without pancreatic ductal\ndilatation or peripancreatic fluid.No pancreatic lesions are seen.\n\nSpleen: The spleen is enlarged measuring 17.4 cm read with numerous\nsusceptibility foci compatible with Gamna Gandy bodies. There are peripheral\nlinear areas of T1 and T2 signal hypo intensity which do not enhance, likely\nrepresenting scarring from prior infarct.\n\nAdrenal Glands: The adrenal glands are normal in shape and size.\n\nKidneys: The kidneys demonstrate normal corticomedullary differentiation and\nare symmetric and normal in size without hydronephrosis.There is a 1.9 x 1.6\ncm T2 hypo intense T1 isointense solid enhancing mass in the interpolar region\nof the right kidney abutting the hilum. This lesion does not extend beyond\nthe renal cortex. Washout on delayed imaging is noted (15:10, 13:10). The\nright renal vein is patent. There is a 1.6 x 1.1 cm lesion in the medial\ninterpolar region of the left kidney with similar imaging characteristics\n(14:8).\n\nGastrointestinal Tract: The visualized large and small bowel demonstrate\nnormal thickness and caliber. There is colonic diverticulosis without\nevidence of acute diverticulitis.\n\nLymph Nodes: Lymph nodes along the course of the right renal vein (16:11,\n16:10) measuring up to 8 mm is difficult to assess given the non breath hold\ntechnique.\n\nVasculature: The abdominal aorta is normal in size. There is a 4.4 cm\nopacified splenic artery pseudoaneurysm (13:17). Numerous splenic varices are\nseen.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen. \nThe body wall is within normal limits.", "output": "1. Cirrhotic liver morphology with the sequela of portal hypertension\nincluding moderate ascites, splenomegaly, and upper abdominal varices. Again\nseen is either atrophy or surgical absence of the left hepatic lobe.\n2. Suspicious 1.9 x 1.7 cm T2 hyperintense arterially enhancing lesion with\ndiffusion restriction located between the portal vein and the IVC. Washout\ncannot be assessed due to non breath hold technique. Further evaluation with\nmulti phase CT is recommended.\n3. 1.9 cm solid enhancing mass in the interpolar region of the right kidney.\n1.6 cm lesion in the left kidney with similar characteristics. These lesions\nare incompletely characterized due to the non breath hold technique and can be\nfurther evaluated on multiphasic CT. There are a few sub cm lymph nodes near\nthe right renal hilum which can also be reassessed on that study.\n4. 4.4 cm splenic artery pseudoaneurysm." }, { "input": "12 mm hemangioma is again demonstrated in segment 6 of the liver. No\nadditional hepatic lesion is demonstrated. The portal and hepatic veins are\npatent. There is no intra or extrahepatic biliary dilatation. Cholelithiasis\nis again noted.\n\nThere is an enhancing lobulated mass again demonstrated within the tail of the\npancreas measuring 6.1 x 4.5 cm (series 11, image 36) previously measuring 5.2\nx 4.0 cm. The mass is in close proximity to the splenic vein without invasion.\nThere is fatty replacement of the pancreas. No pancreatic ductal dilatation is\ndemonstrated.\n\nThere is no adenopathy. The adrenal glands are unremarkable. There is no\nhydronephrosis involving either kidney. Bilateral renal cortical cysts are\nnoted measuring up to 11 mm in the lower pole of the left kidney. There is no\nascites. There is an aortoiliac graft again noted (Series 12, image 4) that is\nincompletely evaluated\n\nNormal bone marrow signal is demonstrated. There is no osseous lesion.", "output": "1. Interval increase in size of pancreatic tail mass now measuring 6.1 x 4.5\ncm (previously 5.2 x 4.0 cm.\n2. No evidence of metastatic disease within the abdomen. Stable segment 6\nhepatic hemangioma measuring 12 mm.\n3. Cholelithiasis." }, { "input": "LUNG BASES: The visualized lung bases demonstrate a trace left pleural\neffusion. The heart is normal in size with no pericardial effusion.\n\nABDOMEN: Within the pancreatic tail, there is a 5.7 x 4.2 cm enhancing mass\n(19:41), previously measuring 6.1 x 4.5 cm. Signal void from fiducial markers\nin the lesion are again noted. The remainder of the pancreatic parenchyma is\natrophic. The liver demonstrates a 1.5 x 1.3 cm hemangioma in segment VI\n(19:37). There is no intrahepatic biliary dilatation and the common bile duct\nis normal in caliber. The gallbladder again contains stones, with no evidence\nof cholecystitis. The spleen and adrenal glands are normal. The kidneys\ndemonstrate multiple bilateral T2 hyperintense, non-enhancing lesions,\ncompatible with cysts. Kidneys enhance homogeneously with no evidence of\nhydronephrosis. Intra-abdominal loops of bowel are normal in caliber. There is\nno lymphadenopathy or free fluid.\n\nInfrarenal abdominal aortoiliac graft is incompletely imaged. The celiac axis,\nSMA, and renal arteries are patent.\n\nThe bone marrow signal is homogeneous with no concerning osseous lesions.", "output": "1. Interval decrease in size of enhancing pancreatic tail neuroendocrine\ntumor, now measuring 5.7 x 4.2 cm, previously 6.1 x 4.5 cm. No evidence of\nmetastatic disease.\n\n2. Stable hepatic segment VI hemangioma." }, { "input": "Lower thorax: There are trace bilateral pleural effusions.\n\nLiver: There is mild drop of signal on out of phase imaging, consistent with\nmild steatosis, as seen previously. There are focal triangular, peripheral\nareas of hyperperfusion on arterial phase imaging without signal abnormality\non delayed phase imaging, likely transient hepatic intensity differences. \nThere are no suspicious liver lesions.\n\nBiliary: There is adherent sludge versus sludge ball in the gallbladder. \nThere is no intra or extrahepatic biliary duct dilation.\n\nPancreas: Hyperenhancing lesion adjacent to the pancreatic neck has increased\nin size and is more ill-defined, compared to prior, now measuring 2.1 x 1.9\ncm, felt to represent a retroperitoneal serosal deposit on the surface of the\npancreas (series 19, image 48). Postsurgical changes from distal\npancreatectomy are present.\n\nSpleen: Spleen is absent.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There are no suspicious renal lesions. A simple cyst measuring 2.6\ncm noted in the right upper pole. There is no hydronephrosis.\n\nGastrointestinal Tract: There is no bowel obstruction.There has been interval\nworsening of septated ascites, including along the posterior aspect of the\nliver. There is also increasing size of multiple omental/peritoneal enhancing\nnodules for example, anterior to the liver and stomach measuring 0.8 and 1.3\ncm, respectively (series 6, image 17; series 16, image 39, 43). Abnormally\nmatted small bowel loops in the lower abdomen with suggestion of multiple\nserosal deposits are also noted and increased, for example on (series 19,\nimage 108), as has peritoneal thickening and nodularity in the mid lower\nabdomen (series 22, image 48). Known peritoneal deposits in the right lower\nquadrant pericolic gutter have only minimally increased (series 22, image 27).\n\nPelvis: Views of the pelvis demonstrate persistent midline enhancement at the\nlevel of the seminal vesicles. There is tethering of adjacent rectum.\n\nLymph Nodes: Scattered retroperitoneal and mesenteric lymph nodes are not\npathologically enlarged.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions.\nThere is a hemangioma of L4. There is increasing enhancement and soft tissue\nthickening along the anterior abdominal wall (series 18, image 126).", "output": "Worsening peritoneal metastatic disease with increasing septated ascites, and\nincreasing serosal/peritoneal deposits including a new retroperitoneal serosal\nlesion on the anterior surface of the pancreas.\nMild hepatic steatosis." }, { "input": "Limited images demonstrate cholelithiasis. There are partially imaged renal\nand hepatic cysts. Peritoneal thickening and tethering of bowel loops is\nagain seen, but better evaluated on prior complete MRI. Note is made of\ndilation of the transverse colon. Small bowel loops are normal in caliber.", "output": "Incomplete examination, findings detailed above." }, { "input": "There are no pleural or pericardial effusions.\n\nThere are no pleural effusions. Note is made of a 15 x 20 mm lymph node in\nthe right hilum (1801:10). Note was previously made of mediastinal and hilar\nadenopathy on a CT study from ___ however, this lymph node appears\nto have increased slightly in size but is incompletetly imaged on the\nabdominal MRI. Correlation with interval imaging if any is advised and if\nthere is ongoing concern, a dedicated CT of thorax is advised.\n\nThe liver is normal in size. No focal lesions are identified within the liver\nparenchyma on T1, T2 or post-contrast sequences. There is signal drop off on\nthe out-of-phase imaging indicative of parenchymal fatty replacement. \n\nUsing a multiple-TE gradient echo technique, quantitative assessment of iron\ndeposition within the liver was performed, yielding an estimated iron load\nwithin liver parenchyma of approximate 60 umol/g (less than 4 mg/g liver),\nwhich is minimally increased or high-normal.\n\nUsing ROI measurements from dual-echo chemical shift imaging, an approximation\nof the degree of fatty liver is calculated at 16%. It is noted that this might\nbe slightly underestimated due to mild susceptibility effects related to the\niron overload.\n\nNo features of cirrhosis are identified with normal size of the hepatic lobe\nand smooth liver contour. \n\nThe spleen is normal in size measuring 9.5 cm in maximal dimension. No\nvarices noted.\n\nNote is made of a pancreas divisum, a normal variant. Note is made of a 6-mm,\nT2-hyperintense focus in the pancreatic tail, which may represent a small cyst\nor IPMN. A routine followup in six months is advised to ensure stability. \nNormal appearance of both kidneys and both adrenal glands. Normal appearance\nof the gallbladder. No enlarged upper abdominal or retroperitoneal lymph\nnodes. There is no ascites. \n\nThere is conventional mesenteric anatomy. Note is made of an accessory right\nrenal artery (1801:125).", "output": "1. No evidence of cirrhosis or a focal liver lesion.\n\n2. Moderate fatty liver with estimated fatty percentage of 16%. This may\nslightly underestimate fat given the slightly increased hepatic iron content.\n\n3. Estimated iron load calculation yielding approximate 60 umol/g (less than\n4 mg/g), probably high-normal or slightly elevated.\n\n4. Pancreas divisum with a tiny lesion in the pancreatic tail, which may\nrepresent a small pancreatic cyst or IPMN. Routine surveillance imaging in\nsix months is advised to ensure stability.\n\n5. Enlarged hilar lymph node. It is noted that adenopathy in the chest was\npresent in older chest CT examinations from ___ this examination cannot\nassess stability as only a small portion of the chest is imaged. If\nassessment of stability is desired, dedicated chest CT could be performed." }, { "input": "Lower thorax: The heart is mildly enlarged without pericardial effusion. There\nis mild subsegmental atelectasis within the right cardiophrenic angle. There\nis no pleural effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is no\nevidence of hepatic steatosis. There is a tiny cyst or biliary hamartoma the\nborder of segments VI and VII. No suspicious hepatic lesion is identified.\n\nBiliary: There is a 3 mm enhancing nodule along the gallbladder wall (series\n1403, image 68), likely representing a polyp. The gallbladder is otherwise\nunremarkable. There is no intra- or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. No focal\npancreatic lesion is identified. There is no main pancreatic ductal\ndilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The bilateral adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size. There is a tiny cortical cyst in\nthe posterior interpolar region of the left kidney. There is no\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. The patient is status\npost right colectomy. Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nRetroperitoneum: Again seen are postsurgical changes within the right\nretroperitoneum, including thickening of Gerota's fascia and fat stranding. \nThere are multiple enhancing nodular foci within the surgical bed which\ndemonstrate restricted diffusion, the largest measuring 2.3 x 1.6 cm (series\n15, image 23), unchanged compared to the prior CT of the abdomen/pelvis from\n___, but gradually increased in size over multiple prior studies. \nThere is a newly visualized 2.5 x 1.8 cm enhancing mass within the right psoas\nmuscle (series 15, image 25) and another tiny intramuscular focus of\nenhancement more inferiorly (series 15, image 41). Findings are concerning for\nlocal tumor recurrence.\n\nWithin the right pelvis, there is a 2.2 x 2.0 cm enhancing mass abutting the\niliacus muscle (series 15, image 58), compatible with another tumor deposit,\nunchanged compared to CT of the abdomen/pelvis from ___, but\nincreased in size since ___, at which time it measured 0.7 cm.\n\nPelvis: The uterus and bilateral ovaries are surgically absent. There is\ntrace free fluid in the pelvis.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent. The common hepatic artery is replaced to the\nSMA. An accessory left hepatic artery supplying segments II and III and the\nleft gastric artery share a common origin. The splenic artery arises directly\nfrom the aorta.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. There are incisional changes along the midline anterior lower\nabdominal and pelvic wall. There is a midline incisional hernia with mild\nventral protrusion of bowel loops.", "output": "1) Postsurgical changes within the right retroperitoneum. Multiple enhancing\nnodular foci within the surgical bed, the largest measuring 2.3 x 1.6 cm,\nunchanged compared to the prior CT of the abdomen/pelvis from ___,\nbut gradually increased in size over multiple prior studies. Newly visualized\n2.5 x 1.8 cm enhancing mass within the right psoas muscle and another tiny\nintramuscular focus of enhancement more inferiorly. Findings are concerning\nfor local tumor recurrence.\n2) 2.2 x 2.0 cm enhancing mass abutting the right iliacus muscle, compatible\nwith another tumor deposit, unchanged compared to CT of the abdomen/pelvis\nfrom ___, but increased in size since ___." }, { "input": "Lower thorax: Limited evaluation of the lung bases are clear. No pleural or\npericardial effusion.\n\nLiver: The liver is homogeneous in signal intensity without focal lesion. \nInferior to the right hepatic tip is a stable 0.9 x 0.4 cm circumscribed T2\nhyperintense cystic collection which is postsurgical in nature. (04:27). No\nsignal drop on out of phase imaging to suggest hepatic steatosis. Trace\nperihepatic free fluid. There is a 3 x 14 mm linear area of enhancement along\nthe right hepatic capsule, similar to prior (series 1202, image 61).\n\nBiliary: No intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis unremarkable.\n\nPancreas: The pancreas is homogeneous in signal intensity without focal\nlesion. No pancreatic duct dilatation. No peripancreatic fat stranding.\n\nSpleen: The spleen is normal in size the vocal lesion.\n\nAdrenal Glands: Adrenal glands are unremarkable.\n\nKidneys: Kidneys are homogeneous in signal intensity and normal in size. No\nhydronephrosis. No perinephric fat stranding. Again is right retroperitoneal\nscarring coursing along the right ureter down to the pelvis without\nhydroureteronephrosis.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small large\nbowel are unremarkable. No obstruction.\n\nPelvis: Trace pelvic free fluid. Status post hysterectomy.\n\nLymph Nodes: No retroperitoneal, mesenteric, pelvic sidewall, or inguinal\nlymph node enlargement.\n\nVasculature: No abdominal aortic aneurysm. Aberrant hepatic anatomy with left\ngastric artery arising directly off of the aorta, and common hepatic artery\narises off the SMA. Patent vasculature. Hepatic veins, main portal vein,\nSMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: Again seen anterior to the right psoas\nmuscle is an enlarging 1.3 x 1.5 cm T2 hypointense homogeneously enhancing\nnodule which demonstrates restricted diffusion worrisome for\nresidual/recurrent tumor (13:37) (previously 1.2 x 1.2 cm). This is in close\nproximity to the right ureter.\n\nAdditional small foci of enhancement:\n\n-0.2 cm nodule posterior to the cecum is slightly more prominent than on prior\nexamination (13:28).\n-Previously noted enhancement along the right iliopsoas muscle currently\nmeasures 11 mm, previously 10 mm (13:81).\n-Multiple subcentimeter scattered foci of fusiform enhancement are\ndemonstrated in the right lower quadrant anterior abdominal wall musculature,\nsimilar to prior.\n-9 mm left psoas muscle enhancing lesion (series 1202, image 132), stable.\nAdditional 1.7 x 1.5 cm T2 hypointense nonenhancing lesion posterior to the\ncecum is likely related to scarring and prior fat necrosis (08:20).\n\nWithin the right flank, surrounding the right inferior kidney again seen is a\nlobulated heterogeneous appearance to the mesenteric fat making it difficult\nto fully assess definite extent of residual disease.\n\nSmall bowel and fat containing ventral hernia noted. No adjacent fat\nstranding or fluid collection (04:39). There is right hip synovitis with\nright greater trochanteric bursitis. Soft tissues and osseous structures are\notherwise unremarkable.", "output": "1. Increase in 1.5 cm nodule anterior to right psoas muscle as well as\nincreased prominence of 0.2 cm nodule posterior to cecum, worrisome for\nresidual/recurrent disease.\n2. Several additional small foci of enhancement which are similar to prior\nalong the right iliacus muscle, left psoas muscle, right lower quadrant\nanterior abdominal wall, and along the right hepatic capsule. These are\nindeterminate in nature, however small foci of residual/recurrent disease are\nnot excluded.\n3. Lobulated and stranded appearance of retroperitoneal fat within right flank\nmakes it difficult to assess definite extent of residual disease.\n3. Small bowel and fat containing ventral hernia.\n4. Right hip synovitis and right greater trochanteric bursitis." }, { "input": "Lower thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Sub-5 mm T2 hyperintense nonenhancing focus within segment 6 is stable\nfrom prior examinations, likely a small cyst or hamartoma. 15 mm nonenhancing\nfluid collection adjacent to the inferior margin of the right hepatic lobe is\nlikely postsurgical, minimally increased in size in comparison to the prior\nexamination where it measured 11 mm.\n\nBiliary: Layering sludge is noted within the gallbladder lumen. No intra\nextrahepatic biliary ductal dilatation.\n\nPancreas: Unremarkable pancreas. No pancreatic ductal dilatation.\n\nSpleen: Spleen is normal in size.\n\nAdrenal Glands: Unremarkable adrenal glands.\n\nKidneys: Homogeneous enhancement of the renal parenchyma. No\nhydroureteronephrosis. Asymmetric increased fat in the perinephric space on\nthe right in comparison to the left, unchanged, with mild perinephric fat\nstranding.\n\nGastrointestinal Tract: Stomach is unremarkable. There is a small\nparaumbilical hernia containing a nonobstructed loop of small bowel. No small\nor large bowel distention is identified.\n\nPelvis: Normal contour of the urinary bladder wall. Trace pelvic free fluid.\n\nLymph Nodes: No retroperitoneal or mesenteric adenopathy.\n\nVasculature: No abdominal aortic aneurysm. Hepatic and portal venous systems\nare patent.\n\nOsseous and Soft Tissue Structures: There are 2 enhancing nodules anterior to\nthe right psoas muscle, appear to be part of a conglomerate fat and soft\ntissue density lesion (axial series 14, image 48) measuring 16 x 30 mm,\npreviously 13 x 30 mm. The dominant enhancing nodule measures 12 x 18 mm\n(axial series 14, image 47), previously 11 x 14 mm.\n\nThere are multiple additional enhancing foci (axial series 14): within the\nanterior left psoas muscle (image 37), measuring 10 mm, previously 9 mm; and\nwithin the right iliacus muscle (image 94), measuring 14 mm, previously 11 mm.\n\nFascial thickening and enhancement involving the transversalis and posterior\nperirenal fascia with mild stranding of the posterior para renal space appears\nsimilar to previous (axial series 14, image 2). There is also fascial\nenhancement involving the lower anterior abdominal wall musculature with mild\nnodularity (axial series 14, image 80) which appears similar to previous.\n\nPreviously identified nodule posterior to the ascending colon is not well\nvisualized on the current examination. There is an 8 mm enhancing nodule\nposterior to the ascending colon slightly more laterally (axial series 1303,\nimage 147), which is likely present on the prior exam but slightly more\nconspicuous. 19 mm T2 hypointense non-enhancing nodule (coronal series 4,\nimage 24) in the right lower quadrant is unchanged.\n\nSmall paraumbilical containing a nonobstructed loop of small bowel. Facet\ndegenerative changes at left L5-S1.", "output": "1. Stable or minimal increase in size of enhancing soft tissue nodules\nanterior to the right psoas muscle, within the left psoas muscle, and within\nthe right iliacus muscle in the region of the patient's known, treated,\nretroperitoneal liposarcoma.\n2. Fascial thickening and stranding within the right-sided retroperitoneal fat\n(perirenal and posterior para renal space) as well as facial enhancement\ninvolving the lower right anterior abdominal wall with some nodularity appears\nsimilar to previous." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Nodular enhancement along the surface of segment 6 (axial series 1302,\nimage 66) measures 19 mm, similar to previous. No parenchymal lesion is\nidentified. Punctate cyst or hamartoma within segment 7 is unchanged. 19 mm\nfluid collection inferior to the right lobe of the liver appears similar to\nprevious.\n\nBiliary: No biliary ductal dilatation. Unremarkable gallbladder.\n\nPancreas: Homogeneous signal of the pancreatic parenchyma. No pancreatic\nductal dilatation.\n\nSpleen: No splenomegaly.\n\nAdrenal Glands: The adrenal glands are normal in size and morphology.\n\nKidneys: Unremarkable kidneys. No hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. The imaged small and\nlarge bowel are normal in caliber. Ventral wall hernia containing a\nnonobstructed loop of small bowel. Uncomplicated colonic diverticulosis.\n\nLymph Nodes: Unremarkable.\n\nVasculature: Incidental note is made of a common trunk of the SMA and common\nhepatic artery, with splenic artery arising separately from the aorta.\n\nRetroperitoneum: 2 dominant retroperitoneal enhancing lesions are again noted,\nwhich have increased in size in comparison to the prior examination:\n\n1. Heterogeneously enhancing lesion anterior to the left renal vein (axial\nseries 1302, image 87) measuring 38 x 61 mm, previously 24 x 53 mm when\nremeasured with similar technique.\n2. Avidly enhancing mass anterior to the right psoas muscle (axial series\n1401, image 27) measuring 39 x 39 mm, previously 24 x 34 mm.\nAdditional fat containing masses which are conspicuous on the\ndiffusion-weighted images but are more difficult to visualize on the\nadditional pulse sequences, with slight heterogeneity of the retroperitoneal\nfat on the T2 weighted sequences:\n\n1. Mass anterior to the IVC (axial series 6, image 33), measuring 22 x 54 mm,\nbest previously 22 x 51 mm.\n2. Mass anterior to the right kidney (axial series 6, image 33) measuring 17 x\n27 mm, previously 12 x 21 mm.\nThere is diffuse fascial enhancement involving the retroperitoneum bilaterally\n(axial series 1302, images 110 and 118) with asymmetric prominence of the\nright-sided posterior pararenal fat, similar to previous. Trace pelvic free\nfluid.\n\nOsseous and Soft Tissue Structures: Stable punctate focus of enhancement\nwithin the right lateral body wall (axial series 1302, image 127) ventral wall\nhernia containing nonobstructed loops of small bowel. No suspicious osseous\nlesion. Fluid overlying the right greater trochanter may be in keeping with\nbursitis.", "output": "1. Interval increase in size of multiple fat containing retroperitoneal masses\nas described above, consistent with disease progression.\n2. Facial enhancement within the retroperitoneum bilaterally, with more\nnodular area of enhancement overlying hepatic segment 6 and asymmetric\nprominence of the right posterior pararenal fat appears similar to previous." }, { "input": "Lower Thorax: Within limitations of MRI, subsegmental atelectasis in the lung\nbases bilaterally. There is a large left and moderate right pleural effusion,\nsignificantly worsened from prior CT. No abnormal nodular enhancement along\nthe pleural lining.\n\nLiver: Liver demonstrates normal morphology and signal characteristics. There\nis no significant drop of signal on the out of phase images as compared to the\nin-phase images to suggest hepatic steatosis. There are few focal lesions\nwithin the liver around the gallbladder fossa within segments IVb and V that\ndemonstrate hyperintense signal on the T2 weighted images with diffusion\nrestriction and rim enhancement on the postcontrast images (series 1103, image\n77, 82, 88 and 74), the largest of which measures 1.2 x 1.2 cm. They all\nappear superficial adjacent to the liver surface. No other worrisome\nenhancing hepatic mass lesions.\n\nBiliary: Gallbladder is present containing multiple gallstones. There is a\nfocal ill-defined and asymmetric thickening at the gallbladder fundus with\nheterogeneous enhancement on the postcontrast images.\n\nPancreas: Pancreas demonstrates normal morphology and signal characteristics\nwithout dilatation of the main pancreatic duct. No peripancreatic fluid\ncollections.\n\nSpleen: Spleen is normal in size and signal characteristics. There are small\nperipheral areas of hypoenhancement measuring 9 mm without signal abnormality\non the T2 weighted images or DWI sequences, most likely related to small\ninfarct.\n\nAdrenal Glands: Adrenal glands are normal bilaterally without focal nodules.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There is adequate excretion of contrast on\nthe more delayed phases. Small tubular hypo intensity at the lower pole of\nthe right kidney (series 1103, image 104), nonspecific, however most likely\nrepresenting tiny infarct. No suspicious renal masses or hydronephrosis.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are normal in caliber. There is mild diffuse thickening of the\nsmall bowel loops, likely related to third spacing. There is a moderate to\nlarge amount of ascites in the abdomen with enhancing omental thickening,\ncompatible with peritoneal carcinomatosis (series 7, image 37). There are\nalso multiple enhancing serosal implants along the liver surface (series 1103,\nimage 12, 14).\n\nLymph Nodes: No suspicious mesenteric or retroperitoneal lymphadenopathy by\nsize criteria.\n\nVasculature: Abdominal aorta is normal in caliber and its major branches are\npatent. Hepatic arterial anatomy is conventional. The splenic vein, SMV,\nportal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "1. Asymmetric wall thickening at the gallbladder fundus. Primary\nconsideration would be of primary gallbladder neoplasm, however a metastatic\nlesion at the gallbladder fundus is also possible.\n2. Multiple superficial enhancing liver lesions around the gallbladder fossa\nwithin segments IVb and V along the liver surface. These most likely\nrepresent invading metastatic serosal implants.\n3. Moderate to large amount of ascites with serosal implants along the liver\nsurface as well as peritoneal carcinomatosis.\n4. Large left and moderate right pleural effusion, worsened from prior CT\ndated ___.\n5. Small peripheral areas of hypoenhancement within the spleen as well as the\ninferior border of the right kidney, nonspecific, possibly representing tiny\ninfarcts." }, { "input": "Lower thorax: No pleural or pericardial effusion is seen. Limited evaluation\nof the lung bases shows focal area of enhancement in the right lower lobe that\ncould be related to atelectasis.\n\nLiver: There is diffuse signal dropout of the liver parenchyma in T1 out of\nphase compared to T1 in phase consistent with diffuse hepatic steatosis. \nThere is a 1.6 cm T2 hyperintense nonenhancing lesion in segment ___ of the\nliver consistent with a cyst. Note is made of hypervascular foci in segments\n8 and 5 of the liver, with no signal abnormality seen in the additional\nsequences, likely representing perfusion anomalies.\n\nBiliary: The patient is status post cholecystectomy with mild intra biliary\nductal prominence. The CBD measures 1.0 cm. Lower insertion of the cystic\nduct is incidentally noted.\n\nPancreas: The pancreas is diffusely atrophic with multiple subcentimeter\ncystic lesions likely representing side-branch IPMNs, measuring up to 1.1 cm\nin the pancreatic body. The main pancreatic duct is normal in caliber.\n\nSpleen: The spleen is mildly enlarged measuring 15.0 cm craniocaudally.\n\nAdrenal Glands: Again noted is a 1.4 cm left adrenal gland nodule, with no\nsignal dropout in the T1 out of phase, that demonstrated intense FDG uptake on\nprior PET-CT. The right adrenal gland is normal size and shape.\n\nKidneys: The patient is status post left nephrectomy with interval decrease in\nsoft tissue within the nephrectomy bed, suggesting improving post surgical\nchanges. There is an unchanged 1.6 cm T1 hyperintense exophytic lesion in the\ninterpolar region of the right kidney that demonstrates a nodular area of\narterial enhancement (18:104), consistent with a complex hemorrhagic cyst. \nThere is a 4 mm T1 hyperintense nonenhancing lesion in the inferior pole of\nthe right kidney consistent with a hemorrhagic cyst. Otherwise, there are\nunchanged T2 hyperintense nonenhancing right renal lesions, measuring up to\n3.3 within its lower pole consistent with simple cysts. Note is made of a\nnodular area noted in the right renal pelvis (4:9) only seen on the coronal\nT2 weighted images. However, enhancement cannot be assessed given contrast\nexcretion in the post contrast phase and this is indeterminate. There is no\nhydronephrosis.\n\nGastrointestinal Tract: Note is made of a small diverticulum posteriorly in\nthe gastric fundus. Additionally there is a 9 mm fat containing lesion in the\ngastric wall suggestive of a small lipoma (15:66). There is no mass seen in\nthe large or small bowel.\n\nPelvis: The patient is status post hysterectomy. Note is made of colonic\ndiverticulosis involving the sigmoid and descending colon.\n\nLymph Nodes: There are unchanged small upper abdominal lymph nodes, including\na 1.3 x 0.7 cm portacaval node. Small retrocaval lymph nodes are slightly\nmore prominent compared to prior, such as a 1.1 x 0.9 cm node (15:82) and a\n1.0 x 0.8 cm node (15:74).\n\nVasculature: There are marked atherosclerotic calcifications of the aorta and\niliac arteries. No evidence of abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is mild levoscoliosis with\ndegenerative changes throughout the lumbar spine. Hemangiomas are noted in\nT7, T10, T12, L4 and L5 vertebral bodies. Again noted is diastasis of the\nanterior abdominal wall musculature.", "output": "1. Hemorrhagic right renal cyst with an eccentric enhancing nodule is\nconsistent with Bosniak 4 cyst and is worrisome for a cystic RCC.\n2. Indeterminate signal 4mm nodule in a non dependent position of the right\nrenal pelvis only seen on the T2-weighted images for which contrast\nenhancement could not be assessed given contrast excretion in the collecting\nsystem. This could represent a flow related artifact however a solid lesion\ncannot be excluded. Attention to follow-up is recommended.\n3. Left adrenal gland nodule that does not demonstrates intra voxel fat and\nwas FDG avid on prior PET-CT is concerning for metastasis.\n4. Post left nephrectomy status with postsurgical changes with interval\nresolution of the left nephrectomy bed hematoma. No suspicious enhancement to\nsuggest local recurrence.\n5. Mildly prominent retroperitoneal lymph nodes are slightly increased\ncompared to prior- close attention on subsequent follow-up is recommended.\n6. Cystic pancreatic lesions likely representing side-branch IPMNs measuring\nup to 1.1 cm.\n7. Mild splenomegaly. Underlying etiology for the same is unclear.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:34 into the Department of\nRadiology critical communications system for direct communication to the\nreferring provider." }, { "input": "Please note is that the study is slightly limited due to significant motion\nartifacts.\n\nLower thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver demonstrates normal contours without morphological signs of liver\ncirrhosis. There is diffuse drop of signal on the out of phase images as\ncompared to the inphase images, compatible with diffuse hepatic steatosis. \nStable 1.6 cm T2 hyperintense lesion within segment III posteriorly,\ncompatible with a cyst. No worrisome hepatic mass lesions within limitations\nof a noncontrast study.\n\nBiliary: Patient status post cholecystectomy. Stable mild intrahepatic\nbiliary duct prominence within normal limits of post cholecystectomy status. \nThe common bile duct tapers normally towards the ampulla without obstructing\nfilling defects or choledocholithiasis\n\nPancreas: Pancreas is diffusely atrophic with multiple subcentimeter cystic\nlesions, most likely representing side-branch IPMNs the largest measuring up\nto 10 mm. The main pancreatic duct is not dilated. No peripancreatic\ninflammatory changes or fluid collections.\n\nSpleen: Mild splenomegaly measuring 15 cm in craniocaudal dimension.\n\nAdrenal Glands: Right adrenal gland is normal. 1.4 cm left adrenal gland\nnodule without intra voxel fat, is grossly stable in size when compared to\nprior. It demonstrated FDG uptake on prior PET-CT, and remains nonspecific. \nMetastasis cannot be ruled out.\n\nKidneys: Patient status post left nephrectomy with stable postsurgical changes\nin the left nephrectomy bed. Within the right kidney, re- demonstration of a\n1.9 cm T1 hyperintense exophytic lesion in the interpolar region of the right\nkidney with a fluid-fluid suggestive of hemorrhagic products. It appears\ngrossly stable when compared to prior and no focal intra cystic nodularity is\nidentified although slightly limited by lack of intravenous contrast. No\nhydronephrosis.\n\nGastrointestinal Tract: Note is made of a small gastric lipoma, stable in\nsize. The visualized small bowel loops are normal in caliber. There is\nmoderate colonic diverticulosis. There is a small right paraumbilical hernia\ncontaining a small segment of nonobstructed bowel (series 17, image 21).\n\nPelvis: Status post hysterectomy. No size significant pelvic lymphadenopathy.\n\nLymph Nodes: A few prominent retroperitoneal lymph nodes, subcentimeter in\nsize and stable when compared to prior. No suspicious mesenteric or porta\nhepatis lymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta is normal in caliber and not aneurysmal.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions. Multilevel degenerative disc disease of the lower lumbar spine.", "output": "1. Status post left nephrectomy with postsurgical changes in the nephrectomy\nbed. No suspicious soft tissue nodularity to suggest residual or recurrent\ntumor, however slightly limited given the lack of intravenous contrast.\n2. Stable 1.9 cm exophytic lesion arising from the interpolar region of the\nright kidney with a fluid -fluid level suggestive of hemorrhagic products. No\nfocal nodule seen within the cyst, although slightly limited by lack of\nintravenous contrast. Continued attention on follow-up imaging is\nrecommended.\n3. Stable 1.4 cm left adrenal gland nodule that demonstrated FDG uptake on\nprior PET-CT. It remains nonspecific and metastasis cannot be ruled out.\n4. Small right paraumbilical hernia containing a small segment of\nnonobstructed small bowel." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: The liver has a nodular contour due to multiple metastases. There is\nno background hepatic steatosis. Since th prior exam, the patient has\nundergone Y-90 treatment to segments 4A and 4B. Since the prior CT, there\nnumber of lesions in these segments have increased, though they may just be\nmore visible due to post-treatment changes, as well as the difference in\nmodality. For example, the largest is in segment 4A/B and measures 28 x 24\nmm. This previously measured 13 x 14 mm. The lesions in these segments, and\nin the dome of the liver in segment 8 demonstrate hyperenhancing rims, which\nlikely denotes post-treatment changes. Continued attention on follow-up exams\nis recommended.\n\nIn comparison to the most recent cross-sectional imaging from ___,\nthere has been significant interval progression of disease in the left lobe. \nThere least twenty lesions, some of which are coalescing together. For\nexample, in segment 3, there is a 21 x 18 mm lesion, which is new from the\nprior exam. The majority of the lesions in segment 2 and 3 are new. These\nlesions do not have the same degree of rim enhancement as the lesions in\nsegment 4A and 4B. There intermediate signal on the T2 weighted images,\nsuggesting there is likely some internal necrosis.\n\nIn the right lobe of the liver, there is also been significant progression of\ndisease. There are approximately fifteen to twenty metastasis. For example,\nin segment ___, there is a 42 x 40 mm lesion which previously measured 27 x 22\nmm. In segment 6, there is a 31 x 27 mm lesion which previously measured 23 x\n26 mm. In the dome of the liver, there is significant increase heterogeneity,\nand the small confluent masses which have also increased in size.\n\nThe known fiducial markers in the right lobe of the liver were better assessed\non the prior CT. The lesion treated by cyberknife in the dome of the liver\nappears unchanged. The lesions in the inferior aspect of the liver are\ndifficult to evaluate due to the other surrounding metastases, though are also\nlikely not significantly changed.\n\nThe hepatic arterial anatomy was better assessed on the recent Y-90 treatment\narteriogram. The portal veins are patent. The hepatic veins are diminutive,\nthough also patent.\n\nBiliary: There is mild prominence of the intrahepatic bile ducts,\npredominately and in the right posterior distribution, likely due to focal\nobstruction from a metastasis. This is not changed from the prior CT. There\nis no central intrahepatic biliary duct dilation. The common bile duct is\nnormal. There is no abnormal enhancement around the bile ducts to suggest\nactive cholangitis.\n\nPancreas: The known tumor in the uncinate process of the pancreas is not\nsignificantly changed from the prior CT. It is somewhat difficult to\nvisualize, measuring approximately 10 mm. No new mass is identified. There\nis no duct dilation. No diffusion-weighted abnormality corresponds to the\nlesion in the uncinate process.\n\nSpleen: The spleen is normal in size, measuring 11.9 cm. There are no focal\nlesions.\n\nAdrenal Glands: The right adrenal gland is normal. The left adrenal gland is\nmildly thickened, though no discrete nodule is identified.\n\nKidneys: The kidneys are normal in size. There is no renal lesion,\nhydronephrosis, or perinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is trace ascites in the right upper quadrant.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild multilevel degenerative changes are noted in the lumbar spine. The soft\ntissues are unremarkable.", "output": "1. Progression of disease in both the left and right lobes of the liver, as\ndescribed above.\n2. The number of lesions visualized in the treated segments 4A and 4B has\nincreased, though that could be related to increased visualization related to\ntreatment effect from the prior Y-90 therapy. Continued attention on followup\nexams is recommended.\n3. Unchanged mild biliary dilation the right posterior intrahepatic ducts,\nlikely are related to focal obstruction from a metastasis.\n4. Unchanged appearance of the mass in the uncinate process of the pancreas.\n5. No upper abdominal lymphadenopathy." }, { "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: There is a 2.6 x 3.4 x 3.2 cm T2 hyperintense lesion in segment V/VI\nshowing peripheral nodular enhancement with delayed centripetal enhancement\ncompatible with a hemangioma (05:24; 901:79; 904:79). A 1.4 x 1.5 x 1.7 cm\nhemangioma with similar imaging characteristics is noted in segment IVb/V\n(5:19; 3:11; 901:63; 904:63). A smaller 8 mm hemangioma is noted in segment V\n(904:67; 5:21). Another 6 mm hemangioma is noted in segment II (904:53; 5:16).\nAnother 9 x 9 mm hemangioma is noted in segment VII (5:10; 904:37; 901:37). A\n6 mm enhancing focus in the periphery of segment 7 likely represents a flash\nfilling hemangioma (901:54). There is no suspicious focal hepatic lesions.\n\nGallbladder and Biliary System: The gallbladder is normal with no evidence of\nstones. There is no significant intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.There is classic pancreatic ductal anatomy without dilatation.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal\nlesion.The adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "Multiple scattered hepatic hemangiomas as described above including a 3.4 cm\nsegment V/VI hemangioma." }, { "input": "LOWER CHEST: Visualized lung bases are grossly clear. There is no pleural or\npericardial effusion. Bilateral breast prostheses are partially imaged.\n\nABDOMEN:\n\nLIVER: The liver is normal in morphology. The hepatic parenchyma demonstrates\nloss of signal on out-of-phase relative to in-phase imaging with a calculated\nfat fraction of 6%. There is an exophytic cyst arising from the inferior\naspect of segment VI measuring 4.7 x 4.1 cm (3:24, 4:38). There are a few\nother scattered subcentimeter cysts and/or biliary hamartomas. No concerning\nlesions. There is no ascites.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is normal.\n\nPANCREAS: There is moderate diffuse atrophy of the pancreas, which otherwise\ndemonstrates normal signal intensity and enhancement. No focal lesions or\npancreatic duct dilatation. No evidence of peripancreatic inflammation.\n\nSPLEEN: The spleen is normal size and signal intensity, measuring 8.9 cm in\nlength. There is no focal lesion.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys normal in size with symmetric nephrograms. There is no\nconcerning lesion. There is a 1.6 cm exophytic cyst arising from the anterior\nlower pole of the left kidney with dependently layering T1 hyperintensity,\ncompatible with hemorrhagic content (9:106). There is an additional 6 mm T1\nhyperintense, T2 hypointense hemorrhagic cyst in the lower pole of the left\nkidney (9:124). There is a 3.4 cm cyst arising from the anteromedial lower\npole of the right kidney with a single, thin nonenhancing septation (4:38),\nBosniak II. There are a few other tiny cortical cysts. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. Portal veins and hepatic veins are\npatent. Hepatic arterial anatomy is conventional.\n\nBONES: There multilevel degenerative changes of the lumbar spine. There is no\nsuspicious osseous lesion.\n\nSOFT TISSUES: Small fat containing umbilical hernia. The abdominal wall is\notherwise unremarkable.", "output": "1. Mild hepatic steatosis. No concerning hepatic lesion. No findings of\nportal hypertension.\n2. No concerning renal lesion. Two hemorrhagic cysts in the left kidney. 3.4\ncm minimally complex cyst in the right kidney, Bosniak II." }, { "input": "Lower Thorax: Visualized lung bases are clear. No pericardial or pleural\neffusion.\n\nLiver: No suspicious hepatic masses. Corresponding to the presumed gastric\nmass seen on prior CT, there is a 3.8 x 2.3 x 2.4 cm (___) T2\nhyperintense, T1 hypointense lesion with peripheral, nodular enhancement, most\nlikely representing an exophytic hepatic hemangioma. There are a few\nsubcentimeter T2 hyperintense, well-circumscribed lesions throughout the\nliver, measuring up to 0.7 cm (___), likely representing simple cysts or\nbiliary hamartomas. No significant loss of signal on out of phase compared to\nin phase sequences to suggest hepatic steatosis.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. \nIncidentally noted adenomyomatosis in gallbladder fundus. The gallbladder is\notherwise unremarkable.\n\nPancreas: Normal in size and signal intensity. No focal lesions. Main\npancreatic duct is nondilated.\n\nSpleen: The spleen is normal in size and signal intensity. No focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and signal\nintensity without focal nodularity.\n\nKidneys: Normal in size, signal and enhancement. There is a right midpole\nsimple cyst, measuring up to 2.0 cm (___). No hydronephrosis or perinephric\nabnormality.\n\nGastrointestinal Tract: The stomach and visualized portions of the small\nbowel and colon are unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Aorta is normal in caliber. Conventional hepatic arterial\nanatomy.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. Small fat\ncontaining umbilical hernia.", "output": "1. Corresponding to the presumed gastric mass seen on prior CT, there is a 3.8\nx 2.3 x 2.4 cm T2 hyperintense, T1 hypointense lesion with peripheral, nodular\nenhancement, most likely representing an exophytic hepatic hemangioma. \nRecommend tagged RBC nuclear medicine scan for further evaluation.\n2. No gastric mass.\n3. No lymphadenopathy. No evidence of suspicious hepatic lesions.\n\nRECOMMENDATION(S): Recommend tagged RBC nuclear medicine scan for further\nevaluation.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 09:59 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "There is a right lower quadrant renal transplant with overlying abdominal wall\nsurgical incision scar. A lesion at the superior pole the right kidney\ncontinues to demonstrate gradual growth. Currently this has ___ of 3 x\n3 x 2.8 cm. The lesion is heterogeneous on T2 weighted imaging with\npredominant hyperintensity and a thick nodular hypointense rim (2:17). This\nperipheral component demonstrates mild restricted diffusion, while the center\ndoes not. There is no identified intralesional fat. On T1 weighted imaging,\nthe lesion is predominantly hypointense with foci of peripheral intermediate\nsignal. After administration of gadolinium, there is avid enhancement within\nthis lesion. This is predominantly peripheral in distribution with central\nnodular extension of enhancing material (14:38). The lesion is partially\nexophytic, with approximately 50 % of the mass extending beyond the expected\ncapsular contour. Approximately 4 mm of normal renal parenchyma separates the\nmass from an adjacent superior pole calyx.\n\nThe remainder of the transplanted kidney is normal in appearance. There is no\nadditional lesion or hydroureteronephrosis.\n\nThe native kidneys are symmetrically atrophied, without concerning lesion.\n\nThe visualized portions of the liver and spleen are low in T2 signal, in\nkeeping with known hemosiderosis. The pancreas and adrenal glands are\nunremarkable as visualized.\n\nThe uterus is notable for two T2 hypointense fibroids along the anterior\nserosal surface. These are either subserosal or associated with the broad\nligament, but are unchanged from multiple priors. The left adnexa again\ndemonstrates a 1 cm simple cyst (4:19). The right ovary is unremarkable.\n\nThere is no pelvic lymphadenopathy or free fluid. Osseous structures are\nunremarkable.", "output": "Enhancing mass arising from the superior pole of the transplanted kidney,\ndemonstrating gradual enlargement, concerning for RCC, likely cystic clear\ncell type. T1a stage by imaging." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\n\nLiver/Spleen: The liver and spleen are diffusely hypointense in appearance,\nwhich may represent hemosiderosis. The liver contours are smooth. The spleen\nis normal in size. No hepatic for splenic solid or cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The native kidneys are mildly atrophic and otherwise unremarkable. \nAgain seen is an upper pole renal mass in the right lower quadrant transplant\nkidney, stable to slightly decreased in size measuring 2.9 x 2.6 x 2.8 cm\n(04:11, 02:15), previously 3.0 x 3.0 x 2.8 cm. There is persistent central T2\nhyperintensity with a thick nodular avidly enhancing rim. No intralesional\nfat is identified. The lesion is again noted to be partially exophytic with\napproximately 50% of the mass extending beyond the expected renal capsule. No\nextension to the renal sinus fat. Per clinical notes on OMR, this lesion\nrepresents a biopsy proven RCC.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. \nScattered colonic diverticulosis.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.\n\nPartially visualized pelvis: The partially visualized upper bladder is normal\nin appearance.\n\nReproductive system: Partially visualize uterus again demonstrates T2\nhypointense small subserosal fibroids. The visual uterus and adnexa are\notherwise normal in appearance.\n\nThere is mild fat stranding in between the cecum and transplant kidney, which\nmay be secondary to post radiation changes.", "output": "1. Slight decrease in size of the treated mass in the upper pole of the\nright lower quadrant renal transplant.\n\n2. The liver and spleen are diffusely hypointense in appearance, which may\nrepresent hemosiderosis." }, { "input": "Liver and Spleen: The liver and spleen are normal in size and low in signal\nintensity, likely reflecting hemosiderosis, improved compared to the prior MRI\nfrom ___.\n\nBiliary: The gallbladder surgically absent. There is mild prominence of the\ncentral intrahepatic bile ducts, likely secondary to postcholecystectomy\nstate. The common bile duct is normal in caliber, measuring up to 6 mm.\n\nPancreas: The pancreas is diffusely atrophic. Again seen is a 5 mm cystic\nlesion in the pancreatic tail (series 3, image 22), likely representing a\nsidebranch IPMN.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and shape.\n\nKidneys: The native kidneys are atrophic. There is a tiny cyst in the lower\npole of the left kidney. There is mild nonspecific perinephric stranding\nbilaterally. There is a transplanted kidney in the right pelvis. Again seen\nis a 2.7 x 2.5 cm, heterogeneously T2 hyperintense lesion in the upper pole of\nthe transplanted kidney, compatible with known biopsy-proven renal cell\ncarcinoma, unchanged in size and previously 2.8 x 2.6 cm on MRI from ___.\n\nGastrointestinal Tract: Small and large bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nPelvis: The bladder is unremarkable. There are few fibroids in the uterus. \nThere are tiny, benign appearing cystic foci in both ovaries, unchanged. \nThere is no free fluid in the pelvis.\n\nOsseous and Soft Tissue Structures: The bone marrow is normal in signal\nintensity. There are incisional changes along the right anterior pelvic wall.", "output": "1. Limited evaluation in the absence of intravenous contrast. No interval\nchange in size and appearance of a 2.7 x 2.5 cm lesion in the upper pole of\nthe transplanted kidney since the prior MRI from ___, compatible\nwith known biopsy-proven renal cell carcinoma.\n\n2. Low signal intensity of the spleen and liver, likely reflecting\nhemosiderosis, improved since the prior MRI." }, { "input": "Liver: Limited views of the liver demonstrate a low signal intensity on T2\nweighted images, also noted in the spleen, which may be compatible with\nhemosiderosis.\n\nBiliary: The gallbladder surgically absent. Mild prominence of the central\nintrahepatic and extrahepatic bile ducts is noted. No change since priors.\n\nPancreas: The previously seen cystic lesion in the pancreatic tail is not\nentirely imaged on the current study. The pancreas is otherwise unremarkable.\n\nSpleen: The spleen is normal in size. Low signal intensity of the spleen may\nbe seen in hemosiderosis.\n\nAdrenal Glands: Only partially visualized, but unremarkable.\n\nKidneys: The native kidneys are again noted to be atrophic.\n\nA transplanted kidney is seen in the right lower quadrant. Re-demonstrated is\na 2.7 x 2.3 cm, heterogeneously T2 hyperintense, diffusion restricting mass in\nthe upper pole of the transplanted kidney is unchanged since the most recent\nprior, and compatible with renal cell carcinoma (5:4), status post CyberKnife.\nThere is no extension into the renal sinus fat or involvement of the renal\nvasculature, though evaluation is limited without intravenous contrast.\n\nPelvis: A T2 hypointense subserosal fibroid is seen along the anterior uterus\n(05:23).\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified.", "output": "1. No interval change in the size or appearance of a 2.7 x 2.5 cm lesion in\nthe upper pole of the transplanted kidney since the prior MRI from ___.\n2. Low T2 signal intensity in the spleen and liver may reflect hemosiderosis,\nand is unchanged since ___." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The hepatic signal intensity appears diffusely low and demonstrates\nsignal drop on the in phase sequences, compatible with iron overload. No\nconcerning focal lesion is identified. There is no perihepatic ascites.\n\nBiliary: No evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPancreas: Pancreas is normal in signal intensity and bulk without concerning\nmass lesion or main pancreatic ductal dilatation. A couple of adjacent T2\nhyperintense cystic lesions in the pancreatic tail are unchanged since exams\ndating to ___, with the largest measuring up to 5 mm (3:8).\n\nSpleen: The spleen signal intensity is diffusely low on T2 sequences,\ncompatible with secondary hemosiderosis.\n\nAdrenal Glands: The adrenal glands appear thickened but normal in signal\nintensity without discrete nodule.\n\nKidneys: The bilateral native kidneys appear atrophic. A transplanted kidney\nis seen in the right lower quadrant. There is a 3.5 (AP) x 2.9 (TV) x 3.1\n(SI) cm heterogeneously T2 hyperintense mass in the upper pole of the\ntransplanted kidney without significant diffusion restriction, which is\nminimally increased in size since the exams dating to ___ and similar to\nexams dating to ___ (3:4 and 9:28). There is no evidence of hydronephrosis\nor perinephric abnormality surrounding the native kidneys over the right lower\nquadrant transplant kidney.\n\nGastrointestinal Tract: The visualized small and large bowel loops are normal\nin caliber without evidence of obstruction.\n\nLymph Nodes: There is no evidence of adenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without aneurysmal\ndilatation.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesion is\nidentified. There appears to be minimal signal loss on the T1 weighted images\nwithin the marrow which may be due to mild iron deposition. Incidental note\nis made of a fibroid uterus. Incidental note is made of a small fat\ncontaining umbilical hernia. There is a tiny left ovarian cystic lesion,\nmeasuring 0.8 cm, likely benign (3:8) and similar to prior pelvic MRI of ___. In the right ovary there is a cystic lesion with 3 cystic\ncomponents measuring up to 1.8 cm, which is similar to prior pelvic MR of ___.", "output": "1. Overall, similar appearance of the 3.1 cm mass in the upper pole of the\ntransplanted right lower quadrant kidney as compared to exams dating to ___,\nalthough minimally increased in size since ___.\n2. A few cystic lesions in the pancreatic tail are unchanged since exams\ndating to ___, with the largest measuring up to 5 mm, likely side branch\nIPMNs.\n3. Diffusely low signal in the liver and spleen and minimally in the bone\nmarrow are suggestive of secondary hemosiderosis, unchanged.\n4. Bilateral ovarian cystic lesions without concerning features are stable\nsince ___.\n\nRECOMMENDATION(S): The pancreatic cystic lesions can be reassessed at the\ntime of future follow up imaging exams for the known renal mass." }, { "input": "The lung bases are clear. There is no pleural or pericardial effusion.\n\nThe transplanted liver and spleen are diffusely hypointense on T2WI, with\nsignal drop-off on longer-echo T1-weighted images, consistent with\nhemosiderosis. Peripheral subcapsular wedge-shaped area of arterial hyper\nenhancement in segment V is seen (1101:61), without correlation on later\nphases of the post contrast study or on T2WI, compatible with transient\narterial intensity differences. In segment VI a nonenhancing peripheral area\nof T2 hyperintensity is demonstrated again (07:17, 1104: 50), and may\nrepresent sequela of prior injury or hematoma. No new areas of arterial\nhyperenhancement are identified.\n\nThere is a reconstructed celiac axis and a reanastomosed accessory/replaced\nleft hepatic artery(confirmed on the operative notes). Stents are seen again\nat the supraceliac origin of the hepatic artery from the aorta and distally\nand appear to be unchanged in position (1101:38, 46). Although the patency of\nthe conduits cannot be assessed on this exam due to susceptibility artifact,\ndistal arterial flow appears patent. The intrahepatic portal and hepatic\nveins are patent. The portal and IVC anastomoses appear patent.\n\nNo CBD stent is present. Some irregularity at the biliary anastomosis is seen\n(4:13), without dilatation of the CBD or the intrahepatic biliary ducts, and\nwithout evidence of stones.\n\nThe spleen is enlarged up to 14 cm.\n\nThe kidneys and adrenals are unremarkable. A small accessory left renal\nartery is seen.\n\nThe pancreas is mildly atrophied, without focal mass. The pancreatic duct\nremains normal in caliber.\n\nTrace ascites is decreased from the prior CT (4:14).\n\nThe bone marrow signal is normal.", "output": "1. Post liver transplant. Patent hepatic arteries and portal veins. No\nconcerning hepatic mass.\n2. No intra or extrahepatic bile duct dilation.\n3. Hepatic and splenic hemosiderosis.\n4. Stable mild splenomegaly.\n5. Trace ascites has decreased since the prior CT." }, { "input": "The lung bases are grossly clear. There is no ascites.\n\nLiver: In segment VI (series 3, image 18) there is a peripheral, wedge-shaped\narea of increased T2 and decreased T1 signal relative to hepatic parenchyma,\nstable compared to the previous exam and likely postsurgical in etiology. \nEvaluation for focal lesions is limited by lack of IV contrast, however, no\nsuspicious lesions are identified.\n\nThe liver parenchyma demonstrates loss of signal on in phase images,\ncompatible with iron deposition.\n\nMild central intrahepatic duct dilation without peripheral dilation. The CBD\nis dilated measuring up to 11 mm in diameter, increased from the prior exam.\n\nGallbladder: Absent.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nfocal mass or ductal dilatation. There is classic pancreatic ductal anatomy.\n\nSpleen: The spleen demonstrates signal loss on in phase (longer echo T1\nweighted image) compatible with hemosiderosis.\n\nKidneys and Adrenals: The adrenal glands and kidneys are normal in signal and\nmorphology.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is widely patent.\n\nBones: The osseous structures are unremarkable.", "output": "1. Lack of IV contrast limits evaluation for focal hepatic lesions however\nno suspicious lesions are identified.\n2. Iron deposition in the liver and spleen compatible with hemosiderosis.\n3. Extrahepatic and mild central intrahepatic bile duct dilation without\ndistal obstructing mass or stone, likely because of prior cholecystectomy and\npossibly also sphincter of Oddi dysfunction or papillary stenosis. This has\nincreased from on ___ and correlation with liver enzymes and\nclinical picture is recommended" }, { "input": "Lower Thorax: There is a small right pleural effusion with mild bibasilar\natelectasis. Heart size is moderately enlarged.\n\nLiver: The liver is normal in morphology and signal intensity. The liver\ndemonstrates heterogeneous arterial enhance with multiple transient hepatic\nintensity differences in the periphery. There are few scattered simple cysts\nin the liver.\n\nCorresponding to the lesion at the hepatic dome in segment ___ adjacent to the\nmiddle hepatic vein is a 1.8 cm vague oblong mildly T2 hyperintense lesion\nwith delayed filling on post contrast imaging (series 1104, image 38). No\nadditional hepatic lesions are seen. There is no ascites.\n\nBiliary: The gallbladder is unremarkable without evidence of stones. There is\nno intra or extrahepatic biliary duct dilation.\n\nPancreas: The pancreas is normal in morphology and signal intensity. There is\nno main duct dilation. There are no focal lesions.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. There are scattered cortical\nhyperintense lesions which are consistent with a the largest measuring 0.9 cm\nin the left upper pole. A few of these cysts demonstrate hemorrhagic\ncomponents.\n\nGastrointestinal Tract: There is no hiatal hernia. There is no bowel\nobstruction.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. The portal vein and hepatic veins are patent.\n\nUpper pelvis: There is a partially imaged uterine mass seen on the coronal\nimage consistent with known leiomyosarcoma.\n\nOsseous and Soft Tissue Structures: There are no suspicious osseous lesions. \nMultilevel degenerative changes are noted of the lumbar spine. There is mild\nanasarca.", "output": "1. 1.8 cm lesion at the hepatic dome corresponding to the CT finding is most\nconsistent with a slightly atypical hemangioma.\n2. Small right pleural effusion.\n3. Partially imaged uterine mass. Please see recent CT for further\ncharacterization." }, { "input": "Liver is generally shrunken and highly nodular consistent with cirrhosis\nincluding redistribution of volume to the caudate and left lateral segments. \nRelative hyperintensity of the anterolateral eighth segment on T2-weighted\nimages, correlating with mild hyper enhancement on delayed images, is\nconsistent with regional fibrosis. Although liver is markedly nodular with\nmany small regenerating regenerative nodules, no suspicious focal liver\nlesions are identified. A few small cysts or biliary hamartomas are also\nfound.\n\nThere is no intrahepatic biliary dilatation. Common bile duct measures up to\n9 mm in diameter, at the upper limits of normal size. No gallstones are\nfound. Mild gall bladder wall thickening is often seen with cirrhosis.\n\nPancreas and adrenals appear within normal limits. Spleen is moderately\nenlarged measuring up to 17.2 cm in length. Simple appearing cyst in the mid\nright kidney measures up to 20 mm in diameter. There is no evidence for solid\nmasses or hydronephrosis involving either kidney.\n\nLimited evaluation of the stomach and small bowel also shows no abnormality. \nNo enlarged lymph nodes are detected.\n\nThere is an accessory left hepatic artery arising from the left gastric\nartery. Main portal vein and its major branches are widely patent. Hepatic\nveins are also widely patent. Left paraesophageal and esophageal varices are\ndetected.\n\nThere is a large quantity of ascites. No enlarged lymph nodes are found.\n\nThere is a chronic appearing compression deformity of the L1 vertebral body,\nwhich also appears fused to T12. Bone marrow signal intensities appear within\nnormal limits.", "output": "1. Findings consistent with cirrhosis and portal hypertension including a\nlarge quantity of ascites, splenomegaly and esophageal and paraesophageal\nvarices.\n\n2. No suspicious focal liver lesions identified.\n\n3. Accessory left hepatic artery." }, { "input": "Evaluation is severely limited due to motion, requiring use of non-breath hold\ntechnique, and dielectric effect from ascites, which limits evaluation of\ncentral structures.\n\nLower Thorax: Small bilateral pleural effusions, right greater than left.\n\nLiver: The liver has a shrunken, nodular contour consistent with known\ncirrhosis. There is a 1.1 cm cyst or biliary hamartoma in segment II (series\n12, image 23), as seen on ultrasound from ___. There is a 7 mm\nsubcapsular T1 hypointense, nonenhancing lesion in segment III (series 17,\nimage 18) which corresponds with a known calcified granuloma on CT of the\ntorso from ___ and also seen on recent ultrasound. There is no\nsuspicious hepatic lesion given the technical limitations above.\n\nThere is moderate volume intra-abdominal ascites.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is mildly distended and grossly unremarkable.\n\nPancreas: Grossly unremarkable.\n\nSpleen: The spleen is enlarged, measuring 15.1 cm in craniocaudal dimension.\n\nAdrenal Glands: Not well visualized.\n\nKidneys: There is a 2.0 cm cyst in the interpolar region of the right kidney. \nNo hydronephrosis.\n\nGastrointestinal Tract: Not well assessed.\n\nLymph Nodes: No bulky lymphadenopathy.\n\nVasculature: There are two TIPS, extending from the right and left portal\nveins to the suprahepatic IVC, which appear patent. The main portal vein is\npatent. No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions. Soft\ntissue structures of the abdominal wall are unremarkable.", "output": "1. Severely limited evaluation due to motion, requiring use of non-breath hold\ntechnique, and dielectric effect from ascites, which limits evaluation of\ncentral structures.\n2. No suspicious hepatic lesions given the technical limitations above. \nRedemonstration of a small cyst and calcified granuloma in the left hepatic\nlobe.\n3. Small bilateral pleural effusions, right greater than left.\n4. Moderate volume intra-abdominal ascites.\n5. Two TIPS, which appear patent." }, { "input": "Lower thorax: Unremarkable.\n\nLiver: The liver is unremarkable with no focal lesion.\n\nBiliary: Normal appearance of the gallbladder with no cholelithiasis. No\nbiliary dilation.\n\nPancreas: Unremarkable. No peripancreatic inflammatory changes.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Unremarkable. No hydronephrosis or perirenal inflammatory change.\n\nGastrointestinal Tract: The cecum and ascending colon are compressed by the\ngravid uterus. The appendix is not able to be identified. However, there are\nno secondary signs of acute appendicitis such as a fluid collection or\ninflammatory fat stranding.\n\nPelvis: Single intrauterine gestation. Both ovaries appear within normal\nlimits. No significant free fluid.\n\nLymph Nodes: No enlarged lymph nodes are identified.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: Unremarkable. No acute findings.", "output": "Appendix not able to be definitively identified, but no secondary signs of\nacute appendicitis. No evidence of intra-abdominal inflammatory process to\naccount for the patient's pain.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at approximately 6:00 pm, 10 minutes\nafter discovery of the findings." }, { "input": "Lower thorax: Visualized lung fields do not demonstrate pleural effusion.\n\nLiver: Visualized portion of the liver demonstrate no significant finding,\nthere is no focal lesion.\n\nBiliary: Normal appearance of the gallbladder with no cholelithiasis. No\nbiliary dilatation.\n\nPancreas: The pancreas is unremarkable, main pancreatic duct is not dilated,\nno peripancreatic inflammatory changes.\n\nSpleen: The spleen is normal in size and shape without any focal lesion.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: Both kidneys are of normal size and shape and there is no\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is on remarkable. The small bowel loop\nis not dilated. There is a previous history of gastric bypass surgery, there\nis no evidence of internal hernia or complication at this level. The colon is\nunremarkable. The appendix is well seen and normal. There is no fat\nstranding.\n\nPelvis: Both ovaries are unchanged and unremarkable. Intrauterine pregnancy,\nthere is no significant intrauterine finding within the limits of this\nexamination since it is not a complete fetal anatomical survey.\n\nLymph Nodes: There is no lymphadenopathy in the abdomen and pelvis.\n\nVasculature: Aorta is not dilated. The IVC is patent.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion or\nsignificant abnormality of the abdominal wall.", "output": "There is no evidence of internal hernia, no dilatation small bowel loops or\ncomplication previous gastric bypass surgery.\nThe appendix, the ovaries, the gallbladder and both kidneys are within normal\nlimits.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:00 pm." }, { "input": "Liver: Imaged portions of the liver parenchyma appear unremarkable. There is a\n7 mm T2 hyperintense lesion within the right hepatic lobe seen only on the\nwide field-of-view sagittal T2 weighted images, likely a small cyst or\nhamartoma.\n\nBiliary: No biliary ductal dilatation. Unremarkable gallbladder.\n\nPancreas: Unremarkable.\n\nSpleen: Unremarkable.\n\nKidneys: No hydronephrosis.\n\nGastrointestinal Tract: Uncomplicated colonic diverticulosis. No bowel\nobstruction.\n\nLymph Nodes: No retroperitoneal or mesenteric adenopathy is identified. No\npelvic lymphadenopathy.\n\nVasculature: Unremarkable, within the limitations of an unenhanced study.\n\nPelvis: Multiple T2 hypointense lesions within the uterus, likely small\nintramural fibroids. The uterus is small in size in keeping with\npostmenopausal status.\n\nOsseous and Soft Tissue Structures: Ventral abdominal wall mesh appears\nunremarkable with no evidence of recurrent ventral wall hernia. No fluid\ncollection or mass identified the site of palpable abnormality as indicated by\nthe patient in the left upper anterior abdominal wall. Incidental perineural\n(___) cysts noted at the level of S2. T1 and T2 hypointense lesion within\nthe left sacral ala, likely a small bone island.", "output": "No evidence of recurrent ventral wall hernia. No focal abnormality in the\narea of palpable concern in the left anterior upper abdominal wall." }, { "input": "The lung bases are grossly clear.\n\nThe liver is mildly shrunken and nodular in contour in keeping with known\ncirrhosis. There is no evidence of hepatic steatosis. A geographic area\nmeasuring 1 cm in segment 8 (10, 44) demonstrates arterial enhancement but no\nevidence of washout and no T2 correlate consistent with a transient hepatic\nintensity difference. In segment 8 there is also confluent fibrosis denoted\nby restricted diffusion, There is cholelithiasis but no evidence of\ncholecystitis. No intra or extrahepatic biliary duct dilatation. The pancreas\nis normal. The spleen is normal. The adrenal glands are normal. There are T2\nhyperintense nonenhancing lesions in the kidneys bilaterally consistent with\ncyst. No hydronephrosis. No mesenteric or retroperitoneal lymphadenopathy. No\nascites.\n\nThe abdominal vasculature is patent.\n\nNo suspicious osseous lesions. There is evidence of gynecomastia\nbilaterally.", "output": "Cirrhosis. No suspicious hepatic lesions. The questioned area on recent\nultrasound in segment 8 likely corresponds to an area of confluent fibrosis. \nThe second questioned area corresponds to the caudate lobe.\n\nCholelithiasis.\n\nSimple renal cysts bilaterally." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. There is no hepatic\nsteatosis. There is no worrisome focal liver lesion. Specifically, no focal\nlesion is seen in segment II to correspond to the hypoechoic focus on the\nrecent right upper quadrant ultrasound. There is a tiny 3 mm cyst or biliary\nhamartomas segment 7 (2, 34). The hepatic arterial anatomy is conventional. \nThe portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is collapsed, which limits evaluation. There is no evidence of\ncholelithiasis.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation. There is a 3 mm T2 hyperintense\nfocus at the neck/body junction, compatible with a cystic lesion, most likely\na side branch IPMN. No other lesions are identified.\n\nSpleen: The spleen is normal in size. There are no focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There is no focal lesion,\nhydronephrosis, or perinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe soft tissues are unremarkable.", "output": "1. No worrisome focal liver lesion. Specifically, the small lesion in\nsegment II seen on ultrasound has no correlate on the MRI.\n2. Normal appearance of the liver without hepatic steatosis or morphologic\nsigns of cirrhosis.\n3. 3 mm cystic lesion in the pancreas, most likely a side branch IPMN. Per\ndepartmental policies, a follow-up MRCP is recommended in ___ year.\n\nRECOMMENDATION(S): MRCP in ___ year." }, { "input": "Lower Thorax: Unremarkable.\n\nLiver: A few subcentimeter T2 hyperintensities in the left and right lobes are\nlikely cysts or biliary hamartomas. The visualized liver is otherwise\nunremarkable.\n\nBiliary: There is cholelithiasis with no evidence of acute cholecystitis. \nThere is no evidence of biliary dilation. No choledocholithiasis seen on this\nnondedicated study.\n\nPancreas: Unremarkable.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The left upper pole renal cyst measures 7.8 x 6.5 x 7.3 cm,\npreviously 6.7 x 5.3 x 5.6 cm. It again contains a thin nonenhancing\nseptation. There are no solid nodular elements. There are scattered small\ncortical cysts elsewhere in both kidneys. There is no hydronephrosis or solid\nenhancing renal mass.\n\nGastrointestinal Tract: Visualized bowel is grossly unremarkable aside from\ncolonic diverticulosis. There is no ascites.\n\nLymph Nodes: No enlarged nodes are demonstrated.\n\nVasculature: Replaced left hepatic artery arising from the left gastric artery\nnoted. There is mild ectasia of the infrarenal aorta measuring up to 2.5 cm.\n\nOsseous and Soft Tissue Structures: Unremarkable.", "output": "Left renal cyst has benign features (Bosniak 2) and does not require further\nroutine follow-up." }, { "input": "Lower Thorax: Airspace disease in the bilateral lower lobes appears similar to\nthe previous CT scan dated ___.\n\nLiver: The liver is homogeneous in signal characteristics. The liver contours\nare smooth. No solid or cystic lesions. There is a trace amount of free\nfluid around the liver.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. There is medial insertion of the cystic duct remnant. \nThe gallbladder is not visualized.\n\nPancreas: There are at least four sub 5 mm lesions in the head and tail of the\npancreas (series 4, image 21 and 23; series 9b image 66 and 94) which in\nretrospect are unchanged compared to the previous exam. No nodularity or duct\ndilatation. The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions. There is an 11 mm accessory spleen.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained. There are no solid or\ncystic lesions. No hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. Four stable sub 5 mm pancreatic cystic lesions most likely represent\nside-branch intraductal papillary mucinous neoplasms. No concerning features\nfor malignancy. Follow-up MRI in ___ year is recommended.\n2. Trace free fluid around the liver." }, { "input": "Lower Thorax: Limited evaluation of the lungs shows upper lobe predominant \nlinear T2 hyperintensities in keeping with known sarcoidosis. Please refer to\nprior chest CT of ___. There is no pleural or pericardial\neffusion.\n\nLiver: No focal hepatic lesion is seen.\n\nBiliary: The gallbladder is surgically absent. There is no intra or\nextrahepatic biliary ductal dilatation. There is no choledocholithiasis .\n\nPancreas: The pancreas is normal in bulk. The main pancreatic duct is normal\ncaliber. There are unchanged 3 mm cystic lesions throughout the pancreas,\nlikely represent side-branch IPMNs.\n\nSpleen: Spleen is normal in size with no focal splenic lesion. An accessory\nspleen is again noted anteriorly.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size with no renal lesion seen. There is\nno hydronephrosis.\n\nGastrointestinal Tract: The visualized gastrointestinal tract is\nunremarkable.\n\nLymph Nodes: No enlarged upper abdominal or retroperitoneal lymph node is seen\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is seen.", "output": "1. Stable 3 mm cystic pancreatic lesions suggestive of side branch IPMNs.\n2. Partially visualized upper lobe predominant lung abnormalities in keeping\nwith known sarcoidosis. Please refer to prior chest CT.\n\nRECOMMENDATION(S): Follow-up MRCP in ___ years is recommended to assess\nstability of of the subcentimeter side-branch IPMNs." }, { "input": "There is a hypovascular right renal mass in the mid to lower pole of the right\nkidney measuring 1.3 cm in maximal dimension. The mass is unchanged in size\nfrom the prior imaging, and is isointense to the kidney on precontrast T1, and\nT2 weighted imaging. There is no associated signal drop on opposed phase\nimaging. Restricted diffusion is demonstrated.\n\n\n\n3 mm T1 hyperintense hemorrhagic cyst is demonstrated in the upper pole of the\nright kidney (series 9, image 16). Additional simple appearing cortical cysts\nare seen in both kidneys measuring up to 8 mm in the interpolar region of the\nleft kidney.\n\n\n\nThere is a 12 mm hemangioma in segment 6 of the liver. The spleen is normal\nsize measuring 10.3 cm. There is no intrahepatic biliary dilatation. The\ncommon bile duct measures 10 mm unchanged from the prior exam. There are no\ngallstones demonstrated. Gallbladder fundal adenomyomatosis is noted.\n\n\n\nThe pancreas demonstrates normal signal and bulk. There is a 6 mm cystic\nlesion in the pancreatic neck. The pancreatic duct is mildly prominent, with\na few minimally prominent side branch is noted. No ductal stricture is\ndemonstrated. The adrenal glands are unremarkable. The spleen is normal size\nmeasuring 10 cm. There is no adenopathy.\n\n\n\nThe visualized loops of small and large bowel are unremarkable. There is mild\nscoliosis of the lumbar spine convex to the left.", "output": "1. Hypovascular right renal mass the measuring 1.3 cm is stable in size from\nthe prior imaging. Differential considerations would include angiomyolipoma\nwith minimal fat, or oncocytic neoplasm. If clinically desired, the lesion\nwould be amenable to CT-guided biopsy. Alternatively ongoing imaging followup\n(in ___ months) is advised.\n2. 6 mm cystic lesion in the pancreatic neck likely representing side branch\nIPMN. Mildly prominent pancreatic duct/ductal side branches are demonstrated\nwithout ductal stricture." }, { "input": "Lower Thorax: There is linear subsegmental atelectasis of the left posterior\ncostophrenic angle.\n\nLiver: There is a 0.9 x 0.8 cm T2 hyperintense lesion in the inferior right\nhepatic lobe which demonstrates progressive enhancement (series 7, image 31\nand series 1701, image 82), compatible with a hemangioma. There is no\nevidence of hepatic steatosis.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There are two\nadjacent 5-6 mm cystic lesions in the pancreatic head (series 6, images\n___, likely representing sidebranch IPMNs and unchanged compared to the\nprior MRI from ___. There is no main pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. Again seen is a 1.0 x 1.0 cm minimally T2\nhyperintense, diffusion restricting, hypoenhancing mass in the interpolar\nregion of the right kidney stable compared to the prior MRI of the abdomen\nfrom ___, nonspecific and could represent a lipid poor AML or indolent\nrenal cell carcinoma. There is a 1.4 x 0.9 cm simple cyst in the interpolar\nregion of the left kidney. There is no hydronephrosis.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are nondilated.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is diffuse atherosclerosis of the abdominal aorta without\naneurysmal dilatation. There are single bilateral renal arteries. The\nbilateral renal veins are patent.\n\nOsseous and Soft Tissue Structures: There is mild lumbar levoscoliosis and\nmultilevel spinal degenerative changes. No suspicious osseous lesion is\nidentified.", "output": "1) 1.0 x 1.0 cm minimally T2 hyperintense, diffusion restricting,\nhypoenhancing mass in the interpolar region of the right kidney stable\ncompared to the prior MRI of the abdomen from ___, nonspecific and\ncould represent a lipid poor AML or indolent renal cell carcinoma.\n\n2) Two adjacent 5-6 mm cystic lesions in the pancreatic head, likely\nrepresenting sidebranch IPMNs, stable. Per departmental protocol, MRCP\nfollow-up in ___ years is recommended.\n\nRECOMMENDATION(S): MRCP follow-up of pancreatic cystic lesion in ___ years." }, { "input": "Lower Thorax: Unremarkable.\n\nLiver: Portion visualized of the liver is unremarkable. No focal lesion. No\nhepatic steatosis.\n\nBiliary: No biliary duct dilatation. The gallbladder is unremarkable.\n\nPancreas: The pancreas demonstrates normal enhancement with no focal lesion. \nNo main duct dilatation.\n\nSpleen: The spleen is normal in size and contains 8 mm T2 hyperintense at the\nupper pole.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The right kidney is unremarkable besides scattered subcentimeter\ncortical cysts. No hydronephrosis.\n\nAt the interpolar/upper pole and posterior aspect of the left kidney, there is\na 4.3 x 3.5 x 4 cm heterogeneous isointense T2 lesion demonstrating enhancing\ncomponents and restriction diffusion. The rest of kidney contains few\nsubcentimeter cortical cysts. No hydronephrosis. The renal vein is patent. \nOf note, there is cortical thinning of the inferior pole of left kidney.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No abdominal adenopathy.\n\nVasculature: Moderate atherosclerotic disease is noted. Again seen is a\nfusiform suprarenal abdominal aortic aneurysm measuring 4.9 cm and a saccular\ninfrarenal abdominal aorta aneurysm measuring 4.6 cm with mural thrombus. \nAgain seen is an ectatic celiac trunk measuring 14 mm likely due to a chronic\ncompression from an arcuate ligament.\n\nOsseous and Soft Tissue Structures: Unremarkable. There is an uncomplicated\nfat containing umbilical hernia with the neck measuring 2.1 cm.", "output": "1. 4.3 cm left interpolar/upper pole renal mass with MR characteristics\nfavoring a clear cell renal cell carcinoma. No venous extension or regional\nlymphadenopathy.\n2. No distant metastases or abdominal lymphadenopathy.\n3. Saccular infrarenal abdominal aortic aneurysm measuring up to 4.6 cm." }, { "input": "The study is limited due to motion artifacts as well as limited sequences.\n\nThere is small pleural effusion on the left. There is modeate quantity of\nascites.\n\nThe liver is cirrhotic with nodular border. Precontrast T1 hyperintense\ncontents are seen within the main, left and right portal veins (5:20), with no\nenhancement on post contrast images (08:16), consistent with portal vein\nthrombosis. Presence of calcifications within the main portal vein thrombus on\nprior CT is noted and consistent with chronic thrombosis. Diffuse\nheterogeneous enhancement of the hepatic parenchyma could be attributable to\nportal vascular obstruction (8:17), however, the examination is limited by\ntechnical factors and focal or infiltrative hepatic lesions cannot be\nexcluded. The hepatic veins are patent. Intrahepatic arterial flow is\npreserved. The hepatic arterial anatomy cannot be assessed with accuracy due\nto motion artifacts.\nThe gallbladder wall is edematous due to third spacing / ascites. There is no\nbiliary ductal dilatation.\nThe spleen is enlarged measuring 20 cm. Varices are demonstrated in the\nsplenic hilum and around the lower esophagus.\nThe pancreas is grossly normal.\nCortical renal cysts are demonstrated (03:28).\nT2 hyperitense bony lesions at T11 and L1 probably represent hemangiomas.", "output": "1. Cirrhosis with chronic main, right and left portal vein thrombosis, and\nsequelae of portal hypertension including ascites and splenomegaly.\n2. Diffuse heterogeneity of the liver parenchyma is probably perfusional in\nnature given portal thromosis, however focal or infiltrative liver lesions\ncannot be excluded. Although a multiphasic CT of the liver is preferred given\nmotion artifacts on this and prior MR examinations, at discussion with\nclinical team it is noted that CT cannot be performed due to renal failure. \nTherefore, repeat MR examination is planned.\n3. Moderate ascites and small left-sided pleural effusion." }, { "input": "Lower Thorax: The visualized lung bases and lower mediastinum are grossly\nunremarkable. No pleural or pericardial effusion.\n\nLiver: The liver is normal and homogeneous in signal intensity. A punctate,\nnonenhancing, T2 hyperintense lesion in segment V reflects a cyst or biliary\nhamartoma (04:32). No suspicious hepatic lesions.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. Incidental\nnote is made of an accessory right posterior bile duct inserting the low on\nthe common hepatic duct (8:5, 9:34). The gallbladder is normal.\n\nPancreas: The pancreas is normal and homogeneous in signal intensity and\nenhancement. No focal lesions or pancreatic ductal dilation.\n\nSpleen: The spleen is normal size and signal intensity without focal lesions.\n\nAdrenal Glands: The right and left adrenal glands are normal in size and\nshape.\n\nKidneys: The right and left kidneys are normal and symmetric in size and\nshape. A T1 hypointense, T2 hyperintense lesion measuring 1.1 x 0.9 cm\narising from the left lower pole reflects a simple cyst. A 2.2 x 2.2 cm T1\nhypointense, T2 hyperintense lesion arising from lower pole the right kidney\ndemonstrates thin internal septations without mural nodularity or appreciable\nenhancement\n\nGastrointestinal Tract: The stomach and visualized loops of large small bowel\nare grossly unremarkable.\n\nLymph Nodes: No visualized retroperitoneal or mesenteric lymphadenopathy. \nPeriportal and portocaval lymphadenopathy measures up to 1.5 and 1.6 cm (5:14,\n16).\n\nVasculature: No abdominal aortic aneurysm. Hepatic arterial anatomy is\nconventional. The hepatic veins are patent. Incidental note is made of an\naccessory right posterior hepatic vein. The hepatic portal, splenic, and\nsuperior mesenteric veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "1. 2.2 cm Bosniak ___ cyst arising from the lower pole of the right kidney. \nRecommend follow-up renal ultrasound as previously indicated in ___.\n2. No MR evidence of PSC. No concerning hepatic lesion. Enlarged porta\nhepatis nodes are likely reactive.\n\nRECOMMENDATION(S): Bosniak ___ cyst arising from the lower pole of the right\nkidney. Recommend follow-up renal ultrasound as previously indicated in ___." }, { "input": "Lower Thorax: Visualized lung bases are clear. No pleural or pericardial\neffusion.\n\nLiver: Liver contour is smooth with mild widening of the ___ space. No\nsuspicious hepatic lesions. There is an unchanged subcentimeter T2\nhyperintense, well-circumscribed nonenhancing lesion in hepatic segment V\n(___), consistent with a simple cyst or biliary hamartoma. No significant\nloss of signal on out of phase compared to in phase sequences to suggest\nhepatic steatosis.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. The\ngallbladder is unremarkable.\n\nPancreas: Normal in bulk and signal intensity without focal lesion. No\npancreatic ductal dilatation.\n\nSpleen: Mildly enlarged, measuring 13.8 cm in AP diameter. The spleen is\nnormal in signal intensity without focal lesion.\n\nAdrenal Glands: The right adrenal gland is unremarkable. The left adrenal\ngland is bulky without definite nodule.\n\nKidneys: The bilateral kidneys are normal in size with normal corticomedullary\ndifferentiation. Slight interval decrease in a T2 hyperintense 1.6 x 1.2 cm\nright lower pole cystic lesion with a single thin enhancing septation (___),\npreviously 2.2 x 2.0 cm. A focus of suspected nodularity likely represents\nthe confluence of septations. Unchanged 0.6 cm T2 hyperintense exophytic\nsimple cyst in the lower pole of the left kidney (___).\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are\nnondilated.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Aorta is normal caliber. Conventional hepatic arterial anatomy.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Compared to ___, mild interval decrease in a 1.6 x 1.2 cm right\nlower pole cystic renal lesion with a single thin enhancing septation, Bosniak\n2.\n2. No hepatic lesions meeting OPTN-5 criteria for HCC." }, { "input": "Lower Thorax: No pleural or pericardial effusion.\n\nLiver: Focal steatosis is noted adjacent to the falciform ligament. Posterior\nnotching is compatible with chronic liver disease. Several subcentimeter foci\nwith hyperintense signal on T2 weighted images measure up to 6 mm in the right\nhepatic lobe compatible with cysts. No concerning lesions identified.\n\nBiliary: The gallbladder is unremarkable. No intrahepatic or extrahepatic\nbiliary dilation.\n\nPancreas: Normal parenchymal signal without ductal dilation focal lesions.\n\nSpleen: Measures 13.5 cm in AP dimension, stable from prior. No focal\nlesions.\n\nAdrenal Glands: Normal size and shape bilaterally.\n\nKidneys: In the lower pole of the right kidney, a T2 hyperintense 1.5 x 1.5 x\n1.3 cm lesion with a thin enhancing septation (series 15, image 85-89; series\n3, image 42). No nodularity present. In the lower pole the left kidney, a 8\nmm a nonenhancing simple cyst is present. No hydronephrosis.\n\nGastrointestinal Tract: Unremarkable stomach. No obstruction or ascites.\n\nLymph Nodes: Porta hepatis lymph nodes measure up to 13 mm in short axis,\npossibly reactive in the setting of cirrhosis (series 12, image 47). A celiac\naxis lymph node measures 10 mm in short axis, also possibly reactive (series\n10, image 42).\n\nVasculature: Hepatic arterial anatomy is conventional. Celiac axis, SMA,\norigin of the ___, single bilateral renal arteries, portal vein, and SMV are\npatent.\n\nOsseous and Soft Tissue Structures: No concerning abnormalities.", "output": "1. Hepatic morphology suggestive of early cirrhosis. Prominent porta hepatis\nnodes are likely reactive. No OPTN-5 lesion.\n2. Stable right renal cyst with thin enhancing septations without focal\nnodularity (Bosniak 2)." }, { "input": "Lower Thorax: No pleural or pericardial effusion.\n\nLiver: Normal macroscopic hepatic morphology. No steatosis. No suspicious\nhepatic lesions. Subcentimeter hepatic cystic are unchanged compared to\nprior.\n\nBiliary: The CBD is dilated measuring 10 mm in diameter (this is increased\ncompared to prior MR done ___ when it measured 4 mm in diameter). \nThe central intrahepatic ducts are also prominent. The pancreatic duct is not\ndilated.\n\nPancreas: No focal pancreatic lesions.\n\nSpleen: Splenomegaly with the spleen measuring 14.5 cm in longest diameter. \nNo focal splenic lesions.\n\nAdrenal Glands: Unremarkable\n\nKidneys: Right renal lower pole cystic lesion is T1 isointense, T2\nhyperintense, well-circumscribed and measures 22 x 17 mm in the coronal plane\n(similar compared to prior MRI done ___ but slightly increased in\nsize compared to prior imaging done ___ when it measured 9 x 8 mm). \nIt demonstrates minimal intrinsic T1 hyperintensity suggesting episode of\nprior hemorrhage. The cystic lesion contains multiple hairline thin septae\nwith minimal perceived enhancement of this septa. No measurable enhancement. \nLeft renal lower pole cyst measuring 11 mm in diameter appear similar compared\nto prior imaging.\n\nGastrointestinal Tract: No features of bowel obstruction.\n\nLymph Nodes: Multiple enlarged lymph nodes measuring up to 16 mm in the porta\narea (series 3, image 28 and 31) as well as in relation to the gastrohepatic\nligament where it measures 12 mm in diameter (series 3, image 25).\n\nVasculature: The major vasculature is patent and without concerning finding.\n\nOsseous and Soft Tissue Structures: No suspicious bony lesions.", "output": "The CBD is dilated up to 10 mm, which is increased compared to prior MR done\n___ when it measured 4 mm in diameter. The central intrahepatic\nducts are also prominent. The pancreatic duct is not dilated. No gallstone\nor course identified for the biliary dilatation. Correlation with hepatic\nenzymes is advised and if increased, ERCP should be considered.\n\nNo focal suspicious hepatic lesions in a liver that does not be appear overtly\ncirrhotic. Splenomegaly is again noted. Upper abdominal lymph nodes are\nincreased in size as described above.\n\nCystic lesion in the lower aspect of the right kidney with minimal intrinsic\nhemorrhage, multiple hairline thin septa demonstrate perceivable enhancement\n(Bosniak ___ F) and appear similar compared to prior imaging dating back to ___, but slightly increased in size compared to imaging done ___." }, { "input": "Lower Thorax: The large left lung base mass undergone recent prior biopsy is\nre-demonstrated in the left lower lobe, better evaluated on recent prior CT.\n\nLiver: The liver is normal in signal intensity and morphology without focal\nlesion. The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nA small enhancing gallbladder polyp is noted at the fundus (15:37). The\ngallbladder is otherwise unremarkable.\n\nPancreas: The pancreas is normal in signal intensity and morphology without\nductal dilatation or focal lesion.\n\nSpleen: The spleen is mildly enlarged measuring 14.5 cm (03:21).\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Arising exophytically from the interpolar region of the left kidney,\nthere is a 1.6 x 1.9 x 2.0 cm T2 mildly hypointense and T1 mildly hypointense\nrenal lesion that demonstrates moderate heterogeneous postcontrast enhancement\nand marked restricted diffusivity (1201:58, 15:62). This lesion does not\ncontact the renal sinus fat and the renal vasculature is unremarkable. There\nis a single renal artery and a single renal vein bilaterally. No other\nsuspicious lesion is identified.\n\nGastrointestinal Tract: The visualized loops of large and small bowel are\nunremarkable.\n\nLymph Nodes: Prominent upper mesenteric lymph nodes are noted with the largest\nin the central abdomen measuring up to 1.7 cm in short axis (15:63).\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: Within the L2 vertebral body, there is an\nintrinsically T1 hyperintense enhancing lesion with extensive surrounding\nnonenhancing T1 hyperintensity suggestive of associated hemorrhage or\nproteinaceous material (15:96, 10:26). This was previously described as a\npossible hemangioma, but its full extent was not apparent on the CT images. \nno other suspicious lesions are identified.", "output": "There is a 2 cm exophytic enhancing left interpolar renal lesion for which the\ndifferential includes chromophobe renal cell carcinoma, oncocytoma, or\nmetastasis. Additional L2 lesion likely compatible with a metastasis.\n\nGiven the constellation of additional findings, including T1 hyperintense\nbrain lesions, multiple pulmonary lesions, multiple rounded soft tissue\nattenuation nodules in the subcutaneous fat seen on prior CT, an intrinsically\nT1 hyperintense enhancing osseous lesion, and intra-abdominal lymphadenopathy,\nfindings could represent metastatic melanoma, although the renal lesion itself\nis not intrinsically T1 hyperintense (not a typical appearance for melanoma\nmetastasis).\n\nA small chromophobe renal cell carcinoma is unlikely to account for the\nextensive metastatic disease seen elsewhere and could be a lesion in the\nsetting of a syndrome such as tuberous sclerosis. Further work-up will depend\nupon the results of the recently performed biopsy of the lung lesion." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are smooth. No solid\nor cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid lesions. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Mildly dilated left gonadal vein and left pelvic vessels. The\nvisualized abdominal aorta and proximal mesenteric vessels appear patent\nwithout any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions. Mild diastasis of the rectus\nabdominus musculature. No hernia, mass, or abnormal enhancement is seen\nwithin the umbilicus.\n\nTrace free fluid in the pelvis, likely physiologic. Partially visualized\npelvic organs are unremarkable.", "output": "1. No abnormality identified at the umbilicus.Specifically, no mass or\nabnormal enhancement. Mild diastasis of the rectus abdominus muscles is noted\nwithout hernia.\n\n2. Mildly enlarged left gonadal vein and left pelvic vessels, which can be\nseen in pelvic congestion syndrome but also can be a normal asymptomatic\nimaging finding. Clinical correlation is necessary." }, { "input": "Lower Thorax: There is no pericardial or pleural effusion. The lower thorax\nis within normal limits.\n\nLiver: The liver is nodular in contour with hypertrophy of the left hepatic\nlobe, compatible with cirrhosis. The background liver drops out on out of\nphase imaging compatible with diffuse hepatic steatosis.\n\n5.5 x 4.7 cm hepatocellular carcinoma in segment ___ is re- demonstrated, the\nmajority of which still demonstrates pronounced arterial hyperenhancement,\nintralesional fat, and washout on delayed imaging. This previously measured\n5.5 x 4.8 cm on the outside exam from ___.\n\nTwo sub cm peripheral nodules in the left hepatic lobe with hyperintensity on\ndiffusion-weighted imaging and T2 weighted sequences may have peripheral\narterial hyperenhancement with possible washout and pseudocapsule (11:04:46),\nnot clearly visualized on the previous MRI.\n\nNumerous arterially enhancing foci without T2 correlate and no washout are\nseen. The largest measures 1.9 x 1.2 cm in segment VIII and appears increased\nin conspicuity since the prior study. The majority of these most likely\nreflect transient hepatic intensity differences, however attention to this\nlarger area on follow-up examinations is recommended.\n\nTrace ascites is noted.\n\nBiliary: There is cholelithiasis without evidence of acute cholecystitis. \nThere is no intrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal. There is a 3 mm T2 hyperintense\nnonenhancing focus in the tail of the pancreas, compatible with side-branch\nIPMN, unchanged since the prior study.\n\nSpleen: The spleen is mildly enlarged measuring up to 13.3 cm. There is a\ntiny T2 hyperintense focus within the spleen which likely represents a small\ncyst.\n\nAdrenal Glands: There is a 1.5 cm left adrenal myelolipoma, unchanged. The\nright adrenal gland is normal in size and shape.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. There are nonenhancing T2 hyperintense foci\nwithin both kidneys, compatible with cysts.\n\nGastrointestinal Tract: The visualized small and large bowel are normal in\ncaliber and thickness.\n\nLymph Nodes: A mildly enlarged 1.2 cm porta hepatis lymph node is likely\nreactive.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is bilateral gynecomastia.The\nosseous structures and soft tissues are otherwise within normal limits.", "output": "1. Status post chemoembolization of the left lobe of the liver with 5.5 cm\nleft hepatic lobe HCC (OPTN 5X), the majority of which still demonstrates\narterial hyperenhancement and washout on delayed imaging.\n2. Two sub cm peripheral nodules in the left hepatic lobe, bright on T2\nweighted imaging and diffusion weighted sequences which may have peripheral\narterial hyper enhancement, possible washout and pseudocapsule formation, not\nclearly seen on the prior study. While these 2 lesions do not meet OPTN\ncriteria based on size, close attention to these areas on follow-up imaging is\nrecommended.\n3. Numerous arterially enhancing foci without T2 correlate and without washout\nmost likely represent transient hepatic intensity differences, however the\nlargest measuring 1.9 x 1.2 cm in segment VIII appears increased in\nconspicuity since the prior study and attention to this area on follow-up\nimaging is recommended.\n4. Cirrhosis with trace ascites and mild splenomegaly. Diffuse hepatic\nsteatosis.\n5. Cholelithiasis without evidence of acute cholecystitis.\n6. 3 mm T2 hyperintense nonenhancing focus in the tail of the pancreas is\ncompatible with side-branch IPMN, unchanged.\n7. 1.5 cm left adrenal myelolipoma, unchanged.\n\nRECOMMENDATION(S): Short interval follow-up MRI." }, { "input": "Lower Thorax: There is no pericardial or pleural effusion. The lower thorax\nis within normal limits.\n\nLiver: The liver is nodular in contour with hypertrophy of the left hepatic\nlobe, in keeping with cirrhosis. There is diffuse hepatic steatosis with\ncalculated fat fraction of 6%. There are innumerable T1 hyperintense,\nhypoenhancing nodules throughout the liver, compatible with regenerative\nnodules.\n\nAgain seen are post TACE changes (performed on ___ and ___ of a hepatocellular carcinoma in segment ___, now measuring 4.8 x 4.4\ncm, decreased in size and previously 5.2 x 5.2 cm. Internal arterial\nenhancement has overall decreased compared to the prior MRI from ___. However there are at least three foci of nodular arterial enhancement\nwithout washout that remain suspicious for residual tumor.\n\nThere is a 1.2 x 1.0 cm arterially enhancing lesion without washout or a\npseudocapsule at the border of segments V and VIII (series 1201, image 64),\nunchanged in size compared to the prior MRI from ___. There is\na 0.8 x 0.7 cm arterially enhancing lesion in the periphery of segment VIII\n(series 1201, image 58) without washout or a pseudocapsule, also unchanged. \nThere are other subcentimeter scattered lesions demonstrating low-grade\narterial enhancement and no washout. These lesions do not meet OPTN 5\ncriteria for ___, however attention on follow-up imaging is warranted.\n\nHepatic arterial anatomy is conventional. The portal and hepatic veins are\npatent.\n\nThere are small esophageal and perigastric varices.\n\nBiliary: The gallbladder is filled with T1 hyperintense sludge. There also a\nfew small stones. There is no intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. Again seen is\na 3-4 mm cystic focus in the tail of the pancreas, likely representing a\nside-branch IPMN, unchanged since the prior study.\n\nSpleen: The spleen is mildly enlarged measuring up to 13.9 cm and normal in\nsignal intensity. Note is made two small accessory spleens.\n\nAdrenal Glands: Again seen is a 2.1 x 1.4 cm lesion in the left adrenal gland\nwhich demonstrates a component of bulk fat and an enhancing solid nodule,\ncompatible with a myelolipoma. The right adrenal gland is normal in size and\nshape.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. There are a few tiny cortical cysts in both\nkidneys.\n\nGastrointestinal Tract: The stomach is unremarkable. Visualized upper\nabdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is moderate bilateral gynecomastia.\nThe osseous structures and soft tissues are otherwise within normal limits.", "output": "1. Cirrhotic liver with innumerable regenerative nodules and sequela of portal\nhypertension, including splenomegaly and small esophageal and perigastric\nvarices. Post TACE changes of a hepatocellular carcinoma in segment ___, now\nmeasuring 4.8 x 4.4 cm, decreased in size and overall internal arterial\nenhancement compared to the prior MRI from ___. However there\nare at least three foci of nodular arterial enhancement without washout that\nremain suspicious for residual tumor.\n2. 1.2 x 1.0 cm arterially enhancing lesion at the border of segments V and\nVIII and a 0.8 x 0.7 cm arterially enhancing lesion of the periphery of\nsegment VIII, without washout or a pseudocapsule, unchanged in size. Other\nsubcentimeter foci in the liver with low-grade arterial enhancement. These do\nnot meet OPTN 5 criteria for HCC, though attention on follow-up imaging is\nwarranted.\n3. Cholelithiasis.\n4. 3 mm cystic lesion in the tail of the pancreas, likely representing a\nside-branch IPMN, unchanged. This may be followed on surveillance imaging of\nthe liver.\n5. Unchanged 2.1 cm left adrenal myelolipoma." }, { "input": "Lower Thorax: Unchanged 1.0 cm nodule in the right lower lobe, characterized\non same-day CT as a calcified granuloma. Incidentally noted bilateral\ngynecomastia.\n\nLiver: Cirrhotic morphology and steatosis are again noted. Again seen are\ninnumerable T1 hyperintense, hypoenhancing nodules throughout the liver,\ncompatible with regenerative nodules.\n\nAgain seen are post TACE changes of a hepatocellular carcinoma in segment ___,\nnow measuring 4.4 x 3.8 cm (___), previously 4.8 x 4.4 cm. Again seen are\nthree foci of nodular arterial enhancement which are concerning for residual\ntumor. The largest measures 1.0 cm (___), stable.\n\nA 1.2 x 0.8 cm arterially enhancing lesion without washout or pseudo capsule\nin segment VI-VII on series 11, image 36 is unchanged. This is suspicious for\n___, although indeterminate.\n\nThere is a 1.2 cm arterially enhancing lesion without washout or pseudo\ncapsule in segment VIII on series ___, image 26, slightly more prominent on\ncurrent exam. Similar but smaller lesion is seen anteriorly on series 11,\nimage 26. These remain suspicious for ___ but indeterminate.\n\nThere are numerous subcentimeter lesions with low level arterial enhancement\nin the periphery of the liver which are nonspecific.\n\nBiliary: Gallbladder sludge. No biliary ductal dilatation.\n\nPancreas: Unchanged diminutive side-branch IPMN in the pancreatic tail (___).\nOtherwise, unremarkable with no main ductal dilatation.\n\nSpleen: Splenomegaly, measuring 14.2 cm. No splenic lesions.\n\nAdrenal Glands: Unchanged 1.2 cm left adrenal myelolipoma. Unremarkable right\nadrenal gland.\n\nKidneys: Unchanged few stable diminutive cortical and parapelvic cysts in both\nkidneys.\n\nGastrointestinal Tract: No ascites or bowel obstruction in the upper abdomen\nobstruction.\n\nLymph Nodes: No abdominal adenopathy.\n\nVasculature: Hepatic arterial anatomy is conventional. The portal and hepatic\nveins are patent. Again seen are upper abdominal portosystemic shunts,\nsequela of portal hypertension.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions.", "output": "Cirrhotic liver morphology, sequela of portal hypertension with treatment\ncavity redemonstrating residual tumor in segment ___. A few indeterminate\nlesions, one of which is slightly more prominent while others remain stable. \nThese lesions are suspicious for HCC although not meeting OPTN criteria.\n\nStable pancreatic cystic lesion, likely representing side-branch IPMNs,\namenable to follow-up on routine oncologic exams." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are notable for a stable\n0.7 cm right lower lobe pulmonary nodule, unchanged since ___ (6:6). \nNo pleural effusion.\n\nLiver: The liver is nodular and heterogeneous in contour with hypertrophy of\nthe left lateral segment and reticular enhancement consistent with cirrhosis\nand confluent hepatic fibrosis. No ascites.\n\nAgain seen are numerable T1 hyperintense hypoenhancing nodules throughout the\nliver, consistent with regenerative nodules.\n\nStatus post TACE and RFA of ___ in segment 4a with associated T1\nhyperintensity consistent with coagulation necrosis. Treatment cavity\nmeasures 5.3 x 3.2 cm (08:44). Peripheral to this cavity is an additional 1.7\nx 1.2 cm treatment bed (11:40). No nodular enhancement to suggest residual\ndisease.\n\nInterval increase in size of a 1.3 x 1.1 cm arterially hyperenhancing lesion\nwithout washout or pseudo capsule within segment 8 is indeterminate\n(previously 1.2 x 0.8 cm). (10:35).\n\nAn additional arterially enhancing lesion without washout or pseudo capsule\nwithin segment ___ measures 1.2 x 0.8 cm (previously 1.2 x 0.8 cm) which is\nindeterminate and unchanged since ___ (10:47).\n\nAdditional multiple subcentimeter arterially enhancing lesions within the\nperiphery of the liver do not definitely persist on delayed imaging and are\nmost consistent with transient hepatic intensity differences.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. Gallbladder\nsludge noted. No gallbladder wall thickening or dilatation.\n\nPancreas: A stable 0.3 cm T2 hyperintense pancreatic tail cystic lesion is\nunchanged since ___ (03:31). No new lesions. The pancreas is otherwise\nhomogeneous in signal intensity.\n\nSpleen: The spleen is homogeneous in signal intensity and mildly enlarged\nmeasuring 14.9 cm (previously 14.2 cm). No focal lesion.\n\nAdrenal Glands: Right adrenal gland is unremarkable. Stable 2.1 x 1.3 cm left\nadrenal myelolipoma.\n\nKidneys: Few stable cortical and parapelvic cysts noted. Kidneys are\notherwise homogeneous in signal intensity. No focal lesion. No\nhydronephrosis. No perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are otherwise unremarkable. No obstruction.\n\nLymph Nodes: No retroperitoneal, mesenteric, or periportal lymph node\nenlargement.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and proximal ___ are patent. Hepatic anatomy is conventional. \nHepatic veins, left portal vein, anterior and posterior right portal vein,\nmain portal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: Bilateral gynecomastia noted. Osseous\nstructures and soft tissues are otherwise unremarkable.", "output": "1. Increase in nonspecific 1.3 x 1.1 cm segment 8 arterially hyperenhancing\nlesion without washout or pseudo capsule does not meet OPTN 5 criteria for\nHCC, however remains suspicious. (Previously 1.2 x 0.8 cm)\n2. No change in nonspecific 1.2 cm segment ___ arterially hyperenhancing\nlesion without washout or pseudo capsule does not meet OPTN 5 criteria for\nHCC, however remains suspicious.\n3. Status post TACE and RFA of hepatic segment 4A with expected coagulation\nnecrosis. No residual or recurrent disease.\n4. Cirrhosis with confluent hepatic fibrosis, regenerative nodules, and mild\nsplenomegaly. Patent vasculature. No ascites.\n5. Stable 0.7 right lower lobe pulmonary, unchanged from ___\n6. Bilateral gynecomastia." }, { "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The liver has a cirrhotic, nodular morphology with extensive confluent\nfibrosis. Hepatic steatosis is again noted. There is a 5.6 x 3.9,\nheterogeneously T2 and T1 hyperintense lesion in segment 4A (series 9, image\n50) which is consistent with the prior TACE and RFA bed. A 1.8 cm adjacent\nhypovascular treatment bed in segment 3 (series 1101, image 60) is consistent\nwith prior RFA bed. No evidence of recurrence or untreated tumor.\n\nA 15 x 18 mm arterially hyperenhancing nodule with washout (series 1101, image\n41, 1102, image 41) in segment 8 is increased in size (previously 14 x 11 mm).\nd\n\nA 11 X 15 mm arterially rim hyperenhancing lesion in segment 6 (series 1101,\nimage 59@$) does not demonstrate definite washout and is unchanged in size.\n\nA 7 mm arterially enhancing lesion in segment 7 (series 1101, image 44)\npreviously measured 3 mm. The lesion does not demonstrate definite washout or\ndemonstrate definite correlate on diffusion.\n\nA 3 mm arterially enhancing lesion in segment 4A (1101, 42) is unchanged and\ndoes not have definite correlates on additional phases of imaging.\n\nA 3 mm arterially hyperenhancing lesion at the dome (series 1101, image 22)\ndoes not demonstrate definite washout and appears unchanged in size.\n\nA 2.0 cm arterially hyperenhancing lesion near the dome (series 1101, image\n32) does not demonstrate washout, but appears significantly increased in size\nfrom the prior examination.\n\nAdditional punctate foci of arterial hyperenhancement (series 1101, image 44,\n71, 58, 62) do not have definite correlates on additional phases of imaging.\n\nThere is new nonocclusive thrombus in the left portal vein (series 1102, image\n61), likely enhancing (series 1004, 66).\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is collapsed and contains a small stone.\n\nPancreas: The pancreas is normal in size and signal intensity. There is no\nmain pancreatic ductal dilatation.\n\nSpleen: The spleen contains a T2 hyperintense cyst. The signal intensity is\notherwise unremarkable and there is no splenomegaly.\n\nAdrenal Glands: There is a myelolipoma in the left adrenal gland. The right\nadrenal gland is unremarkable.\n\nKidneys: The left kidney contains cysts. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach and visualized loops of small large bowel\nare unremarkable.\n\nLymph Nodes: A peripancreatic lymph node measures up to 13 mm in short axis\n(series 1103, image 86), unchanged and possibly reactive. There is no\nadditional lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional.\n\nOsseous and Soft Tissue Structures: There is no osseous malignancy or\ninfection.", "output": "1. Unchanged appearance of the treatment beds without evidence of recurrence\nor untreated tumor.\n2. Interval enlargement of the dominant 1.5 cm arterial enhancing lesion in\nsegment 8 with apparent washout. The lesion meets OPTN 5A criteria.\n3. Additional arterially enhancing lesions, which do not demonstrate definite\nwashout or pseudocapsule are suspicious and attention on follow-up is\nrecommended.\n4. New nonocclusive left portal vein thrombus, there appears to be\nenhancement, suggesting that this represents intravascular tumor.\n5. Myelolipoma in the left adrenal gland.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 14:59 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: There is a nodular surface contour of the liver, consistent with\ncirrhosis. Numerous intrinsically T1 hyperintense nodules are seen throughout\nthe liver are suggestive of regenerative nodules. There is progressive\nreticular linear enhancement throughout the liver parenchyma consistent with\nconfluent background fibrosis.\n\n1. New from prior is confluent, T2 hyperintense heterogeneous and nodular\narterial hyperenhancement surrounding the segment IV treatment areas, with\nrestricted diffusion encompassing much of segments IV-A and IV-B (for example\nsee series ___, image 40, 59, 69, and 71), consistent with extensive\nconfluent recurrence surrounding the treatment area.\n\n2. Previously 18 mm arterially hyperenhancing nodule in segment VIII has\ngrown, now 25 mm, demonstrating washout and probable pseudocapsule ___\nand ___: 51).\n\n3. Previously 7 mm segment VII arterially hyperenhancing lesion is now 16 mm\n(1151:52), without definitive washout or pseudo capsule.\n\n4. A 16 mm focus of segment VII more linear high arterial hyperenhancement\n(1151:66) without washout or pseudocapsule is not appreciably changed from\nprior.\n\n5. The previously demonstrated 2- and 3 mm foci of arterial hyperenhancement\nin segments IV-A and near the liver dome are not well seen on today's study.\n\nPreviously demonstrated nonocclusive thrombus in the left portal vein is no\nlonger seen. The medial branch of the left portal vein remains occluded.\nPatent central aspects of the hepatic veins. Patent SMV and splenic vein.\n\nBiliary: There is no intra- or extrahepatic biliary ductal dilation. The\ngallbladder is decompressed and there are small gallstones seen in the lumen.\n\nPancreas: The pancreas demonstrates normal homogeneous signal intensity. \nThere is no main pancreatic ductal dilation.\n\nSpleen: There is mild splenomegaly. No concerning focal splenic lesion.\n\nAdrenal Glands: Left adrenal approximately 14 mm myelolipoma is unchanged. \nRight adrenal gland is normal.\n\nKidneys: There are subcentimeter bilateral renal cortical cysts without\nsuspicious features. The renal parenchyma otherwise demonstrates normal,\nsymmetric enhancement and signal bilaterally. No hydronephrosis.\n\nGastrointestinal Tract: Esophageal varices are noted. Gastrohepatic varices\nare additionally noted in the region of the gastric cardia. The stomach is\notherwise within normal limits. Imaged loops of small and large bowel are\ngrossly unremarkable. No ascites.\n\nLymph Nodes: A right anterior diaphragmatic lymph node previously seen\nmeasuring 6-7 mm is now 8-9 mm, slightly larger since prior (1502:50). There\nis no evidence of retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. Major proximal tributaries are patent. The IVC is\nnormal in caliber and patent. The hepatic veins are patent. Patent portal\nvein, SMV, and splenic vein.\n\nOsseous and Soft Tissue Structures: No suspicious foci of abnormal marrow\nsignal are seen.", "output": "1. Confluent recurrent HCC surrounding the segment IV treatment areas, new\nsince ___.\n2. Interval enlargement of segment VIII and VII lesions meeting OPTN 5B and\nOPTN 5G criteria for HCC.\n3. Arterially hyperenhancing focus in segment VII measuring 16 mm is more\nnodular and demonstrates washout, now meeting OPTN 5A criteria for HCC.\n4. Interval enlargement of a now 8-9 mm right diaphragmatic lymph node which\nis rounded and just anterior to the area of recurrent HCC in segment IV.\n5. Interval resolution of nonocclusive left portal vein thrombus. Unchanged\nocclusion of the medial branch of the portal vein in the segment IV treatment\narea.\n6. Small distal esophageal wall and gastrohepatic varices. Mild splenomegaly\nis unchanged. No ascites.\n7. Left adrenal myelolipoma, unchanged.\n8. Cholelithiasis. Other incidental findings, as above." }, { "input": "Lower thorax: A right lower lobe pulmonary nodule correlates with a calcified\ngranuloma seen on recent CT (8:3). The lung bases are otherwise grossly\nclear.\n\nLiver: The liver is nodular in contour, consistent with cirrhosis. \nSusceptibility artifact in the segment VIII treatment zone is due to a\nfractured metallic tip of the microwave ablation probe seen at the end\nCT-guided ablation in ___. There are numerous T1 hyperintense\nnonenhancing nodules throughout the liver suggestive of regenerative nodules. \nAgain seen is a Y-90 treatment cavity in segment IV with intrinsic T1\nhyperintensity. Confluent arterial enhancement surrounding the treatment\nstone in segment IV is similar to prior, without washout or pseudo capsule in\nthis region on delayed images. New microwave ablation treatment zones are\nseen in segments VI/VII and VIII which contain intrinsic T1 hyperintensity. \nThere is no definite internal arterial enhancement within the new ablation\ncavities to suggest residual or recurrent disease, with evaluation slightly\nlimited by metallic artifact in the segment VIII treatment zone. An\narterially enhancing lesion in segment 8 superior to the ablation cavity is\nincreased in size from prior, currently measuring 14 mm, compared with 10 mm\npreviously, without definite washout or pseudo capsule on additional sequences\n(100:25). There is moderate ascites, increased from prior.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is collapsed and contains gallstones. Mild gallbladder wall edema\nis likely secondary to third spacing.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is mildly enlarged, measuring 15 cm, stable.\n\nAdrenals: A left adrenal myelolipoma is unchanged. The right adrenal gland is\nnormal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis. There are a few T2 hyperintense nonenhancing\nlesions in the kidneys consistent with simple cysts.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. There are\nesophageal and gastrohepatic varices, similar to prior.\n\nLymph nodes: 8 mm right diaphragmatic lymph node is similar to prior (14:28). \nThere is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.", "output": "1. Status post interval microwave ablation of multiple lesions in segments\nVIII and VI/VII, with no evidence residual or recurrent disease in the\ntreatment zones, with evaluation of the segment VIII cavity slightly limited\ndue to artifact from a retained fragment of the metallic ablation probe.\n2. No significant change in confluent enhancement surrounding a segment IV\ntreatment zone without associated washout or pseudo capsule, possibly\nrepresenting post treatment change versus recurrent disease. Continued\nattention on follow-up is recommended.\n3. Interval slight increase in size of a 14 mm arterially enhancing lesion in\nsegment VIII without definite washout or pseudo capsule on delayed sequences. \nThis lesion does not currently meet OPTN criteria for ___, however attention\non follow-up is recommended.\n4. Cirrhosis with splenomegaly and moderate ascites.\n5. Cholelithiasis." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: The liver demonstrates cirrhotic morphology. Innumerable scattered\ncircumscribed T1 hyperintensities are again demonstrated, probably\nrepresenting regenerative nodules, similar to prior studies.\nWithin hepatic segment ___ at the location of the most recently ablated HCC,\nthere is a cavitary lesion measuring up to 6.7 cm, associated with a central\narea of susceptibility artifact which is likely representing the previous\nreported fractured probe tip, not significant changed from prior. Surrounding\nthe artifact within the cavity there are intrinsic irregular areas of T1\nintense signal. No internal enhancement is demonstrated. Additional cavitary\nlesions sequela of prior ablations are again demonstrated involving hepatic\nsegments 4, 6, 7, appear stable. Surrounding the cavitations are areas of\nheterogenous enhancement without definite evidence of masslike lesions. No\nnew suspicious hepatic lesion.\n\nBiliary: Gallstones are again noted. There is no biliary ductal dilatation.\n\nPancreas: The pancreas is unremarkable without ductal dilatation.\n\nSpleen: The spleen measures up to 14.7 cm. The spleen is without focal\nlesion.\n\nAdrenal Glands: The adrenal glands are normal.\n\nKidneys: Bilateral renal cysts are unchanged. There is no hydronephrosis.\nThere is no suspicious renal lesion.\n\nGastrointestinal Tract: No focal abnormality.\n\nLymph Nodes: A right diaphragmatic lymph node measuring up to 8 mm is largely\nunchanged (1101:44). No lymphadenopathy in the upper abdomen by imaging\ncriteria.\n\nVasculature: The portal and hepatic veins are patent. Esophageal and\ngastrohepatic varices are again noted.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "Cirrhotic liver with sequela of portal hypertension, numerous regenerating\nnodules, and 3 post-treatment cavitary lesions without evidence of internal\nenhancement, largely unchanged. No new lesions meeting OPTN 5 criteria." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Cirrhotic morphology is re-demonstrated with extensive T1 hyperintense\nregenerative nodules. Patient has undergone the following interventions:\n\n-TACE of segment ___ hepatocellular carcinoma on ___, and ___\n-RFA of segment ___ IVb on ___.\n-Selective Y-90 ablation of segment 4 tumor thrombus supplied by the middle\nhepatic artery dated ___.\n-Microwave ablation of segment VIII on ___ with a fractured tip of\nthe microwave ablation probe remaining in situ causing susceptibility\nartifact.\n-Microwave ablation of segment VII on ___.\n-Microwave ablation of segment VI/VII on ___.\nThere is intrinsic T1 hyperintensity within the ablation cavities consistent\nwith coagulation necrosis. There is no residual enhancement to suggest\nlocally recurrent disease. There is diffuse persistent hyperenhancement\nsurrounding the segment 4 area of prior chemoembolization with progressive\nkinetics suggesting areas of confluent fibrosis with linear filling defects\nconsistent with treated tumor thrombus with no residual enhancement. There is\nsmall to moderate ascites.\n\nWithin segment VIII superior to the ablation cavity, there is a 3.4 cm focus\nof faint arterial hyperenhancement with washout on the delayed phases\n(1201:43, 1204:15).\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is unremarkable.\n\nPancreas: The pancreas is normal in signal intensity and morphology without\nfocal lesion or ductal dilatation.\n\nSpleen: The spleen is enlarged measuring 15.9 cm. An accessory spleen is\nnoted.\n\nAdrenal Glands: A left adrenal myelolipoma is unchanged. The right adrenal\ngland is unremarkable.\n\nKidneys: There is no suspicious renal lesion or hydronephrosis.\n\nGastrointestinal Tract: Visualized loops of large and small bowel are\nunremarkable.\n\nLymph Nodes: Mildly enlarged porta hepatis lymph nodes are likely related to\nunderlying liver dysfunction. A diaphragmatic lymph node measuring up to 10\nmm in short axis is similar to prior studies (1201:44).\n\nVasculature: Esophageal, paraesophageal, and gastric varices are noted.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Cirrhotic liver with innumerable regenerative nodules, small to moderate\nascites, moderate splenomegaly, and numerous varices.\n2. Status post multiple interventions for hepatocellular carcinoma as\ndescribed above without evidence of local recurrence.\n3. 3.4 cm area of faint arterial hyperenhancement with washout within segment\nVIII superior to the ablation cavity that meets OPTN 5B criteria but may\nrepresent a regenerative nodule surrounded by fibrotic liver parenchyma." }, { "input": "The heart is mildly enlarged. Mild atelectasis at each lung base.\n\nEvaluation of the liver for focal lesions is truly limited in this case by\nmotion artifact and reduced signal to noise ratio associated with body\nhabitus, particularly in the central part of the abdomen. In the dome of the\nright lobe (3:11), there is a very small focus of hyperintensity on\nT2-weighted imaging, and hypointense on T1-weighted imaging without clear\nenhancement suggesting a small cyst or potentially a late filling hemangioma;\nalthough not optimally characterized hepatocellular lesion is doubtful. \nMorphology of the liver is consistent with cirrhosis. There is no biliary\ndilatation. Gallbladder appears normal. Pancreas is unremarkable. Spleen is\nmild-to-moderately enlarged measuring up to 16.1 cm in length. Adrenals and\nkidneys appear within normal limits.\n\nThere are numerous collateral pathways associated with portal hypertension. \nAlthough not optimally to depicted the main portal vein and its major branches\nappear patent though diminutive which is often seen with hepatic few pole\nflow. Umbilical vein is patent. Paraesophageal varices are very large. \nMucosal esophageal varices are also likely. Omental and retroperitoneal\ncollaterals are moderately extensive including medium-sized splenorenal\nshunts.\n\nStomach and visualized bowel are unremarkable. No visible lymphadenopathy. \nModerate to large quantity of ascites.\n\nBone marrow signal intensities are unremarkable.", "output": "Very limited examination. Very small lesion in the hepatic dome that is\nprobably not significant clinically, although not optimally characterized. It\nis not whether this may represent the lesion of concern on outside CT, which\nis not available. Direct correlation of these images the prior study is\nrecommended, if feasible.\n\nBecause of the limitations of MR in this case, multiphasic contrast-enhanced\nCT protocol may be more helpful for evaluation of any potential focal liver\nlesions and for anatomic evaluation prior to transplant if needed clinically." }, { "input": "Image quality is markedly degraded by motion artifact, particularly limiting\nevaluation for subtle findings.\n\nLower Thorax: Included lower thorax shows no gross abnormality.\n\nLiver: The liver appears shrunken with nodular contours, consistent with\ncirrhotic morphology. There is no loss of signal between in and out of phase\nimaging. A 6 mm T2 hyperintense focus at the hepatic dome (7:12) relates to a\ntiny simple cyst versus biliary hamartoma. Ill-defined 1 cm region of\nperipheral hyperenhancement with mild restricted washout and in equivocal\nwashout (1104; 43 and 8; 6) was not clearly seen on the previously severely\nmotion degraded study.\n\nThere is trace ascites. Extensive perisplenic, periesophageal and\ngastrohepatic varices are present.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. There is\ncholelithiasis without evidence of acute cholecystitis.\n\nPancreas: Pancreas shows diffusely decreased parenchymal signal without\nevidence of a worrisome focal lesion or main pancreatic ductal dilatation.\n\nSpleen: The spleen is enlarged, measuring up to 16 cm. No focal splenic\nlesion is identified.\n\nAdrenal Glands: Normal size and signal.\n\nKidneys: The kidneys are normal in size and position without evidence of\nhydronephrosis or a worrisome solid lesion.\n\nGastrointestinal Tract: No gross abnormality of the small or large bowel is\nidentified.\n\nLymph Nodes: No abdominal lymphadenopathy is appreciated.\n\nVasculature: The abdominal aorta shows normal caliber. A replaced right\nhepatic artery arising from the superior mesenteric artery is identified,\nbetter appreciated on prior MRI of ___. The portal and hepatic\nveins are patent. The superior mesenteric and splenic veins are also patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. Bone marrow signal is within normal limits.", "output": "1. Similar to the prior study, study is degraded by motion artifact limiting\nsensitivity for subtle lesions. Recommend future evaluation with a multiphase\nCT\n2. Cirrhotic liver morphology with sequela of portal hypertension including\nvarices and splenomegaly. No lesion meeting OPTN 5 criteria for HCC. \nIndeterminate segment 2 lesion. Attention on follow-up.\n3. Cholelithiasis.\n4. Probable replaced right hepatic artery arising from SMA." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: The liver is markedly heterogeneous with nodular contour consistent\nwith cirrhosis. There is extensive reticular progressive enhancement\nthroughout the liver consistent with fibrosis. No hepatic mass demonstrated,\nspecifically no lesions meeting criteria for HCC.\n\nBiliary: The gallbladder is minimally distended. No biliary ductal\ndilatation.\n\nPancreas: Unremarkable. No mass or pancreatic ductal dilatation.\n\nSpleen: The spleen measures 14.3 cm. Otherwise unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The kidneys are unremarkable except for scattered stable small simple\ncysts throughout the kidneys.\n\nGastrointestinal Tract: No bowel obstruction. No ascites.\n\nLymph Nodes: There is a heterogeneously enhancing gastrohepatic lymph\nmeasuring 2.3 cm (series 1302, image 56). The enhancement pattern is\nheterogeneous, concerning for pathologic adenopathy. When compared to ___, this node is unchanged in size. There are additional prominent\nretroperitoneal lymph nodes. For example, there is a precaval node measuring\n1.5 cm, previously 1.5 cm (series 1302, image 74).\n\nVasculature: Again seen is a replaced left hepatic artery arising from the\nleft gastric artery. There are innumerable portosystemic shunts including\nparaesophageal varices and a splenorenal shunt, as on prior.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesions.", "output": "1. Cirrhotic liver with extensive fibrosis and redemonstration of sequela of\nportal hypertension. No HCC.\n2. Heterogeneous enlarged gastrohepatic lymph node measuring 2.3 cm. \nAlthough this is stable compared to prior, it is concerning for pathologic\nlymph node enlargement. This could be reassessed for additional change on\nroutine examinations, given stability from prior, or further evaluated with\ntissue sampling." }, { "input": "Lower Thorax: Visualized lower lungs are clear. There is no pleural effusion.\n\nLiver:\nThere is re-demonstration of morphologic changes of cirrhosis. There is once\nagain delayed reticular enhancement throughout the liver parenchyma in keeping\nwith confluent fibrosis. There is mild geographic drop of signal on the out\nof phase sequence is consistent with mild hepatic steatosis.\n\nThere is no suspicious arterially enhancing lesion in the liver.\n\nBiliary: Gallbladder is unremarkable. There is no intra or extrahepatic\nbiliary duct dilatation.\n\nPancreas: The pancreas is normal in size, morphology and signal intensity. No\nfocal pancreatic lesion seen.\n\nSpleen: Spleen is enlarged measuring 14 cm in craniocaudal length. There is\nnormal signal intensity of the spleen with no focal lesion.\n\nAdrenal Glands: Adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal in size and demonstrate normal\ncorticomedullary differentiation. Focal area of scarring is again noted in\nthe posterior interpolar cortex of the left kidney. There is no\nhydronephrosis.\n\nGastrointestinal Tract: Visualized small and large bowel loops are\nunremarkable.\n\nThere is no ascites.\n\nLymph Nodes: Re-demonstration of an enlarged round gastrohepatic node\nmeasuring 2.5 cm, previously 2.3 cm. Portacaval node (series 5, image 25)\nmeasures 11 mm, previously 8 mm.\n\nVasculature:\nNormal caliber of the abdominal aorta. Note is again made of a replaced left\nhepatic artery arising from the left gastric as an anatomic variant.\n\nThere is re-demonstration of multiple enlarged portosystemic collateral veins\nincluding gastroesophageal and splenorenal varices. There is a small\nnonocclusive peripheral filling defect within the portal confluence and\nproximal portal vein similar to the prior study from ___ which likely\nrepresents an adherent thrombus. Branches of the portal vein are patent. The\nSMV and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesion identified. \nSoft tissues are unremarkable.", "output": "1. Cirrhotic morphology with confluent fibrosis, splenomegaly and sequela\nportal hypertension.\n2. No arterially enhancing lesion meeting OPTN criteria for HCC.\n3. Enlarging 2.5 cm gastrohepatic ligament node remains suspicious for a\npathologic lymph node. EUS guided biopsy is recommended.\n4. Stable nonocclusive adherent thrombus at the portal confluence and proximal\nportal vein." }, { "input": "Lower Thorax: The visualized lungs are grossly clear. No pericardial or\npleural effusion.\n\nLiver: The liver is shrunken and nodular with widened fissures, consistent\nwith known cirrhosis. There has been interval decrease in size of the liver\nsince the MRI in ___. Delayed reticular enhancement throughout the\nliver parenchyma is again seen, though less apparent than prior study, in\nkeeping with confluent fibrosis. There is no definite arterially enhancing\nfocal liver lesion. No significant stenosis or evidence of iron deposition.\n\nBiliary: The gallbladder is unremarkable. No intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: The pancreas is normal in size, morphology, and signal intensity. \nNo focal pancreatic lesion.\n\nSpleen: The enlarged spleen is grossly unchanged in size, and 13.8 cm in\ncraniocaudal length, previously 14 cm. A 1.0 cm focus within the mid spleen\nexhibits increased T2 signal (3:22, 2:23) compared to the surrounding\nparenchyma as well as early and delayed uniform enhancement, possibly splenic\npeliosis.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and shape. No\nfocal masses.\n\nKidneys: The kidneys are normal and symmetric in size. There is normal and\nsymmetric corticomedullary differentiation. Focal scarring is again noted in\nthe posterior interpolar cortex of the left kidney. No hydronephrosis.\n\nGastrointestinal Tract: No obvious esophageal lesion seen. Small to moderate\nvolume ascites, predominantly collected within the right pericolic gutter, has\nincreased compared to prior. Visualized loops of small and large bowel in\ncaliber.\n\nLymph Nodes: Gastrohepatic nodal tissue has decreased in size (in retrospect\nmay have represented a conglomerate of nodes rather than a single node),\npreviously measuring 3.1 x 2.1 cm, now measuring 2.1 x 1.2 cm (03:16). \nApparent tiny nodes surrounding this region are decreased in size as well. \nThe previously referenced portacaval node has also decreased in size,\npreviously measuring 1.1 cm, now measuring 0.6 cm (03:23).\n\nVasculature: Small nonocclusive peripheral filling defect within the proximal\nportal vein and portal confluence is unchanged and similar to the prior study.\n\nDominant accessory left hepatic artery is again seen. Multiple enlarged\nportosystemic collateral veins, including gastroesophageal and splenorenal\nvarices are grossly similar.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions. The soft\ntissues are unremarkable.", "output": "1. Cirrhosis with interval decrease in size of liver. Stable portal\nhypertensive sequelae. No arterially enhancing lesion meeting OPTN criteria\nfor HCC or suspicious focal liver lesions otherwise.\n2. Interval decrease in size of gastrohepatic and portacaval lymphadenopathy.\n3. Stable non-occlusive adherent thrombus in the portal confluence and\nproximal portal vein." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, bilateral lung bases\ngrossly clear. Trace right pleural effusion is noted.\n\nLiver: The liver is nodular in contour compatible with cirrhosis. There is no\nhepatic steatosis. No suspicious liver lesions are seen. There is large\nvolume ascites.\n\nBiliary: There is no evidence of intra or extrahepatic biliary dilation. The\ngallbladder is within normal limits, having a thin wall and no discrete\ngallstones.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nductal dilation. No focal pancreatic lesions are seen.\n\nSpleen: The spleen is enlarged measuring 14.6 cm. There are 2 mildly T2\nhyperintense lesions in the spleen measuring up to 1.0 cm (03:30) which\nenhance on delayed postcontrast imaging.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral kidneys demonstrate normal signal intensity. No suspicious\nrenal lesions are noted. No hydronephrosis. There is no perinephric\nabnormality.\n\nGI: The stomach and intra-abdominal loops of small and large bowel are within\nnormal limits.\n\nLymph nodes: Previously seen prominent gastrohepatic lymph node measuring up\nto 1.1 cm (17:32) is likely reactive in the setting of cirrhosis. No abnormal\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. The major visualized branches of the aorta are patent. \nMultiple perisplenic and gastric varices are noted compatible with portal\nhypertension.\n\nOsseous and Soft Tissue Structures: No bone marrow signal abnormalities\ndetected. No suspicious osseous or soft tissue lesions detected.", "output": "1. Cirrhotic liver without suspicious focal liver lesions. Enlarged\ngastrohepatic lymph node, likely reactive in the setting of cirrhosis. No\nabnormal lymphadenopathy.\n2. Splenomegaly, extensive varices, large volume ascites compatible with\nsequela of portal hypertension." }, { "input": "Lower Thorax: There is a small right pleural effusion.\n\nLiver: There is no hepatic steatosis. There are numerous small arterially\nenhancing foci scattered throughout the partially imaged liver, which\nnormalize on the more delayed phases and demonstrate no T2 correlate, the\nlargest measuring 1.1 cm in segment VI (series 14, image 59), compatible with\nperfusion anomalies.\n\nBiliary: The gallbladder is incompletely imaged. There is no intra- or\nextrahepatic biliary ductal dilatation where visualized.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation. There is dual drainage\nversus pancreas divisum.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are within normal limits.\n\nKidneys: Again seen is a large, heterogeneously enhancing mass with areas of\nnecrosis arising from the lower pole of the right kidney, measuring 10.0 x 8.8\nx 11.4 cm, unchanged in size compared to CTA of the abdomen/pelvis from ___, previously 10.9 x 8.0 x 10.8 cm. There is tumor thrombus in the right\nrenal vein extending to the junction with the IVC, but not into the IVC. \nThere is edema of the surrounding retroperitoneal fat. There are\nretroperitoneal collateral vessels.\n\nThere are multiple small peripelvic cysts in the interpolar region and lower\npole of the left kidney. There is no hydronephrosis.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is retroperitoneal lymphadenopathy, for example, a 2.3 x\n1.9 cm retrocaval lymph node (series 9, image 3), a 1.7 x 1.4 cm left\npara-aortic lymph node (series 9, image 4), and a 3.4 x 2.1 aortocaval lymph\nnode at the bifurcation (series 9, image 13), which demonstrate central\nnecrosis, compatible with metastatic lymphadenopathy. Right retroperitoneal\nlymph nodes exert mild mass effect on the IVC.\n\nVasculature: The bilateral renal arteries are normal in caliber and patent. \nThere is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. A\n1.8 cm T2 hyperintense, enhancing lesion within the L4 vertebral body is\ncompatible with a hemangioma.", "output": "10.0 x 0.8 x 11.4 cm heterogeneous mass arising from the lower pole the right\nkidney, compatible with renal cell carcinoma, likely clear cell subtype,\nunchanged in size compared to CTA of the abdomen/pelvis from ___. \nTumor thrombus within the right renal vein extending to the junction of the\nIVC, but not definitively into the IVC. Metastatic retroperitoneal\nlymphadenopathy. Findings are compatible with T3a N1 disease." }, { "input": "Lower Thorax: Partially visualized lung bases are unremarkable. No pleural or\npericardial effusions.\n\nLiver: The liver again demonstrates cirrhotic morphology. Few peripheral\nsmall foci of arterial hyperenhancement are again demonstrated without\ncorrelates on subsequent phases, compatible with transient hepatic intensity\ndifferences. No concerning lesions are identified.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. A few\nsmall gallstones are seen in the gallbladder, without evidence of\ncholecystitis. Focal fundal adenomyomatosis is again noted.\n\nPancreas: The pancreas appears diffusely atrophic, with extensive\ncalcifications better seen on prior CT from ___. The main pancreatic\nduct remains diffusely dilated and irregular, measuring up to 10 mm. A small\namount of debris is seen in the pancreatic duct in the region of the\npancreatic head (4:24). Mild periductal hyperemia is seen surrounding the\nduct in the pancreatic head, a nonspecific finding which may be related to\ninflammation and should be followed on subsequent follow-up imaging. A\ndominant calcification is again seen in the pancreatic head, slightly\ndecreased in size compared to the prior study, with ectatic surrounding side\nbranches.\n\nSpleen: The spleen demonstrates normal size and signal intensity, without\nfocal lesion.\n\nAdrenal Glands: Unchanged mild thickening of the left adrenal gland. The\nright adrenal gland is unremarkable.\n\nKidneys: The kidneys demonstrate symmetric size and enhancement. No\nconcerning lesions identified. No hydronephrosis.\n\nGastrointestinal Tract: Partially visualized loops of small and large bowel\nare unremarkable. No evidence of bowel obstruction.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: The abdominal aorta demonstrates normal size and caliber. \nThere's a replaced right hepatic artery arising from the SMA.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions identified. \nThe soft tissues are unremarkable.", "output": "1. Findings consistent with sequela of chronic pancreatitis, including\nextensive calcifications and persistent irregularity and dilatation of the\nmain pancreatic duct measuring up to 10 mm.\n2. Small amount of debris within the pancreatic duct in the region of the\npancreatic head, with mild surrounding periductal hyperemia, a nonspecific\nfinding which may be related to inflammation. Continued attention on\nsubsequent follow-up imaging is recommended.\n3. Cirrhotic liver without evidence of concerning hepatic lesions identified.\n4. Cholelithiasis without evidence of acute cholecystitis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: There is marked signal drop off in T1 out of phase compared to T1 in\nphase with a fat fraction of up to 26 % consistent with severe hepatic\nsteatosis. There is no evidence of fibrosis within the liver. And caudate\nlobe is borderline enlarged. The liver contour is nonnodular. There is not\nrecanalization of the paraumbilical vein. Note is made of a subcentimeter\nhypervascular focus seen on arterial phase which fades in the delayed phase\nwith no washout, that demonstrates a hypoenhancing halo in the portal venous\nphase (14:33). This lesions measures approximately 1.2 cm and likely\ncorresponds to the lesion seen on prior ultrasound. No correlate on T2\nweighted imaging or diffusion-weighted image is seen. There are scattered T2\nhyperintense non enhancing lesions in the liver measuring up to 9 mm in\nsegment ___ consistent with cysts or bile duct hamartomas.\n\nBiliary: There is no intra or extrahepatic biliary duct dilatation.\n\nPancreas: The pancreas is normal in bulk with no focal pancreatic lesion seen.\nThe main pancreatic duct is normal in caliber.\n\nSpleen: Spleen is normal in size with no focal splenic lesion.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size with no hydronephrosis. There is\ncortical thinning in the upper pole of the left kidney along with cortical\nscarring from prior procedure. A small caliceal diverticulum is noted in the\nleft kidney.\n\nGastrointestinal Tract: There is diffuse diverticulosis throughout the colon.\n\nLymph Nodes: No upper abdominal or retroperitoneal lymphadenopathy seen.\n\nVasculature: No evidence of abdominal aorta aneurysm. There is a replaced \ncommon hepatic artery.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is seen.", "output": "1. Severe diffuse hepatic steatosis. No definite evidence of fibrosis or\ncirrhosis, however these cannot be completely excluded by MRI.\n2. Previously seen hypoechoic lesion on abdominal ultrasound corresponds to a\nnon-specific enhancing lesion. As this was seen on ultrasound, a follow-up\nultrasound is recommended in 6 months.\n\nRECOMMENDATION(S): Follow-up ultrasound in 6 months." }, { "input": "Lower Thorax: There are no pleural effusions.\n\nLiver: There is diffuse, heterogeneous drop in signal intensity on opposed\nphase imaging, with a fat fraction of 23%, compatible with moderate steatosis\nwith areas of focal sparing. The contour of the liver is normal. There are\nfew scattered T2 hyperintense liver lesions, measuring up to 9 mm in segment\n5, likely representing either cysts or biliary hamartomas. Stable appearance\nof a 7 mm arterially hyperenhancing focus in segment 4A of the liver (10:35),\nwhich appears to fade and is less conspicuous on the more delayed sequences. \nThere is no T2 correlate, and this focus of enhancement does not demonstrate\ndiffusion restriction. No new liver lesions identified.\n\nBiliary: There is no intra or extrahepatic biliary duct dilatation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas is normal in signal intensity and morphology. The\npancreatic duct is not dilated. No focal pancreatic lesions identified.\n\nSpleen: The spleen is not enlarged.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There are multiple foci of scarring at the interpolar region of the\nleft kidney, with postsurgical changes in the overlying soft tissues and\nmultiple foci of susceptibility artifact. No focal renal mass identified. \nThere is no hydronephrosis.\n\nGastrointestinal Tract: There is uncomplicated colonic diverticulosis. \nOtherwise, the visualized bowel loops in the upper abdomen are unremarkable,\nwithout evidence of obstruction.\n\nLymph Nodes: Few prominent porta hepatis lymph nodes, likely reactive. No\nsize significant lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. The portal and hepatic\nveins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions. Mild grade 1\nL4 on L5 anterolisthesis. Small fat containing umbilical hernia and left\nflank incisional hernia. Incidental 5.2 cm subcutaneous lipoma in the right\nmid back region.", "output": "1. Stable 7 mm arterially hyperenhancing focus in segment 4A of the liver\nwhich remains nonspecific, with FNH or adenoma in the differential diagnosis.\n2. There are few scattered subcentimeter T2 hyperintense foci in the liver,\nlikely representing either cysts or biliary hamartomas.\n3. Diffuse hepatic steatosis, moderate, with areas of focal sparing.\n4. Stable postsurgical changes in the left kidney.\n\nRECOMMENDATION(S): Follow-up MR in ___ months with hepatobiliary contrast\nagent recommended." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: Severe steatosis is demonstrated (Fat fraction >20%). Linear areas of\nfatty sparing are noted, could represent fibrosis. However, no overt\nmorphologic signs of cirrhosis are present. Hepatic cysts, the largest within\nhepatic segment 5 in the inferior border of the right lobe measuring up to 1.1\ncm, are again noted (02:26).\nAn ill-defined arterially enhancing focus without definite washout measuring\nup to 8 mm is seen in hepatic segment 4A (11:30), largely unchanged from prior\nstudy.\nThere is no worrisome lesion meeting OPTN 5 criteria.\n\nBiliary: The gallbladder is unremarkable. There is no biliary ductal\ndilatation.\n\nPancreas: The pancreas is unremarkable. There is no ductal dilatation.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: Adrenal glands are normal.\n\nKidneys: Postoperative changes consistent with partial left nephrectomy are\nagain noted. Bilateral millimetric renal cysts are seen, largely unchanged. \nThere is no hydronephrosis. There is no suspicious renal lesion.\n\nGastrointestinal Tract: There is no ascites, signs of obstruction, or abnormal\nfocal enhancement.\n\nLymph Nodes: No lymphadenopathy are seen in the imaged upper abdomen.\n\nVasculature: The portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: Anterolisthesis of L4 on L5 is noted. No\nsuspicious osseous lesion. No focal abnormality.", "output": "Severe hepatic steatosis with re-demonstration of an arterially enhancing\nperfusional difference in segment 4A measuring up to 8 mm, not significantly\nchanged from prior study. No follow-up necessary for this lesion." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: The liver is not cirrhotic and there is no hepatic steatosis. At the\njunction of segment ___, there is a lobulated 4.1 x 6.2 cm lesion\ndemonstrating T2 hyper signal as well as peripheral progressive nodular\ncontrast enhancement. These features are suggestive of a hemangioma.\n\nBiliary: No intra or extra biliary duct dilatation. The gallbladder is\nunremarkable.\n\nPancreas: The pancreas is normal in signal and bulk. No main duct dilatation.\nNo focal pancreatic lesion.\n\nSpleen: The spleen is normal in size and is homogeneous.\n\nAdrenal Glands: Unremarkable. No focal lesion.\n\nKidneys: The kidneys are unremarkable. No hydronephrosis. No focal lesion.\n\nGastrointestinal Tract: No bowel obstruction. No ascites.\n\nLymph Nodes: There is a 11 x 25 mm left iliac adenopathy (series 2, image 18).\n\nVasculature: No abdominal aortic aneurysm. Left renal vein is retroaortic.\n\nOsseous and Soft Tissue Structures: No concerning bone lesions. The adnexal\nregion is partially covered on this exam. However, there is a T2 bright\ndensity in the pelvis measuring 6.5 x 2.9 cm likely originating from the left\nadnexa. This is to be further characterized by pelvic ultrasound or pelvic\nMRI.", "output": "1. The liver lesion correspond to a simple hemangioma.\n2. Left external iliac lymphadenopathy measuring 11 x 25 mm.\n3. T2 bright left adnexal lesion to be further characterized by either pelvic\nultrasound or pelvic MRI." }, { "input": "Previously described suspicious lesion in the posterior medial interpolar\nregion of the left kidney is without definite enhancement and has decreased in\nsize currently measuring 6 x 7 mm, previously 12 x 9 mm. There is unchanged T1\nhyperintense in the superior aspect of the left upper pole (11:24).\n\nThere is an unchanged T1 hyperintense, T2 hypointense lesion in the anterior\ninterpolar region (10:20, 11:13) consistent with hemorrhagic cyst with\nunchanged adjacent T1 hyperintense focus. There is no new renal lesion. \nThere is no suspicious right renal lesion.\n\nAreas of susceptibility artifact in the posterior right renal fossa are\nsecondary to clips seen on prior CT examination. The adrenal glands are\nunremarkable.\n\nThe hepatic parenchyma has normal signal intensity and enhancement without\nevidence of suspicious mass. There is an unchanged hepatic cyst in the\ninferior aspect of segment VI measuring 8 x 9 mm. There is no intrahepatic or\nextrahepatic biliary dilatation. There is no evidence of cholelithiasis or\ncholecystitis.\n\nPancreas has normal signal intensity. There is no evidence of pancreatic mass\nor pancreatic ductal dilatation. There are no enlarged lymph nodes in the\nupper abdomen. Visualized upper abdominal bowel loops are unremarkable. There\nare atherosclerotic changes of the distal abdominal aorta.", "output": "Decrease in size of left interpolar renal lesion previously described by\nimaging characteristics as papillary subtype renal cell carcinoma. No new\nrenal lesions." }, { "input": "The liver is homogeneous in signal intensity. Again seen is an 8 x 12 mm\ncyst/biliary hamartoma in segment 6. There is no intrahepatic biliary duct\ndilation. The gallbladder is normal in appearance. The spleen is homogeneous\nand normal in size. The pancreas is normal in signal intensity, without focal\nmass or ductal dilation. The adrenal glands are unremarkable.\n\nThe kidneys are symmetric and normal in size, without hydronephrosis. Again\nseen are bilateral well-defined lesions with intrinsic T1 hyperintensity and\nT2 hypointensity, consistent with proteinaceous or hemorrhagic cysts. The mass\nin the posterior medial interpolar region of the left kidney is increased in\nsize, now measuring 13 x 19 mm in coronal plane (15:40, previously 9 x 9 mm). \nThere is again no definite enhancement. T2 internal components are increased.\n\nThe visualized bowel loops are normal in caliber, without wall thickening or\nevidence of obstruction. Retroperitoneal lymph nodes remain enlarged, but with\nnormal morphology, measuring up to 1.7 cm. No concerning osseous lesion is\nidentified.", "output": "1. Interval increased size and complexity of a left renal mass in the\nposterior medial interpolar region, although without overt enhancement. This\nis presumed to be neoplastic given its growth.\n\n2. Retroperitoneal lymphadenopathy, similar in appearance to ___." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology and signal intensity. Again\nseen is a 7 mm T2 hyperintense, T1 hypointense, non-enhancing lesion in\nsegment VI of the liver, consistent with a hepatic cyst or biliary hamartoma\n(6:31). No suspicious focal liver lesion identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. There is a\ntiny gallstone (6:17). There is no gallbladder wall thickening or\npericholecystic fluid.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is normal in size, measuring 12 mm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without\nhydronephrosis. Patient is status post partial right nephrectomy, with\nsusceptibility artifact seen in areas of perinephric surgical clips, and\ndecreased perinephric fat on the right compared with left. There has been\ninterval increase in atrophy in the left kidney compared with prior,\nconsistent with history of CyberKnife.\nAgain seen are bilateral subcentimeter T2 hypointense, T1 hyperintense,\nnonenhancing lesions, consistent with hemorrhagic or proteinaceous cysts\n(7:13, 21). There is a tiny simple cyst in the left kidney (7:19). A\npreviously seen mass in the posterior interpolar region of the left kidney is\ndecreased in size compared ___, measuring 1.1 x 0.9 cm, compared\nwith 1.9 x 1.2 cm, however is similar in size to MRI on ___\n(16:35, 6:22, 7:21). There is a small rim of enhancement, however there is no\ninternal nodularity or internal enhancement. There are no new concerning\nrenal lesions.\n\nBowel: There are colonic diverticula. Partially imaged loops of bowel are\notherwise unremarkable.\n\nVasculature: Abdominal aorta is normal in caliber, with atherosclerotic\ndisease similar to prior. The major branch vessels are patent. The portal\nvein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There are degenerative changes in the visualized spine. \nThere is no abnormal marrow signal or focal suspicious osseous lesion. No\nfree fluid.", "output": "1. A left interpolar biopsy-proven papillary renal cell carcinoma is decreased\nin size compared with MRI on ___, and is similar in size to MRI on ___, with no concerning enhancement or internal nodularity,\nsuggesting the previous increase in size of the mass on MRI on ___\nwas possibly secondary to it bleeding, now resolved.\n2. No new concerning renal lesions.\n3. Cholelithiasis, with no evidence of acute cholecystitis.\n4. Colonic diverticulosis." }, { "input": "Lower Thorax: Limited evaluation of the lower thorax is notable for left lower\nlobe atelectasis. No pleural effusion.\n\nLiver: 0.8 cm T2 hyperintense segment 6 hepatic cyst or biliary hamartoma is\nstable. The liver is otherwise homogeneous in signal intensity without focal\nlesion. No hepatic steatosis on out of phase imaging. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. \nCholelithiasis is noted. No gallbladder wall thickening\n\nPancreas: The pancreas is normal in signal intensity without focal lesion. No\npancreatic duct dilatation. No peripancreatic fat stranding.\n\nSpleen: The spleen is homogeneous in signal intensity and normal in size\nmeasuring 11.7 cm.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: Patient is status post partial right nephrectomy with susceptibility\nartifact and areas of perinephric surgical clips and associated cortical\natrophy consistent with history of CyberKnife. The kidneys otherwise enhance\nsymmetrically without hydronephrosis. Again seen are bilateral subcentimeter\nT2 hypointense, T1 hyperintense, nonenhancing lesions consistent with\nhemorrhagic or proteinaceous cysts. Additional 0.4 cm T2 hyperintense\nnonenhancing right lower pole cyst is noted (05:26).\n\nNo interval change in T2 hypointense peripherally enhancing lesion in the\nposterior interpolar region of the left kidney which measures 0.7 x 0.7 cm\n(previously 0.7 x 0.6 cm) (05:19). No new concerning renal lesions. No\nhydronephrosis. No perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small bowel are\nunremarkable. There is descending colonic diverticulosis without evidence of\nacute diverticulitis. No obstruction.\n\nLymph Nodes: No retroperitoneal, mesenteric, or periportal lymph node\nenlargement.\n\nVasculature: Atherosclerotic calcifications are noted. No abdominal aortic\naneurysm. Celiac axis, SMA, ___, bilateral renal arteries are patent.\n\nOsseous and Soft Tissue Structures: Osseous structures and soft tissues are\nunremarkable.", "output": "1. No interval change in biopsy proven papillary renal cell carcinoma within\nthe left interpolar region since ___. No concerning enhancement or\nnodularity.\n2. No new worrisome lesions.\n3. Status post partial right nephrectomy with associated postsurgical\nchanges.\n4. Cholelithiasis without evidence of acute cholecystitis.\n5. Diverticulosis without evidence of acute diverticulitis." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver capsule is smooth. Hepatic parenchyma is homogeneous. No\nhepatic steatosis. Subcentimeter cyst within the inferior liver.\n\nBiliary: No intra or extrahepatic biliary dilatation. Gallbladder is\nunremarkable in appearance.\n\nPancreas: There is a 11 mm cystic lesion within the pancreatic head (series 6,\nimage 2), unchanged compared to prior, likely representing a side branch IPMN.\nNo other focal lesions. No ductal dilatation. No peripancreatic stranding.\n\nSpleen: Spleen is not enlarged. No focal splenic lesions.\n\nAdrenal Glands: Adrenal glands are normal in size and shape bilaterally.\n\nKidneys: Patient is status post partial right nephrectomy with postsurgical\nchanges at the right upper pole with scarring, but no evidence of local\nrecurrence. Patient is status post CyberKnife of a biopsy-proven papillary\nRCC within the interpolar region of the left kidney. There is progressive\ncortical scarring within the interpolar region of the left kidney (series 18,\nimage 38), but no measurable or enhancing components. No new enhancing\nlesions are seen within the kidneys bilaterally. There are multiple\nsubcentimeter cysts within the kidneys bilaterally, some of which appear\nproteinaceous. No hydronephrosis. No perinephric abnormality.\n\nGastrointestinal Tract: Partially imaged stomach and small bowel are\nunremarkable in appearance. Note is made of descending colonic\ndiverticulosis.\n\nLymph Nodes: No upper mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Major abdominal branches are\npatent. Note is made of moderate atherosclerosis. There are single renal\narteries bilaterally.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. \nSurrounding soft tissues are unremarkable in appearance.", "output": "1. Status post partial right nephrectomy and CyberKnife of a biopsy proven\npapillary RCC within the interpolar region of the left kidney which now has\nthe appearance of scar. No evidence of residual or recurrent RCC. No\nevidence of metastatic disease within the abdomen.\n2. Unchanged 11 mm simple-appearing cystic lesion within the pancreatic head,\nlikely a side branch IPMN.\n3. Other incidental findings include moderate atherosclerosis and\ndiverticulosis." }, { "input": "MR ANGIOGRAM: The abdominal aorta, celiac artery, SMA, ___, and iliac arteries\nare patent without evidence of stenosis, aneurysm, or dissection. Hepatic\narterial anatomy is conventional. A circum-aortic left renal vein is noted.\n\nABDOMEN: The liver is unremarkable without evidence of focal lesion. Hepatic\nand portal vasculature is patent. There is a 9 mm cyst in the spleen,\nunchanged as compared to CT abdomen and pelvis ___. The pancreas is\ngrossly unremarkable without evidence of a lesion or pancreatic ductal\ndilatation. There are simple cortical cysts in the left kidney. Otherwise,\nthe bilateral kidneys are unremarkable. There is no mesenteric or pelvic\nlymphadenopathy.\n\nOSSEOUS STRUCTURES AND SOFT TISSUES. Multilevel degenerative changes of the\nlumbar spine are better assessed on same day MRI lumbar spine.", "output": "1. Abdominal vasculature is patent without evidence of stenosis, aneurysm, or\ndissection.\n2. Multilevel of degenerative changes of lumbar spine are better assessed on\nsame day MRI lumbar spine." }, { "input": "Lower Thorax: Visualized lung bases and cardiomediastinal structures are\nnormal.\n\nLiver: Normal in size. Liver demonstrates diffuse heterogeneity of enhancement\nduring the arterial phase which normalizes on later phases.\n\nThere are at least 2 hemangiomas in the liver. One is an 9 mm lobulated\nstructure within hepatic segment 6 (6:26) which shows imaging characteristics\nof a flash filling hemangioma with AP surrounding shunting. The second\nhemangioma is a 1.1 cm lobulated structure (06:19) at the junction of hepatic\nsegments 6 and 7. This lesion also shows imaging characteristics of a\nhemangioma with high signal on T2 weighted images, arterial phase enhancement\nwith contrast retention on the delayed phases.\n\nThere is a 6 mm somewhat lobulated T2 hyperintense lesion in hepatic segment 7\n(06:13) which likely represents a sclerosed hemangioma. There are also a few\nadditional punctate scattered foci of high signal on T2 weighted images\nwithout enhancement consistent with cysts versus biliary hamartomas.\n\nMild diffuse hepatic steatosis on the dual-echo GRE images.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nis normal. No gallstone.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.\n\nSpleen: Splenomegaly. No mass. Focus of accessory splenic tissue noted at\nthe splenic hilum\n\nAdrenal Glands: Right adrenal gland is normal in size, signal, and\nenhancement. Left adrenal gland shows a 1.0 cm adenoma which loses signal on\nthe out of phase dual echo GRE images indicating internal lipid.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement. No solid\nmass.\n\nGastrointestinal Tract: No evidence of obstruction. No mass. Normal\nenhancement.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Normal branching pattern of the\nceliac axis. Origin of the superior mesenteric artery and inferior mesenteric\nartery are patent. Portal veins and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal.\n\nLeft ovary (seen only on the coronal HASTE images) has a 2.4 x 2.7 cm complex\nappearing cystic structure which is presumably follicular activity. Pelvic\nultrasound in 6 weeks is recommended to ensure resolution.", "output": "1. Lipid rich left adrenal adenoma measures up to 1.0 cm\n\n2. Liver demonstrates hepatic steatosis and diffuse heterogeneity of\nenhancement during the arterial phase along with splenomegaly. These findings\nmay represent steatohepatitis.\n\n3. The left ovary demonstrates a 2.4 x 2.7 cm complex appearing cystic\nstructure which is presumably follicular activity. However, pelvic ultrasound\nis recommended in 6 weeks to ensure resolution.\n\n The impression and recommendation above was entered by Dr. ___\n___ on ___ at 16:31 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider.\n\n\nRECOMMENDATION(S): Pelvic ultrasound is recommended in 6 weeks to ensure\nresolution of the left ovarian complex-appearing cystic structure which is\nlikely normal follicular activity." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Geographic foci of arterial hyper enhancement at the hepatic dome\n(axial series 1201, image 24) as well as involving segments 2 (axial series\n1201, image 43) and 4 (axial series 1201, image 51) without correlate on more\ndelayed phases or T2/diffusion-weighted imaging are likely perfusional,\ncorresponding to the lesions seen on recent CT. No suspicious hepatic lesions\nare identified.\n\nBiliary: The gallbladder is only partially distended but appears otherwise\nunremarkable. No intra or extrahepatic biliary ductal dilatation.\n\nPancreas: Normal T1 signal of the pancreatic parenchyma. No pancreatic ductal\ndilatation or mass\n\nSpleen: The spleen is normal in size.\n\nAdrenal Glands: The adrenal glands are normal in size and morphology.\n\nKidneys: Subcentimeter cyst within the lower pole of the right kidney. No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. No small or large bowel\ndistention.\n\nLymph Nodes: No retroperitoneal or mesenteric adenopathy.\n\nVasculature: No abdominal aortic aneurysm. Hepatic arterial anatomy is\nconventional. The hepatic and portal venous systems are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "Arterially hyperenhancing lesions seen on prior CT scan of the thorax are\nlikely perfusional. No suspicious liver lesion is identified." }, { "input": "Correlating with the lesion of concern on the recent CT, there is in fact a\nsolid mass seen along the medial aspect of the superior pole of the left\nkidney. This has ___ of 2 x 2 x 2 cm with just greater than 50% of the\nlesion extending exophytically towards midline (03:22). The lesion is T2\nhyperintense with some internal heterogeneity. It is T1 hypointense with\npunctate foci of high-intensity. No definitive intralesional fat or\nsusceptibility artifact is identified. Definitive enhancement is noted\nheterogeneously throughout the lesion. The lesion has increased in size from\nprior CTs including ___ (1.6 cm) and ___ (not apparent). \nAppearance is highly suggestive of renal cell carcinoma, of cystic clear cell\nsubtype.\n\nAn additional tiny enhancing lesion is also noted at the inferior pole of the\nleft kidney. This has diameter of only 6 mm (18:40). This structure is\nminimally hyperintense to renal parenchyma on T2 weighted imaging, hypointense\non T1 weighted imaging and avidly enhancing. This likely represents a small\nclear cell renal cell carcinoma.\n\nSubtle thickening of the superior pole calyceal wall at the superior pole of\nthe right kidney. There is some associated differential enhancement within\nthe adjacent parenchyma (13:21). However, this is thought to be artifactual\ngiven lack of asymmetry to the contralateral side and change in configuration\nfrom ___.\n\nAdditionally, there are numerous cysts throughout bilateral kidneys. Several\ndemonstrate internal hemorrhagic proteinaceous content, denoted by T1\nhyperintense signal prior to administration of gadolinium (09:18). Several of\nthe larger simple cysts at have thin the patient has been no nodularity or a\nregularity.\n\nThere are 2 renal arteries bilaterally. Atherosclerotic plaque results in\nsignificant narrowing at the origin of the accessory left renal artery\n(13:37).\n\nNo lymphadenopathy is identified.\n\nA right adrenal lesion is again identified. This has diameter of 1.5 x 2.4\ncm, with central susceptibility artifact (6b:40) and only peripheral\nenhancement. Prior CT demonstrated course calcifications within this lesion. \nAppearance is compatible either with an old adrenal hematoma or treated\nmetastasis.\n\nThe liver is notable for a tiny hemangioma within segment VII, T2\nhyperintense, T1 hypointense and enhancing similar to blood pool on all post\ncontrast sequencers. This has diameter of 6mm (3:9). No concerning liver\nlesion is identified.\n\nThe pancreas, spleen and left adrenal are normal in appearance.\n\nDiffuse atherosclerotic plaque is noted throughout the abdominal aorta. \nFusiform aneurysmal change of the infrarenal aorta is noted with total\ndiameter of 3.4 cm and patent lumen of 1.2 cm (13:40). There is also\nextensive irregularity and narrowing of the proximal 4 cm of the left common\niliac artery, focally within the mid right common iliac artery and proximal\nexternal iliac artery. Multiple foci of high grade stenoses are noted\nthroughout these regions.\n\nA fat containing hemangioma is noted within the T11 vertebral body. No\nconcerning osseous lesion is noted.\n\nThere is a small right pleural effusion with associated pleural enhancement,\nsimilar to prior.", "output": "Two solid exophytic left renal masses, measuring 2 cm at the medial superior\npole and 6 mm at the posterior inferior pole. Each has features highly\nsuggestive of clear cell renal cell carcinoma.\n\nNo evidence of metastatic disease.\n\nRight adrenal calcified lesion consistent with old hematoma or treated\nmetastasis.\n\nExtensive atherosclerotic disease, including multifocal high grade stenoses of\nbilateral pelvic arteries." }, { "input": "Lower Thorax: Lung bases clear. No pleural or pericardial effusion.\n\nLiver: There is diffuse loss of signal on in phase imaging within the liver\nand spleen, consistent with hemosiderosis, with accompanying diffuse low T2\nsignal of the background hepatic and splenic parenchyma. There are a few tiny\nT2 hyperintense foci within the liver, representing cysts versus biliary\nhamartomas.\n\nBiliary: No intrahepatic biliary ductal dilatation. The CBD measures up to 7\nmm, which is within normal parameters for patient's age. Unremarkable\nappearance of the gallbladder. Tiny gallstone within the gallbladder fundus.\n\nPancreas: Normal pancreas. No pancreatic ductal dilatation. The pancreatic\ntail is elongated and extends towards the splenorenal fossa.\n\nSpleen: Diffuse decreased T2 signal of the spleen. There is a 2.1 cm cyst in\nthe inferior pole.\n\nAdrenal Glands: Mild thickening of the right anterior limb as well as the left\nlateral adrenal limb, likely hyperplastic. No focal mass.\n\nKidneys: There are multiple renal lesions bilaterally that are most consistent\nwith cysts with varying degrees of hemorrhagic or proteinaceous contents,\nalthough not fully characterized on this noncontrast examination.\n\nBilaterally, scattered round well circumscribed lesions of fluid signal\nintensity on T2WI and hypointense to renal cortex on noncontrast T1WI, are\nmost compatible with simple cysts. A likely cyst with similar internal fluid\nsignal intensity is located in the right mid kidney measuring up to 1.6 cm,\nand contains a thin septum but no nodularity or mural irregularity.\n\nWithin the right kidney, there is a lobulated lesion or cluster of lesions in\nthe interpolar region measuring 1.3 x 1.0 cm overall,with marked increased\nsignal intensity on T1WI, compatible with hemorrhagic/ proteinaceous cysts.\n\nBilaterally, several additional lesions are seen which are mildly hyperintense\nto renal parenchyma on T1WI and which are of intermediate signal intensity on\nT2WI. No fat content is appreciated within these lesions. These include a 2.2\nx 2.6 x 2.1 cm lesion arising from the right renal upper pole, and a 1.0 x 1.1\nx 1.5 cm lesion in the lower pole of the left kidney.\n\nAdditional subcentimeter T2 and T1 hypointense foci with susceptibility effect\non in phase, longer echo time images of gradient echo pair, are are seen in\nsubcapsular location bilaterally compatible with siderotic content in cysts,\nsome of which are collapsed. There is no evidence of hydronephrosis on either\nside.\n\nGastrointestinal Tract: The imaged alimentary tract is within normal limits.\n\nLymph Nodes: No intra-abdominal or retroperitoneal lymphadenopathy.\n\nVasculature: No evidence of abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: Levoscoliosis within the thoracolumbar\nspine. There are T2 hyperintense lesions within the T11 and L1 vertebral\nbodies compatible with hemangiomas. Mild increased T1 and T2 signal\nappreciated in the right sacral ala favored to represent patchy heterogeneous\nbone marrow signal.", "output": "1. Multiple bilateral renal cysts, and additional lesions with MR features\nwhich strongly favor cysts with hemorrhagic/ proteinaceous content, though not\nfully characterized at noncontrast imaging. Dominant lesions include 2.6 cm\nlesion in the right upper renal pole as well as 1.5 cm lesion in left lower\nrenal pole . These lesions can be followed up with sonography for\nsurveillance.\n2. Findings consistent with hepatic and splenic hemosiderosis.\n\nRECOMMENDATION(S): Sonographic follow-up(suggest in 6 months) recommended for\nthe bilateral renal lesions." }, { "input": "Again redemonstrated in comparison to ultrasound examination from\n___, is a homogeneously hypointense on T1-weighted sequences,\nhomogeneously hyperintense on T2-weighted sequences, well-circumscribed cyst\nlocated within the left renal interpole. This cyst measures approximately 2.0\nx 1.9 cm in the CC and transverse ___ and has a single thin septation\nwith characteristics compatible with a Bosniak type II cyst. There is no\nnodular enhancement. Located within the upper pole of the left kidney, there\nis a hyperintense subcentimeter lesion on T1-weighted images, with\ncharacteristics compatible with a hemorrhagic cyst. Scattered throughout both\nkidneys are multiple subcentimeter homogeneously hyperintense on T2-weighted\nsequences, well- circumscribed lesions with features compatible with simple\nrenal cysts.\n\nWithin segment II/III of the liver is a subcentimeter simple hepatic cyst. No\nconcerning focal liver lesions are identified. There is no intra- or extra-\nhepatic biliary dilatation. The main portal vein and its major branches are\npatent. The gallbladder, spleen, pancreas, right adrenal gland, and\nvisualized loops of intra-abdominal small and large bowel are normal. No\nintra-abdominal free fluid is present. No mesenteric or retroperitoneal\nlymphadenopathy is present.\n\nIncidentally noted is a sub-5-mm lesion that demonstrates drop-out of signal\nintensity on out-of-phase images which either represents a benign adrenal\nmyelolipoma or adenoma.\n\nBone marrow signal is homogeneous throughout with no suspicious osseous\nlesions identified.\n\nMultiplanar 2D and 3D reformations were essential in demonstrating and further\ncharacterizing the left renal cystic lesion.", "output": "1. 2.0-cm cyst with thin internal septation located within the left\ninterpole, compatible with a Bosniak type II cyst for which no further\nfollowup is warranted.\n\n2. No suspicious focal liver lesions identified." }, { "input": "Lower Thorax: Unremarkable.\n\nLiver: The liver is unremarkable with no evidence of focal lesion. There is\nno significant steatosis.\n\nBiliary: A 3 mm T2 hypointense mural focus in the gallbladder neck is likely a\npolyp. The gallbladder is otherwise unremarkable. There is no biliary\ndilation.\n\nPancreas: There are multiple small cystic lesions scattered throughout the\npancreas. The largest individual lesion measures 8 mm in the body (4:9). \nThere is diffuse atrophy of the pancreatic tail with multi-cystic replacement\nin a region measuring 5.5 x 2.1 cm (04:13), which appears to be related to\nmain duct and side branch dilation. There is no evidence of enhancing mass\ndownstream to indicate obstructive lesion.\n\nSpleen: Normal in size and enhancement.\n\nAdrenal Glands: Unremarkable.\n\nKidneys:\n\nThe previously identified complex cystic right lower pole renal lesion\nmeasures 3.8 x 3.8 by 3.3 cm, increased in size from 2.0 x 1.7 x 2.0 cm on\nprior ultrasound. There has been development of solid enhancing components\nwhich now comprise at least 50% of the lesion. There is no gross\nextracapsular extension.\n\nThere is a 2.2 cm cortical cyst in the lower aspect of the right kidney, and\nthere are several tiny subcentimeter cysts in the left kidney.\n\nGastrointestinal Tract: Visualized bowel is grossly unremarkable.\n\nLymph Nodes: No enlarged lymph nodes are demonstrated.\n\nVasculature: No abdominal aortic aneurysm. There are single renal arteries\nbilaterally. The right renal vein shows normal enhancement.\n\nOsseous and Soft Tissue Structures: No worrisome lesions.", "output": "1. Significant enlargement of the complex cystic right renal mass, which now\ncontains solid enhancing components, consistent with renal cell carcinoma,\nlikely of the clear cell type. Urology referral suggested.\n2. Multi-cystic appearance of the pancreatic tail with parenchymal atrophy\ncould be related to combined duct IPMN. No discrete obstructing mass lesion\nidentified, however better evaluation by endoscopic ultrasound recommended and\nreferral for endoscopic ultrasound suggested for further workup.\n\nRECOMMENDATION(S): As above.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:35 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The partially visualized liver is normal in signal intensity and\nmorphology. There is no suspicious lesion. The portal and hepatic veins are\npatent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe visualized gallbladder is normal.\n\nPancreas: Normal in signal intensity without ductal dilatation. There is\nredemonstration of multiple T2 hyperintense cystic lesions scattered\nthroughout the pancreas, the largest in the pancreatic body measuring 8 mm,\nunchanged from prior study (5:7). The pancreatic tail is again diffusely\natrophic and replaced with a cluster of tiny cysts measuring 5.3 x 2.0 cm,\npreviously measuring 5.5 x 2.1 cm in total dimension (5:7). No new suspicious\npancreatic lesions identified.\n\nSpleen: The visualized spleen is normal in size without focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. There is redemonstration of a complex\ncystic mass containing solid components in the lower pole the right kidney\nmeasuring 3.5 x 3.5 cm, grossly unchanged from prior study (03:25). The mass\nis confined to the cortex without invasion into the perinephric space, renal\nsinus fat, or renal vein. There is a stable 2 cm cortical cyst in the lower\npole the right kidney, unchanged. Multiple subcentimeter T2 hyperintense\ncystic lesions in the left kidney are unchanged and compatible with simple\ncysts.\n\nGastrointestinal Tract: The visualized loops of small and large bowel are\nnormal in caliber. No evidence of obstruction.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. Stable appearance of the complex cystic right renal mass measuring 3.5 cm,\nmost compatible with clear cell RCC. No invasion into the perinephric space,\nrenal sinus fat, or renal vein.\n2. Redemonstration of multiple pancreatic cystic lesions with a cluster of\nnumerous cystic lesions in the pancreatic tail measuring up to 5.3 cm in total\ndimension, unchanged from prior study and comaptible with IPMNs. As\npreviously recommended, follow-up with pancreatic cyst clinic and further\nevaluation with endoscopic ultrasound should be considered.\n\nRECOMMENDATION(S): For pancreatic cysts measuring more than 1.5cm, patients\nshould be referred to the pancreas cyst clinic for consultation. These\nreferrals can be made by emailing ___\nor by calling ___.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion. \nThere is bilateral gynecomastia.\n\nLiver: The liver is shrunken and nodular in keeping with the known history of\ncirrhosis. There is no chemical shift on the in or out of phase sequences to\nsuggest the presence of hepatic steatosis or iron deposition. Scattered\nnon-enhancing foci hyperintense on the T2 weighted images are consistent with\nbiliary hamartomas/cyst. In segment 7, there is a subcentimeter lesion which\nis is slightly hyperintense on the T2 weighted images and bright on the high\nb-value diffusion weighted images (8:26). This lesion is not well assessed on\nthe post-contrast images and remains indeterminate. No concerning solid or\ncystic lesions. There is a mild-to-moderate amount of ascites.\n\nBiliary: Centrally adjacent to the bile ducts in the left hepatic lobe, there\nare cylindrical non-enhancing lesions hyperintense on the T2 weighted images\nconsistent with peribiliary cysts. No extra-hepatic duct dilatation. The\ncommon bile duct is within normal limits. There is cholelithiasis without any\nevidence of acute cholecystitis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. There are multiple pancreatic\ncystic lesions scattered throughout the parenchyma: 7 mm in the head (04:18),\n6 mm in the body (04:20), 7 mm in the body (04:21), 6 mm in the tail (04:28). \nNo nodularity or duct dilation. Statistically, these lesions are most in\nkeeping with side-branch IPMN.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no concerning solid or cystic\nlesions. No hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. Marked\nmural edema in the ascending colon is consistent with portal colopathy. There\nis a juxtapapillary duodenum diverticulum.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: There are multiple gastric and esophageal varices. The\nvisualized abdominal aorta and proximal mesenteric vessels appear patent\nwithout any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: There is an age indeterminate compression\nfracture at L1. The bone marrow demonstrates normal signal characteristics. \nNo concerning osseous lesions.", "output": "1. Cirrhosis with evidence of portal hypertension characterized by ascites\nand varices.\n2. No hepatic lesions meeting OPTN 5a criteria for HCC.\n3. Indeterminate subcentimeter lesion in segment 7.\n4. Pancreatic cysts statistically most likely represent side-branch IPMN. No\nconcerning features. Follow-up MRCP in ___ year is recommended to ensure\nstability.\n5. Age indeterminate L1 compression fracture." }, { "input": "There is marked enlargement of the right the ventricle, with dilation of the\nIVC and hepatic veins (7:19). Multiple intrahepatic venous collaterals are\nnoted. The right hepatic vein has a transverse diameter of 2.6 cm. On initial\narterial phase of imaging, there is reflux of IV contrast retrograde into the\nIVC and hepatic veins (1801:57). Subsequently the liver enhances\nheterogeneously, centrally first and more peripherally in a delayed fashion\n(1804:74). The liver however maintains normal size and contour without\nmorphologic features of cirrhosis. T2 hyperintensity along the periphery of\nthe hepatic parenchyma likely reflects edema. There is no focal hepatic\nlesion. There is no evidence of sequela of chronic portal hypertension. The\nspleen, adrenal glands, kidneys and pancreas are unremarkable. There is no\nascites or lymphadenopathy.", "output": "Passive hepatic congestion secondary to known cardiac dysfunction, without\nmorphologic features of cirrhosis." }, { "input": "Lower Thorax: There are small bilateral pleural effusions that have improved\ncompared to the CT chest dated ___.\n\nLiver: The transplant liver demonstrates mild diffuse heterogeneous signal\nintensity on the T2 weighted images when compared to the MRI from ___.\nThere is mild patchy arterial hyperenhancement in the peribiliary locations of\nsegment 8 (series 10, image 24) and segment 4 (series 10, image 34-54) in the\nperipheral portion of the liver, that then appears homogeneous on the portal\nvenous and delayed phase images without marked restricted diffusion. This is\na highly nonspecific appearance but being located in the peribiliary region\nmay represent mild cholangitis in the appropriate clinical scenario.\nNo intrahepatic fluid collections or abscess identified. There is no\ncorrelate to the ultrasound finding.\nStable scattered biliary hamartomas/cysts appear hyperintense on T2 weighted\nimages with no enhancement on post-contrast sequences.\nTransplant liver vasculature:\n-the hepatic artery and its branches are patent.\n-the portal vein and its branches are patent.\n-the hepatic veins are patent.\n\nTrace infra hepatic free fluid noted.\n\nBiliary: See above. There is mild pneumobilia and mild scattered asymmetric\nintrahepatic biliary ductal dilation, not changed significantly compared to\nthe prior exam. Surgically absent gallbladder.\n\nPancreas: The pancreas demonstrates homogeneous signal intensity and\nenhancement without main duct dilation or focal lesions.\n\nSpleen: No splenomegaly or focal splenic lesions.\n\nAdrenal Glands: Normal appearance of both adrenal glands.\n\nKidneys: No hydronephrosis noted on either side. Bilateral extrarenal pelves.\nNo focal renal lesions identified.\n\nGastrointestinal Tract: Bowel is incompletely imaged and evaluated on this\nexam. The visualized portion demonstrates no bowel obstruction.\n\nLymph Nodes: There are no enlarged upper abdominal lymph nodes.\n\nVasculature: Patent as above. Mild atherosclerotic changes in the abdominal\naorta noted. The left gastric artery arises directly from the aorta.\n\nOsseous and Soft Tissue Structures: Partially imaged is fat necrosis/omental\ninfarct in the ventral omentum in the midline measuring 3.9 by 2.0 cm (series\n3, image 38) also present on the prior CT abdomen from ___.\nThere is heterogeneously hyperintense signal on T2 weighted images at the\nadjacent endplates of the L2-3 intervertebral disc space (series 2, image 27)\nwith associated enhancement. Similar changes are also seen at the superior\nendplate of T12 and L1 vertebrae. These changes are similar to the MRI from\n___. No associated fluid collections noted.", "output": "1. No intrahepatic abscess or fluid collections noted within the transplanted\nliver. There is no correlate to the recent ultrasound finding from ___.\n2. Asymmetric intrahepatic biliary ductal dilation has not progressed\nsignificantly compared to the prior exam. There is pneumobilia and mild\ncholangitis in segment VIII and segment IV respectively without presence of an\nintrahepatic abscess.\n3. Patent hepatic transplant vasculature.\n4. Endplate changes at adjacent endplates of the L2-3 intervertebral disc are\nsimilar to the recent lumbar spine MRI from ___ without any\nassociated fluid collections. Unchanged appearance of omental infarct. Bowel\nincompletely evaluated on this exam." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nLIVER: The transplanted liver is normal in signal intensity. Heterogeneous\nenhancement of the liver on arterial phase, which becomes homogeneous on\ndelayed post-contrast phases is nonspecific, likely related to perfusion\nanomalies. No focal concerning lesions. A few subcentimeter cysts/biliary\nhamartomas are again noted.\n\nBILIARY: Segmental intrahepatic biliary ductal dilatation in segments II, II\nand V (3:36) are similar, suggestive of stricturing, which may be related to\nprior infection/inflammation. There is no extrahepatic biliary dilatation. \nPneumobilia is present. The gallbladder is surgically absent.\n\nPANCREAS: The pancreas normal in signal intensity and enhancement. No focal\nconcerning lesions or pancreatic duct dilatation. No evidence of\nperipancreatic inflammation.\n\nSPLEEN: The spleen is normal size and signal intensity, No focal concerning\nlesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are of normal and symmetric size with normal nephrograms.\nNo concerning lesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. A small descending duodenal\ndiverticulum is again noted (4:30). Partially imaged loops of large and small\nbowel are unremarkable. A 3.5 cm area of fat necrosis/omental infarct in the\nanterior mid abdomen appears similar (4:35).\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: The aorta is normal in caliber. The portal and hepatic veins are\npatent. The hepatic artery is patent.\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: No concerning soft tissue lesions.", "output": "1. No evidence of malignancy in the abdomen.\n2. Similar appearance of scattered segmental intrahepatic biliary ductal\ndilatation, suggestive of local stricturing, which may be related to prior\ninfection or inflammation.\n3. Similar appearance of the transplanted liver, with patent hepatic\nvasculature.\n4. Additional unchanged chronic findings, as above.\n5. Please refer to the separate report of CT chest performed on the same day\nfor description of the thoracic findings." }, { "input": "Lower Thorax: Lung bases are clear without pleural or pericardial effusions.\n\nLiver: Liver contour is nodular, in keeping with known history of cirrhosis. \nIn segment VI/VII, there are post TACE changes with persistent surrounding\nedema in the postprocedural bed, at the site of the previously identified 3.4\ncm HCC. There is no residual enhancement in the postprocedural bed to suggest\nremaining or recurrent tumor. The main portal vein appears patent. Moderate\nperihepatic ascites is unchanged since ___. No new enhancing\nhepatic lesion detected.\n\nBiliary: The gallbladder is within normal limits, without pericholecystic\nfluid or gallbladder distention. There is no intrahepatic or extrahepatic\nbiliary dilatation. No filling defects concerning for choledocholithiasis.\n\nPancreas: The pancreas demonstrates normal signal intensity on T1 weighted\nimages with homogeneous enhancement. No suspicious solid or cystic mass\nlesion. The pancreatic duct is not dilated. No peripancreatic inflammatory\nchanges or fluid collections.\n\nSpleen: The spleen is mildly enlarged to 13.2 cm. No focal splenic lesion\ndetected.\n\nAdrenal Glands: Adrenal glands are normal size and shape without discrete\nnodularity.\n\nKidneys: Multiple bilateral parapelvic cysts are nonenhancing and unchanged. \nKidneys are symmetric in size bilaterally. There is no hydronephrosis,\nsuspicious renal mass, or nephric abnormality.\n\nGastrointestinal Tract: Previously described some papillary duodenal\ndiverticulum is small and unchanged. The stomach, small bowel, and colon in\nthe upper abdomen are within normal limits.\n\nLymph Nodes: There is no mesenteric, retroperitoneal, or porta hepatis\nlymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber with patent major branches. \nConventional hepatic arterial anatomy is again noted. An enlarged recanalized\nparaumbilical vein is again seen. The splenic vein, SMV, portal, and hepatic\nveins are patent. Moderate paraesophageal and perigastric varices are again\nseen. Previously described possible nonocclusive filling defects, in the\nright external iliac and common iliac veins seen on the prior CT, are not\nwell-visualized on this abdominal protocol.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "1. Post TACE changes at segments VI/VII without MR evidence of residual or\nrecurrent tumor.\n2. Unchanged moderate perihepatic ascites.\n3. Cirrhotic liver with stigmata of portal hypertension, including\nparaesophageal and perigastric varices, and mild splenomegaly." }, { "input": "Lower Thorax: Evaluation of the lower thorax is notable for right lower lobe\natelectasis. No pleural effusion.\n\nLiver: The liver is shrunken, and nodular with heterogeneous parenchyma\nconsistent with cirrhosis. There is large volume ascites. Patient is post\nTACE in segment ___ with associated coagulation necrosis. There is interval\ndecrease in peripheral T2 hyperintensity surrounding this post treatment area\nconsistent with edema in the postprocedural bed. No definite residual\nenhancement in the postprocedural bed to suggest remaining or recurrent tumor.\nNo arterially enhancing lesions identified.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas is homogeneous in signal intensity without worrisome\nfindings. No pancreatic ductal dilatation.\n\nSpleen: Spleen is normal in signal intensity and top-normal in size measuring\n12.5 cm.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: The kidneys are homogeneous in signal intensity without focal\nlesions. No perinephric fat stranding. No hydronephrosis.\n\nGastrointestinal Tract: Small hiatal hernia. The stomach, visualized small\nand large bowel are unremarkable.\n\nLymph Nodes: No retroperitoneal, mesenteric, or periportal lymph node\nenlargement.\n\nVasculature: No abdominal aortic aneurysm. The celiac axis, SMA, and\nbilateral renal arteries are patent. There is a left gastric artery arising\nfrom the aorta. An accessory left hepatic artery arising off the left gastric\nartery is noted. Patent umbilical vein. Diminutive but patent right portal\nvein, unchanged since prior examination. Otherwise patent main portal vein,\nSMV, and splenic vein. Paraesophageal varices are noted.\n\nOsseous and Soft Tissue Structures: Visualized osseous structures and soft\ntissues are unremarkable.", "output": "1. Status post TACE of segment ___ with associated coagulation necrosis and\ndecreasing edema in the postprocedural bed. No enhancement to suggest\nrecurrent or residual disease.\n2. No worrisome hepatic lesions.\n3. Cirrhosis with large volume ascites and patent umbilical vein.\n4. Paraesophageal varices." }, { "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The liver has a shrunken, cirrhotic morphology. There is no hepatic\nsteatosis. A 5.0 x 4.5 cm T1 heterogeneously hyperintense and T2 hyperintense\npost TACE treatment zone in segment 7 (series 9, image 22). No suspicious\nenhancement with the treatment zone or at its periphery. No suspicious\narterially enhancing foci.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas is normal in size and signal intensity. There is no\nmain pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The adrenal glands are unremarkable, bilaterally.\n\nKidneys: There is no suspicious renal lesion. There are bilateral renal\ncysts, including parapelvic cysts.\n\nGastrointestinal Tract: There is large volume ascites. The stomach is\nunremarkable. There is a duodenal diverticulum. Otherwise, visualized loops\nof small and large bowel are unremarkable.\n\nLymph Nodes: Prominent periportal lymph nodes are likely reactive. There is\nno retroperitoneal lymphadenopathy.\n\nVasculature: There is recanalization of the paraumbilical vein. There is no\nabdominal aortic aneurysm. There is small paraesophageal varices. There is a\nnew nonocclusive thrombus, which extends from the main portal vein into the\nright portal vein (series 13, image 34). Indistinctness of the right\nposterior portal vein, likely represents nonocclusive thrombus as well.\n\nOsseous and Soft Tissue Structures: There is no evidence of osseous malignancy\nor infection.", "output": "1. Cirrhotic liver, status post TACE for HCC. No evidence of local\nrecurrence. No suspicious hepatic lesions. Large volume ascites.\n2. New nonocclusive thrombus in the main, right portal and likely right\nposterior portal veins.\n3. Paraesophageal varices and recanalization of the paraumbilical vein,\nlikely sequelae of portal hypertension.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 13:25 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: Please see report from CT of the chest from same date for\nthoracic findings.\n\nLiver: The liver is again noted to be cirrhotic. At least moderate ascites is\npresent. The patient is status post TACE of a segment VII lesion. The cavity\nmeasures up to 4.1 cm, most recently 4.3 cm. There is no associated enhancing\nor nodular component to suggest residual or recurrent disease. No other\nconcerning lesions are identified.\n\nIn comparison to the prior examination, small, nonocclusive thrombus involving\nthe diminutive right posterior and right portal veins is no longer identified.\nThe hepatic vasculature is patent. A prominent, recanalized paraumbilical\nvein is noted.\n\nBiliary: There is no biliary ductal dilatation. The gallbladder is\nunremarkable.\n\nPancreas: The pancreas is unremarkable n.\n\nSpleen: The spleen measures up to 13 cm and is otherwise unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable except for multiple T2 hyperintense\ncysts are seen, some of which are parapelvic on the left, unchanged.\n\nGastrointestinal Tract: A moderate duodenal diverticulum is again noted. No\nbowel obstruction in the upper abdomen.\n\nLymph Nodes: Prominent portacaval nodes are possibly reactive, stable.\n\nVasculature: The abdominal aorta is normal in caliber. A replaced left\nhepatic artery arises from the left gastric artery. Paraesophageal varices\nare again noted.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified.", "output": "1. Cirrhotic liver and portal hypertension. No new or recurrent HCC.\n2. Interval improvement of previous nonocclusive right portal vein thrombus\nand ascites." }, { "input": "Lower Thorax: No pleural or pericardial effusion.\n\nLiver: Centered in segment VII is a 5.0 x 4.5 cm ablation zone with internal\ncoagulative necrosis (11:18). There is no evidence of abnormal enhancement\nwithin or surrounding the ablation zone to suggest local or residual disease. \nElsewhere within the liver, there are no suspicious focal liver lesions.\n\nBiliary: There is no intra- or extrahepatic biliary ductal dilation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas demonstrates normal homogeneous signal intensity. \nThere is no main pancreatic ductal dilation.\n\nSpleen: There is no splenomegaly or focal splenic lesion.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration.\n\nKidneys: There are multiple left-sided parapelvic renal cysts. Small foci of\nsignal drop on the left renal cortex measuring 4 and 3 mm may represent small\nangiomyolipomas (5:35 and 30). Otherwise, the kidneys display normal\nsymmetric enhancement and signal intensity characteristics. There is no\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. There is a small\njuxtapapillary duodenal diverticulum (02:17) measuring 13 mm. The remaining\nduodenum is unremarkable. Partially imaged non-dilated small bowel loops are\nnormal in course and caliber without evidence of wall thickening, abnormal\nenhancement, or obstruction. The partially imaged colon is unremarkable. \nThere is moderate to large volume ascites seen primarily in the perihepatic\nand perisplenic spaces. Ascites layers dependently in the pelvis, partially\nvisualized.\n\nLymph Nodes: Retroperitoneal lymph nodes are increased in number but not\nindividually enlarged. Upper abdominal lymph nodes are again noted to be\nprominent, for instance at the portal caval station and in the gastrohepatic\nligament (14:37) (14:40). No newly pathologically enlarged lymph nodes are\nseen. No mesenteric lymphadenopathy.\n\nSubtle enhancing thickening of the peritoneal lining is noted (24:37), which\ncan be seen in setting of peritonitis.\n\nVasculature: The abdominal aorta is normal in caliber. Major proximal\ntributaries are patent. The left hepatic artery is replaced to the left\ngastric artery. The IVC is normal in caliber and patent. Patent hepatic\nveins. Patent main and left portal vein. Diminutive but patent right anterior\nand right posterior portal vein, unchanged. Patent SMV and splenic vein. \nThere is a recanalized paraumbilical vein.\n\nOsseous and Soft Tissue Structures: There is a 2.0 cm paraumbilical hernia\ncontaining only omental fat, incompletely visualized on this study, unchanged\nprior exams (24:80). No suspicious foci of abnormal marrow signal are seen.", "output": "1. No evidence of new or recurrent/residual HCC.\n2. 5.0 cm ablation zone in hepatic segment VII is unchanged in appearance.\n3. Cirrhotic liver with sequelae of portal hypertension including moderate to\nlarge volume ascites and a recanalized paraumbilical vein. No splenomegaly.\n4. Enhancement of the peritoneum, which can be seen in the setting\nperitonitis.\n5. Patent main and left portal vein. Diminutive but patent right anterior and\nright posterior portal vein, unchanged.\n6. 2 small foci of signal drop on out of phase T1 weighted images are\nconsistent with 4- and 3 mm left renal angiomyolipomas.\n7. Increased number and mild prominence of upper abdominal retroperitoneal\nlymph nodes, unchanged from prior exams, nonspecific but possibly reactive.\n8. Left hepatic artery replaced to the left gastric artery.\n9. 2 cm paraumbilical hernia containing only omental fat, unchanged from prior\nexams. Left renal parapelvic cyst. 13 mm juxtapapillary duodenal\ndiverticulum. Other incidental findings, as above." }, { "input": "Lower Thorax: Bilateral lung bases are clear.\n\nLiver: Small to moderate ascites is similar to before. 4.5 cm area of\nheterogeneous T1 hyperintensity in the liver segment 7 is unchanged and\nconsistent with treatment changes.\n\nBiliary: Intra and extrahepatic bile ducts are normal caliber. Gallbladder is\nunremarkable.\n\nPancreas: The pancreas demonstrates homogeneous enhancement throughout. \nPancreatic duct is normal caliber.\n\nSpleen: Spleen is normal size.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral nephrograms are symmetric. There is no hydronephrosis. \nMultiple subcentimeter para pelvic renal cysts are noted in the left kidney. \n0.2 cm focus of the signal dropout on out of phase images is unchanged\ncompatible with angiomyolipoma.\n\nGastrointestinal Tract: Stomach is unremarkable. 2.2 cm duodenal\ndiverticulum is again noted. Small and large bowel loops are normal caliber.\n\nLymph Nodes: Periportal lymphadenopathy measuring up to 1.2 cm is similar to\nbefore.\n\nVasculature: Right anterior and posterior portal veins are diminutive but\npatent. Previously demonstrated thrombus seen on prior MRI from ___ is no longer present. Large recanalized umbilical vein is present. \nEsophageal, gastric, and splenorenal varices are noted. Previously noted\nreplaced left hepatic artery arising from the left gastric artery is not well\ndemonstrated on this exam.\n\nOsseous and Soft Tissue Structures: No concerning bone or soft tissue lesion\nis identified. Bilateral gynecomastia, left larger than right, are similar to\nbefore. Fat containing umbilical hernia is again noted.", "output": "1. No focal lesions suspicious for HCC.\n2. Posttreatment changes are stable since the prior study.\n3. Previously-seen portal vein thrombus has resolved. Right anterior and\nposterior portal veins remain diminutive but patent. No new thrombus.\n4. Liver cirrhosis with small to moderate ascites, portosystemic varices, and\nperiportal lymphadenopathy." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The transplanted liver is normal in morphology. There are patchy areas\nof hypoenhancement, predominately within the anterior right lobe. Scattered\nnonenhancing T2 hyperintensities are consistent with simple cysts or biliary\nhamartomas. There is no suspicious liver lesion.\n\nBiliary: Multiple intrahepatic areas of biliary ductal stricturing and\ndilatation are slightly progressed from the prior study, worst within the left\nbiliary system. There is mild peribiliary enhancement within the left-sided\nbile ducts raising concern for cholangitis. A stent is noted within the\ncommon bile duct causing mild artifact. There is T1 hyperintense debris\nwithin the stent, which may represent proteinaceous material or blood\nproducts.\n\nPancreas: The pancreas is normal in signal intensity and morphology without\nductal dilatation or suspicious focal lesion.\n\nSpleen: Spleen is normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: There small simple cysts bilaterally. There is no hydronephrosis or\nsuspicious renal lesion.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No suspicious lymphadenopathy.\n\nVasculature: Unremarkable. The appendix arterial anastomosis appears widely\npatent. The portal and hepatic veins are patent with a widely patent portal\nvenous and IVC anastomosis.\n\nOsseous and Soft Tissue Structures: A mild anterior compression deformity of\nthe a superior endplate of L1 is unchanged from the immediate prior study\n(1:6). There is a fat containing umbilical hernia. An irregular area of\nserpiginous low T2 signal in the anterior abdominal fat is consistent with fat\nnecrosis following liver transplant (08:34).", "output": "1. Slight interval progression of multifocal intrahepatic areas of biliary\nductal stricturing and dilatation. This could represent early ischemic\ncholangiopathy, however stricturing related to cholangitis, which appears\nmildly active, can have a similar appearance.\n2. Patent hepatic venous and arterial anastomoses.\n3. No suspicious liver lesion or lymphadenopathy." }, { "input": "Lower Thorax: Trace atelectasis is seen in the bilateral bases, left greater\nthan right. A triangular-shaped area of enhancement in the right middle lobe\ncorresponds to a vessel on prior CT, and may represent an aberrant\npulmonary-intercostal connection. No pleural effusion or large pulmonary mass\nlesions.\n\nLiver: There is a 4.9 x 4.3 x 4.9 cm heterogeneously enhancing mass in segment\n___. A second heterogeneously enhancing satellite lesion measuring 1.8 x 1.5\nx 1.1 cm is located more superiorly in segment ___. A third heterogeneously\nenhancing satellite lesion measuring 2.3 x 1.4 x 2.3 cm is located\nperipherally in segment ___. These lesions all demonstrate restricted\ndiffusion, were previously noted to be PET avid, and are consistent with\nmetastatic disease. A sub-centimeter peripherally enhancing lesion in segment\n___ (8:24, 12:22, 4:10) demonstrates restricted diffusion, and is also most\nconsistent with metastatic disease. Several punctate T2 hyperintense\nnonenhancing lesions within the liver are consistent with cysts or biliary\nhamartomas.\n\nBiliary: Patient is status post cholecystectomy. There is no intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: Pancreas demonstrates normal signal intensity. No evidence of\npancreatic ductal dilatation or pancreatic mass lesions.\n\nSpleen: A 0.6 x 0.9 x 0.8 cm T2 hyperintense enhancing lesion in the medial\naspect of the spleen demonstrates T2 shine through, and is most consistent\nwith an atypical hemangioma.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Kidneys are symmetric in size and demonstrate normal enhancement and\nprompt excretion of contrast.\n\nGastrointestinal Tract: The stomach is relatively under distended, but\ngrossly normal. The imaged small and large bowel are without evidence of\nobstructive mass lesions or wall thickening.\n\nLymph Nodes: There is a 1.3 x 1 cm irregular centrally hypoenhancing lymph\nnode at the gastrohepatic ligament (14:35, 4:14), which is previously noted to\nbe mildly FDG avid. A small benign-appearing epipericardial lymph node\nappears unchanged from prior studies. No additional pathologically enlarged\nor concerning retroperitoneal or mesenteric lymph nodes.\n\nVasculature: The imaged portion of the abdominal aorta is normal in caliber. \nThe major intra-abdominal branch vessels are patent appear\n\nOsseous and Soft Tissue Structures: Discogenic related degenerative change is\nseen in the upper lumbar spine.", "output": "1. Four metastatic lesions seen within segments ___ and ___, as described\nabove.\n2. An irregular, centrally hypoenhancing lymph node at the gastrohepatic\nligament was previously noted to be mildly FDG avid, and is slightly\nsuspicious. Recommend attention on follow-up imaging. If tissue sampling is\nnecessary, this could be sampled with FNA via endoscopic ultrasound.\n3. Atypical splenic hemangioma.\n\nRECOMMENDATION(S): An irregular, centrally hypoenhancing lymph node at the\ngastrohepatic ligament was previously noted to be mildly FDG avid, and is\nslightly suspicious. Recommend attention on follow-up imaging. If tissue\nsampling is necessary, this could be sampled with FNA via endoscopic\nultrasound." }, { "input": "Lower Thorax: The included lung bases are clear. There is no pericardial or\npleural effusion.\n\nLiver: The liver demonstrates a nodular contour with enlargement of the left\nlobe compatible with known cirrhosis. There is diffuse hepatic fibrosis, but\nparticularly prominent in segment VIII. There is no evidence of hepatic\nsteatosis. In segment II of the liver, there is an oval 1.6 x 0.9 cm\narterially enhancing lesion (1101:33) without correlate on subsequent delayed\nimaging which likely represents a perfusion anomaly. No lesion meeting OPTN\ncriteria is identified. The portal vein is patent. Note is made of a\nreplaced left hepatic artery arising from the left gastric artery and an\naccessory arterial branch arising from the celiac trunk which drains into the\nmiddle hepatic vein consistent with an arterio-portal fistula. A replaced\nright hepatic artery is noted arising from the SMA. There is no ascites. \nExtensive ___ as well as paraesophageal varices are noted.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. A stone\nis seen within a minimally distended gallbladder. There is no gallbladder\nwall thickening or pericholecystic fluid.\n\nPancreas: The pancreas demonstrates normal signal intensity and contour. No\nsuspicious pancreatic lesion is identified. There is no main duct dilatation.\n\nSpleen: The spleen remains massively enlarged measuring 18.4 cm. It\ndemonstrates normal signal intensity.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: The kidneys demonstrate symmetric enhancement and normal in size. \nMultiple cystic lesion are again seen bilaterally measuring up to 11 mm in the\nlower pole of the right kidney. There is no hydronephrosis or spurs renal\nlesion.Mild scarring of the right lower renal pole is noted and unchanged.\n\nGastrointestinal Tract: The stomach, included small and large bowel are\nunremarkable without wall thickening, dilatation, or abnormal enhancement.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without aneurysmal\ndilatation. Major side branches are patent.\n\nOsseous and Soft Tissue Structures: There is no suspicious marrow signal. \nBilateral, right greater than left gynecomastia is noted.", "output": "1. No suspicious liver lesion meeting OPTN criteria is identified.\n\n2. Background cirrhotic liver with sequelae of portal hypertension including\nsplenomegaly, esophageal and perisplenic varices. No ascites.\n\n3. Cholelithiasis without evidence of acute cholecystitis." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, the bilateral lung bases\nare clear. The heart is normal in size. There is no pleural or pericardial\neffusion.\n\nLiver: The liver is nodular in contour, in keeping with cirrhosis. There is\ndiffuse progressive reticular enhancement of the hepatic parenchyma,\ncompatible with fibrosis. There is a tiny cyst or biliary hematoma in segment\nVI (series 6, image 29). No suspicious hepatic lesion is identified.\n\nHepatic arterial anatomy is conventional. The portal and hepatic veins are\npatent.\n\nThere are small esophageal and perigastric varices.\n\nThere is no upper abdominal ascites.\n\nBiliary: The gallbladder is contracted. There is no intra- or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is enlarged, measuring 16.7 cm in length, normal in signal\nintensity.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are symmetric in size. There is a 0.8 x 0.8 cm T1\nhyperintense lesion in the lateral upper pole of the right kidney, compatible\nwith a hemorrhagic cyst. There is no left renal lesion. There is no\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. Visualized upper\nabdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. The abdominal wall is within normal limits.", "output": "Cirrhosis of the liver with findings of portal hypertension, including\nsplenomegaly and small esophageal and perigastric varices. No suspicious\nhepatic lesion. Patent portal and hepatic veins. No upper abdominal ascites." }, { "input": "Lower Thorax: The lung bases are clear.\n\nLiver: The liver is normal in morphology and signal intensity. There are\nscattered T2 intermediate intensity lesions, which demonstrate progressive\nfill-in of contrast and are consistent with hemangiomas. Largest hemangioma\nlocated in hepatic segment VIII, corresponds to the hypodense lesion on CT,\nmeasuring 1.0 cm (series 6, image 14). There is also a subcentimeter simple\nhepatic cyst in segment V (series 6, image 19).\n\nCorresponding to areas of increased uptake on PET in the anterior left hepatic\nlobe in segments IV, III, and II are geographic areas of vague T2\nhyperintensity and arterial hyperenhancement without any correlate on more\ndelayed phase imaging or restricted diffusion. No mass effect os seem. \nlargest area of signal abnormality measures 4.5 x 2.2 cm in segment IVB and\n1.7 x 1.5 cm in segment III (series 6, image 25).\n\nBiliary: Gallbladder is decompressed. No evidence of cholelithiasis. Intra\nand extrahepatic biliary ducts are unremarkable.\n\nPancreas: The pancreas is normal in signal intensity. No focal pancreatic\nlesions are seen. Pancreatic duct is not dilated.\n\nSpleen: Spleen is top-normal in size measuring 12.0 cm.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. There are two scattered\nsubcentimeter cortical cysts in the left kidney.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable. There is a nonenhancing 1.7 x 1.6 cm\nnonenhancing cyst in the left mesentery unchanged from prior CT, likely a\nduplication versus mesenteric cyst (series 6, image 35).\n\nLymph Nodes: There is no mesenteric or retroperitoneal adenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. The portal vein is patent.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. \nThere is no superficial soft tissue abnormality.", "output": "1. Vague areas of T2 hyperintensity with associated arterial hyperenhancement\nin the anterior left lobe of the liver corresponding to increased uptake on\nrecent PET-CT. These findings would be atypical for metastases and could\nrepresent inflammatory change such as cholangitis or vascular shunt. close\nattention on follow-up imaging is advised.\n2. Multiple hepatic hemangiomas, including a 1.7 cm segment VIII hemangioma\nthat corresponds to the hypodense focus seen on the recent CT.\n3. 1.7 cm cystic lesion in the left upper mesentery without aggressive\nfeatures, differentials include a mesenteric or duplication cyst.\n\nRECOMMENDATION(S): Short-term follow-up imaging with MRI to re-evaluate\nimpression 1." }, { "input": "Lower Thorax: There are no pleural or pericardial effusions.\n\nLiver: The patient is status post segmentectomy of segment 4 of the liver. \nBordering segments ___ of the liver, there is a 4.7 x 3.7 subcapsular\ncollection with heterogeneous, predominantly T2 signal hyperintensity, and\nperipheral areas of T1 hyperintensity. This collection demonstrates thin rim\nenhancement post gadolinium administration, without evidence of internal\nenhancement. There is no restriction on diffusion.\n\nNo intraparenchymal liver lesions identified.\n\nBiliary: The patient has had a previous cholecystectomy. There is no intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity morphology. The\npancreatic duct is not dilated. 3 mm T2 hyperintense focus in the body of the\npancreas (04:26) likely representing a small side branch IPMN.\n\nSpleen: The spleen is not enlarged.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: Cortical cysts in the right kidney measuring up to 2.2 cm. There is\nno hydronephrosis.\n\nGastrointestinal Tract: The patient has had a right colectomy. Visualized\nbowel loops in the upper abdomen are otherwise unremarkable, without evidence\nof obstruction.\n\nLymph Nodes: No size significant lymphadenopathy in the upper abdomen.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions.", "output": "4.7 cm subcapsular collection bordering segments ___ of the liver, with thin\nperipheral enhancement. Differential considerations include a postoperative\ncollection (hematoma or complex seroma), with metastatic disease being much\nless likely.\n\n3 mm T2 hyperintense focus in the body of the pancreas, likely representing\nside-branch IPMN. This can be followed on the patient's subsequent imaging.\n\nRECOMMENDATION(S): Aspiration of this subcapsular collection be performed for\nfurther evaluation." }, { "input": "The lung bases are grossly clear. There is no ascites.\n\nLiver: There is a 4.2 x 4.2 cm ablation defect in segment VII of the right\nhepatic lobe. The ablation zone demonstrates intrinsic increased T1 signal\nwith no suspicious postcontrast enhancement. There are no new suspicious\nhepatic lesions. At the hepatic dome (series 10, image 23) there is a linear\narea of hyper enhancement which resolves on more delayed postcontrast\nsequences and likely represents a small perfusional shunt.\n\nGallbladder: A gallstone is present in the gallbladder.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nfocal mass or ductal dilatation. There is classic pancreatic ductal anatomy.\n\nSpleen: The spleen is normal in appearance.\n\nKidneys and Adrenals: The right adrenal gland is normal. There is an\nindeterminate enhancing nodule measuring 7 mm in the left adrenal gland. The\nkidneys are normal in size and enhance symmetrically.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is widely patent.\n\nBones: The osseous structures are unremarkable.", "output": "1. Radiofrequency ablation defect in segment VII as described above without\nany evidence for recurrent or residual disease. No new concerning hepatic\nmasses.\n2. Cholelithiasis.\n3. 7 mm left adrenal nodule remains unchanged and too small to fully\ncharacterize, statistically likely a benign adenoma." }, { "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: Background liver signal intensity is normal. Patient is status post\nRF ablation of a segment VII lesion. The ablation zone is unchanged and\ndemonstrates intrinsic increased T1 signal without postcontrast enhancement to\nsuggest residual tumor or recurrence.\n\nAt the liver dome is a wedge-shaped arterially enhancing region without\nwash-out or T2 correlate, representing a transient hepatic intensity\ndifference. Another 6mm arterially enhancing nodular area in segment VIII\n(12:25) without wash-out likely represents a prominent vessel better\ncharacterized on prior MRI from ___. There are no lesions meeting\nOPTN-5 criteria.\n\nGallbladder and Biliary System: A gallstone is again seen within the\ngallbladder. There is no significant intra or extrahepatic biliary ductal\ndilatation.\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.The main pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: A 7mm enhancing nodule is seen in the left adrenal\ngland which remains too small to fully characterize but does demonstrate some\nsignal drop out on T1 out of phase sequence, suggestive of adenoma, stable\nsince ___. The kidneys are normal bilaterally. Tiny subcentimeter cyst is\nseen in the interpolar region of the right kidney.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "1. Status post radiofrequency ablation of a known segment VII lesion without\nevidence of recurrence or residual disease.\n2. No hepatic lesion meeting OPTN-5 criteria. Arterially enhancing foci at\nthe liver dome and segmental VIII are without washout or T2 correlates. These\ncan be reassessed during followup imaging.\n3. Cholelithiasis.\n4. 7mm left adrenal nodule remains too small to fully characterize but\nstability ovrer ___ years and equivocal intravoxel fat is highly suggestive of\nan adenoma." }, { "input": "Hepatic morphology is notable for undulating contour and prominence the\nlateral segment of the left lobe. There is subtle reticular pattern of\nprogressive enhancement, consistent with fibrosis. No imaging sequela of\nportal hypertension is identified.\n\nAblation zone within segment VII remains unchanged. This lobulated normal\ntreatment sound has approximate ___ of 7.8 x 3.1 x 3.9 cm. Ablation\nzone contains T1 hyperintense and T2 hypo intense the material without\ninternal enhancement. There is no evidence of residual or recurrent tumor at\nthe ablation site.\n\nThere continues to be a 1.5 cm spiculated area of signal and enhancement\nabnormality within the dome of segment VIII, unchanged dating back to ___. This region is T1 hypointense, T2 hyperintense and restricted in\ndiffusion. It demonstrates hyperenhancement on all post-contrast sequences.\n\nThere is cholelithiasis without evidence of cholecystitis.\n\nThe spleen, pancreas, right adrenal gland and kidneys are unremarkable. A\nsmall nodule associated with the left adrenal gland is unchanged. There is no\nascites or lymphadenopathy.\n\nArterial vascular anatomy of the upper abdomen is conventional. Venous\nstructures are widely patent.\n\nThe osseous structures are unremarkable.", "output": "1. Cirrhosis without sequela of portal hypertension.\n2. Stable appearance of ablation zone with coagulation necrosis.\n3. No evidence of residual or recurrent tumor at that site. No additional\narea of concern." }, { "input": "Lower Thorax: Please see the chest CT obtained immediately prior to this exam\nfor a complete description of the intrathoracic findings.\n\nLiver: The liver has a nodular contour, which is in keeping with the history\nof cirrhosis. There is no hepatic steatosis. A reticular pattern of\nprogressive enhancement throughout the liver is compatible with fibrosis. In\nsegment VII, there is an ablation zone with coagulation necrosis that measures\n4.8 x 2.9 cm. Allowing for changes in measurement technique, it is not\nsignificantly changed. There is no surrounding arterial hyperenhancement to\nsuggest local recurrence.\n\nAgain, there is irregular hyperenhancement in the dome of segment VII\nmeasuring approximately 1.4 cm in its longest dimension (901, 25). This is\nstable from ___ and very minimally enlarged from ___. It has\nrestricted diffusion. There is no washout or correlate on the T2 weighted\nimages. It is hypointense on the T1 weighted images (7, 22).\n\nThe hepatic arterial anatomy is conventional. The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. There is\ncholelithiasis without evidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or evidence of a mass.\n\nSpleen: The spleen is normal in size, measuring 9.1 cm. There are no focal\nlesions.\n\nAdrenal Glands: The right adrenal gland is normal. There is an unchanged 7 mm\nnodule in the left adrenal gland, which is unchanged. This is too small to\nfully characterize, though it appears to drop in signal on the out of phase\nimaging, suggesting it is likely an adenoma.\n\nKidneys: In the right kidney, there is a tiny 3 mm cyst. No other renal\nlesions are identified. There is no hydronephrosis or perinephric\nabnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe soft tissues are unremarkable. There is no hernia.", "output": "1. Status post RFA of a segment VII hepatocellular carcinoma. No evidence of\nlocal recurrence.\n2. Unchanged indeterminate focus of arterial enhancement in the dome of\nsegment VII. Continued attention on followup exams is recommended. No\nlesions meet OPTN-5 criteria for HCC. No new lesions.\n3. Cholelithiasis.\n4. Unchanged 7 mm left adrenal nodule, which is likely an adenoma." }, { "input": "Lower Thorax: Atelectasis in the right lung base. No pleural or pericardial\neffusions.\n\nLiver: Patient is status post liver transplant. The liver demonstrates\nnormal morphology and signal characteristics. There is a tiny 4 mm arterially\nenhancing nodule peripherally within segment V (series 10, image 62) that does\nnot washout on the more delayed phases and without a correlate on the T2\nweighted images, most likely a transient hepatic intensity difference. No\nsuspicious enhancing hepatic mass lesions meeting OPTN Class 5 criteria for\nHCC. Small amount of perihepatic free fluid.\n\nBiliary: Minimal intrahepatic ductal prominence is noted without extrahepatic\nbiliary duct dilatation. The common bile duct demonstrates a focal minimal\nnarrowing at the level of the anastomosis, not unexpected, with normal\ntapering to the level of the ampulla. No intraluminal filling defects are\nseen.\n\nPancreas: Pancreas demonstrates normal signal intensity on the T1 weighted\nimages and enhances homogeneously. No suspicious solid or cystic mass\nlesions. The main pancreatic duct is not dilated. No peripancreatic\ninflammatory changes or fluid collections.\n\nSpleen: The spleen is normal in size and demonstrates normal signal\ncharacteristics. It enhances homogeneously on the postcontrast images without\nfocal mass lesion.\n\nAdrenal Glands: The right adrenal gland is normal. There is an 8 mm nodule in\nthe left adrenal gland that demonstrates enhancement on the postcontrast\nimages, and is too small to fully characterize however is stable from prior\ndated ___.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There is adequate excretion of contrast on\nthe more delayed phases. There is a stable tiny simple renal cyst in the\nright kidney. Small T1 hyperintense nonenhancing lesion within the lower pole\nof the left kidney measuring 4 mm, most likely a hemorrhagic cyst. No\nsuspicious renal masses or hydronephrosis bilaterally. No perinephric\nabnormality.\n\nGastrointestinal Tract: The stomach, visualized small bowel and colon in the\nupper abdomen are within normal limits.\n\nLymph Nodes: No suspicious mesenteric or retroperitoneal lymphadenopathy by\nsize criteria.\n\nVasculature: The abdominal aorta and its major branches are patent. Hepatic\narterial anatomy is conventional. The hepatic artery, splenic vein, SMV,\nportal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. Status post liver transplant without suspicious enhancing hepatic mass\nlesions meeting OPTN Class 5 criteria for hepatocellular carcinoma.\n\n2. Small enhancing 8 mm nodule in the left adrenal gland that is too small to\nfully characterize, however stable from prior dated ___, and\nstatistically likely reflective of an adrenal adenoma." }, { "input": "Lower Thorax: There is mild scarring and atelectasis at the right lung base. \nThe lung bases are otherwise clear.\n\nLiver: The patient is status post orthotopic liver transplant. There is no\nhepatic steatosis. No suspicious hepatic lesions.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation.\n\nPancreas: There is mild fatty infiltration of the uncinate process. The\npancreas is otherwise normal in size and signal intensity. There is no main\npancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right adrenal gland is unremarkable. There is a\nre-demonstrated 8 mm enhancing left adrenal nodule (series 1102, image 69)\nwhich is stable from ___ and drops signal on out of phase imaging, compatible\nwith an adrenal adenoma.\n\nKidneys: There is no hydronephrosis or suspicious renal lesion. A T1\nhyperintense lesion arising from the lower pole of the left kidney (series 9,\n128) likely represents a proteinaceous or hemorrhagic cyst.\n\nGastrointestinal Tract: The stomach and visualized loops of small and large\nbowel are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. The portal and hepatic\nveins are widely patent.\n\nOsseous and Soft Tissue Structures: No evidence of osseous malignancy or\ninfection.", "output": "1. Status post liver transplant without evidence of recurrent HCC. Patent\nhepatic vasculature.\n2. Unchanged left adrenal adenoma from ___." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nModerate to severe intra and extrahepatic bile duct dilation has slightly\nincreased since the ___ MRCP (series 3, image 21, 24). Moderate\npneumobilia is stable, reflecting patency of a choledochoduodenostomy (series\n4, image 3). There are no ductal stones. The hepatic parenchyma demonstrates\nnormal signal intensity on T1 and T2 weighted sequences. No concerning hepatic\nmass is detected.\n\nAgain seen is severe dilation of the main pancreatic duct, which appears\nirregular (series 3, image 23, 24), unchanged since the ___ MRCP,\nreflecting chronic pancreatitis. The pancreatic parenchyma is moderately\natrophied.\n\nThe spleen is mildly enlarged (series 10, image 30, series 3, image 28).\nPerisplenic and gastric varices (series 10, image 34) are again seen, denoting\nchronic portal hypertension.\n\nArising from the upper and lower poles of the right kidney are 6 mm and 4 mm\ncyst, respectively (series 3, image 34, 32), denoted by a high internal signal\nintensity on T2 weighted sequences, without appreciable internal contrast\nenhancement. The kidneys are otherwise normal.\n\nThe adrenal glands and intra-abdominal loops of small and large bowel are\nnormal.\n\nThere are no bony lesions concerning for malignancy or infection. Arising from\nthe L4 vertebral body is a 2.1 cm lesion demonstrating high internal signal\nintensity on T2 weighted sequences, most compatible with a hemangioma (series\n3, image 33).\n\nMRA/MRV:\n\nThe abdominal aorta, celiac trunk, SMA, and ___ are patent and normal in\ncaliber (series 901, image 30, 29). The renal arteries are patent.\n\nThe hepatic veins and intrahepatic portal veins remain patent. There is\nchronic thrombosis of the SMV, portal-SMV confluence, and splenic vein,\nunchanged in configuration since the ___ MRCP (series 903, image\n67, 69).\n\n3D postprocessing was performed on an independent workstation, including the\ncreation of 3D maximum intensity projection images, which support these\nfindings.", "output": "1. Chronic thrombosis of the SMV, portal-SMV confluence, and splenic vein are\nunchanged since ___.\n2. Splenomegaly and perisplenic and gastric varices, denoting chronic portal\nhypertension.\n3. Severe intrahepatic bile duct dilation has slightly increased since the\n___ examination, however, moderate pneumobilia denotes continued\npatency of the choledochoduodenostomy.\n4. Irregular pancreatic duct dilation, in keeping with known history of\nchronic pancreatitis, stable since ___." }, { "input": "Liver: There is a region of architectural distortion and hypoenhancement at\nthe site of previously seen cyst in segment 4A/8 with no residual cyst\ndemonstrated. It is presumed that the cyst has been at least drained or\nremoved.\n\nBiliary: Gallbladder is unremarkable. There is no intrahepatic or\nextrahepatic biliary ductal dilatation.\n\nAbdomen: Multiple pancreatic side branch IPMNs are demonstrated measuring up\nto 3 mm with mild prominence of the main pancreatic duct.\n\nThe spleen, and adrenal glands are unremarkable.\n\nThe kidneys are unremarkable except for small bilateral diminutive cysts. No\nhydronephrosis is visualized.\n\nNo bowel obstruction is visualized. No ascites is seen.\n\nNo enlarged upper abdominal lymph nodes are visualized.\n\nVasculature: Is hepatic vasculature is patent with replaced right hepatic\nartery to the SMA.\n\nOsseous structures: No aggressive osseous lesions.", "output": "1. Region of hypoenhancement, likely scarring at the site of a previously\ndemonstrated hepatic cystic lesion, with no residual cyst demonstrated. It is\npresumed that the cyst has been removed or drained.\n2. Multiple pancreatic side branch IPMNs are demonstrated measuring up to 3 mm\nwith mild prominence of the main pancreatic duct.\n\nRECOMMENDATION(S): Recommend ___ year follow-up MRI for mild prominence of the\nmain pancreatic duct." }, { "input": "Lower Thorax: The lung bases are clear. No pleural effusion. The heart size\nis normal. No pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. The contours are\nsmooth. No solid lesions identified.\n\nBiliary: No intra- or extra-hepatic duct dilatation. There is cholelithiasis\nwith multiple calculi near the neck of the gallbladder. No evidence of\ncholecystitis. The common bile duct is within normal limits.\n\nPancreas: The previously described bilobed cystic lesion in the head of the\npancreas appears slightly larger on today's study. It measures approximately\n19 x 12 x 14 mm (previously 17 x 10 x 14 mm). The main pancreatic duct\nappears more prominent on today's study measuring up to 4 mm. There is no\nclear communication between the cyst and duct. There is no new nodularity. \nThe remainder of the pancreas is normal in signal characteristics.\n\nSpleen: Normal in size and signal characteristics.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The kidneys are normal in size and signal characteristics. Bilateral\nsubcentimeter renal cysts are noted. The largest cyst is in the lower pole of\nthe left kidney measuring up to 9 mm. No solid masses. No hydronephrosis or\nhydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric or retroperitoneal adenopathy by size\ncriteria.\n\nVasculature: The visualized portion of the abdominal aorta and mesenteric\nvessels appear patent without any significant areas of narrowing or\ndilatation.\n\nOsseous and Soft Tissue Structures: Normal bone marrow signal characteristics.\nNo concerning osseous lesions.", "output": "The previously described bilobed cystic lesion in the head of the pancreas\nwhich most likely represents a side-branch IPMN appears slightly larger on\ntoday's study. The pancreatic duct is also slightly more prominent on today's\nexam. Follow-up MRCP in 6 months is recommended.\n\nCholelithiasis." }, { "input": "Pelvic images degraded due to artifact from bilateral hip prostheses.\n\nLower thorax: Unremarkable.\n\nLiver: The liver demonstrates normal signal intensity without suspicious focal\nlesions.\n\nBiliary: There is no intra or extrahepatic biliary duct dilatation. Layering\ngallstones are seen.\n\nPancreas: The pancreas demonstrates normal signal intensity without focal\nlesions. There is no pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Unremarkable.\n\nGastrointestinal Tract: There is no evidence of large or small bowel\nobstruction. Colonic diverticulosis.\n\nPelvis: No free fluid.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber and its branches are\npatent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified. There are bilateral hip prostheses.", "output": "1. No findings to explain patient's symptoms.\n2. Diverticulosis." }, { "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver: Normal in morphology. Diffuse hepatic steatosis as evidenced by loss\nof signal on the dual-echo GRE out-of-phase images as compared to the in-phase\nimages. Calculated fat fraction of 25%.\n\nThere are 2 lesions which are consistent with hepatic adenomas and are\nslightly decreased in size when compared to prior. These include a 1.0 cm\nlesion within hepatic segment 4A (22:42) which previously measured 1.2 cm and\na 2.1 x 1.0 cm lesion within hepatic segment 7 (22:57) which previously\nmeasured 2.2 x 1.5 cm. Both of these demonstrate high signal on T1 weighted\nimages, arterial phase enhancement, and no retention of contrast on the\nhepatobiliary phase.\n\nThere are multiple additional small scattered subcentimeter lesions which\ndemonstrate isointense signal on T2 weighted images, hyperintense signal on T1\nweighted images, arterial phase hyper enhancement, and retention of contrast\non hepatobiliary phase consistent with FNHs. These are overall unchanged in\nsize when compared to ___.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nwall is of normal caliber. No pericholecystic fluid. No gallstone.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.\n\nSpleen: Size is normal. No focal lesion.\n\nAdrenal Glands: Normal in signal and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement.\n\nNo solid mass.\n\nGastrointestinal Tract: Normal caliber loops of small bowel and colon.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Normal branching pattern of the\nceliac axis. Origin of the celiac artery and superior mesenteric artery are\npatent. Portal veins and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No soft tissue mass. Normal bone marrow\nsignal.", "output": "1. There is a hepatic adenoma noted within hepatic segment 4A and a second\nadenoma noted within hepatic segment 7. Both of these are slightly decreased\nin size when compared to prior.\n\n2. There are multiple small scattered stable subcentimeter liver lesions\nconsistent with FNHs.\n\n3. Hepatic steatosis with calculated fat fraction 25%." }, { "input": "Lower Thorax: The lung bases are grossly clear. No pleural or pericardial\neffusion.\n\nLiver: Liver demonstrates homogeneous signal intensity and smooth contour. \nNote is made of diffuse hepatic steatosis with loss of signal on out of phase\nimages, as compared to the inphase images (calculated fat fraction 21%).\n\nIn segment IV A there is a 0.7 cm vague arterially enhancing lesion which does\nnot demonstrate retention of Eovist on delayed post-contrast images (07:44,\n23:41), which has decreased in size as compared to ___, when it measured\n1 cm. This is most consistent with a hepatic adenoma.\n\nIn segment VII is a second 1.3 x 0.4 cm vague arterial enhancing lesion which\ndoes not demonstrate retention of Eovist on delayed postcontrast images (7:61,\n23:61), which is decreased in size as compared to ___, when it measured\n2.1 x 1 cm. This is most consistent with a hepatic adenoma.\n\nThere are scattered T2 hyperintense cysts or biliary hamartomas are noted\nwithin the liver. In segment III there is a 1.2 x 1.2 cm T1 isointense, T2\nisointense arterially enhancing lesion which demonstrates peripheral retention\nof Eovist on delayed post-contrast images (7:73, 23:67). This finding is new\nfrom ___ studies, and most consistent with a focal nodular hyperplasia.\n\nAgain seen are multiple small hepatic lesions with arterial hyper enhancement\nand retention of contrast on delayed images, which are overall stable in size\nand number, and are most consistent with focal nodular hyperplasia.\n\nBiliary: The gallbladder is within normal limits. No intra or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: Pancreas demonstrates normal bulk and signal intensity. No focal\npancreatic lesions, ductal dilatation, or peripancreatic stranding.\n\nSpleen: Spleen is normal in size and demonstrates homogeneous signal\nintensity.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Kidneys normal in size and demonstrate symmetric enhancement. \nScattered subcentimeter T2 hyperintense cortical cysts are noted bilaterally. \nAn equivocal 2 mm area of enhancement peripherally in the interpolar region of\nthe right kidney (9:92) was not previously seen, and may represent a prominent\nvessel. No hydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: Imaged loops of large and small bowel are normal in\ncourse and caliber.\n\nLymph Nodes: No enlarged retroperitoneal or mesenteric lymph nodes.\n\nVasculature: The abdominal aorta is normal in caliber. The portal and hepatic\nveins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified.", "output": "1. Hepatic adenomas and segment IV A and VII are again noted, and have\ndecreased in size as compared to the prior study. Continued annual\nsurveillance is recommended.\n2. Multiple small scattered stable subcentimeter hepatic lesions, as well as a\nnew lesion in segment III, are consistent with focal nodular hyperplasia.\n3. Moderate hepatic steatosis with a calculated fat fraction of 21%.\n4. Equivocal 2 mm area of enhancement in the right kidney is likely a\nprominent vessel. This can be followed on subsequent surveillance studies.\n\nRECOMMENDATION(S):\n1. Hepatic adenomas and segment IV A and VII are again noted, and have\ndecreased in size as compared to the prior study. Ongoing surveillance in ___\nyear could be performed.\n2. Equivocal 2 mm area of enhancement in the right kidney is nonspecific but\nlikely represents a prominent vessel. This can be followed on subsequent\nsurveillance studies." }, { "input": "Lower Thorax: There is a moderate right pleural effusion and small left\npleural effusion, better assessed on the prior CT. The base of the heart is\nmildly enlarged. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour without morphologic features\nof cirrhosis. There is no hepatic steatosis. Within the limitations of this\nnoncontrast exam, no focal liver lesion is identified.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is not distended. There is no MRI of evidence of cholecystitis. \nMultiple gallstones are identified.\n\nPancreas: The pancreatic parenchyma is normal in signal. There is mild fatty\natrophy. No duct dilation or solid mass is identified. In the tail of the\npancreas, there are two cystic lesions. The smaller of the two measures 11 mm\n(2, 15). The larger of the two measures 15 mm and has a pseudoseptation (2,\n17). These both appear to have been present in ___, though have slowly been\nincreasing in size since ___.\n\nSpleen: The spleen is normal in size, measuring 9.6 cm. There are no focal\nlesions.\n\nAdrenal Glands: In the right adrenal gland, there is a a 23 x 25 mm nodule and\na 17 x 15 mm nodule. Both are unchanged from prior exams, dating to ___. \nThey demonstrate drop in signal on the out of phase images in comparison to\nthe in phase images. These are compatible with adenomas, or possibly\nmyelolipomas. The left adrenal gland is normal.\n\nKidneys: The kidneys are normal in size. There is minimal bilateral symmetric\ncortical atrophy. There is no mass or other abnormal signal corresponding to\nthe abnormality seen on CT. It is much better characterized on the CT. There\nis no obvious restricted diffusion. Due to motion and the lack of intravenous\ncontrast, it is not fully characterized on this exam.\n\nThere are multiple T2 hyperintense lesions in both kidneys, which are most\ncompatible with cysts. Two in the midpole of the left kidney, one in the\nlower pole of the left kidney, and one in the lower pole the right kidney are\nhyperintense on the precontrast T1 weighted images, suggesting they are\nhemorrhagic or proteinaceous. The largest cystic lesion is in the upper pole\nof the left kidney and measures 12 mm. These are incompletely characterized\non this exam without intravenous contrast.\n\nThere is no hydronephrosis. There is nonspecific perinephric edema, which is\nsymmetric.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in course and caliber without\nevidence of an aneurysm. Evaluation of the vasculature is limited on this\nnoncontrast exam.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe previously identified rib fractures are not included in the field of view\non this exam. There are mild to moderate multilevel degenerative changes\nthroughout the spine. There is mild diffuse anasarca. The soft tissues are\notherwise unremarkable.", "output": "Limited examination as the patient declined intravenous contrast.\n\n1. The previously identified left renal abnormality seen on CT has no\ncorrelate on this noncontrast MRI. Based on it's CT appearance and lack of a\ncorresponding mass, this most likely is an infectious or inflammatory process,\nsuch as focal pyelonephritis. Short term follow-up is recommended after\ntreatment to ensure resolution, as an infiltrative tumor cannot be completely\nexcluded.\n2. Bilateral renal cysts, some of which are hemorrhagic.\n3. Unchanged right adrenal adenomas or myelolipomas.\n4. Pancreatic cystic lesions measuring up to 15 mm. Per departmental\nprotocol, a followup MRCP is recommended in ___ year.\n5. Cholelithiasis.\n6. Moderate right pleural effusion and small left pleural effusion.\n\nRECOMMENDATION(S): 1. Short term follow-up of the left renal lesion with\neither a contrast enhanced MRI or contrast enhanced CT.\n2. Noncontrast MRCP in ___ year." }, { "input": "Lower Thorax: Partially imaged lung bases are clear.\n\nLiver: The liver is of normal size and demonstrates normal signal intensity.\n\nBiliary: No evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is of normal size and signal.\n\nPancreas: The pancreas is of normal bulk and signal intensity. Again\ndemonstrated, are multiple stable pancreatic status, the largest of which\nmeasures 2.1 x 3.0 x 2.1 cm arising exophytically from the pancreatic body. \nNo evidence of pancreatic ductal dilatation or peripancreatic abnormalities.\n\nSpleen: The spleen is of normal size and signal intensity.\n\nAdrenal Glands: The adrenal glands are of normal bulk and signal intensity\nbilaterally.\n\nKidneys: The kidneys are of normal size and signal intensity bilaterally.There\nis a stable 1.2 centimeter right lower pole cyst. Otherwise, no concerning\nrenal lesions.\n\nGastrointestinal Tract: Moderate-sized hiatal hernia, similar to prior. The\nsmall and large bowel loops are of normal caliber and configuration. No\nevidence of bowel obstruction.\n\nLymph Nodes: No evidence of mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Vasculature is patent. No evidence of aortic aneurysm.\n\nOsseous and Soft Tissue structures: Again demonstrated multilevel\ndegenerative changes of the lumbar spine with moderate to severe right\nforaminal stenosis at L2-L3. There is redemonstration of mild to moderate S\nshaped thoracolumbar scoliosis. The soft tissue structures are within normal\nlimits.", "output": "1. Cystic pancreatic lesions, statistically likely representing side-branch\nIPMNs,. The largest is in the body, measures 3 cm and stable since ___. \nRecommendation per below.\n2. Moderate size hiatal hernia.\n\nRECOMMENDATION(S): For pancreatic cysts measuring more than 1.5cm, patients\nshould be referred to the pancreas cyst clinic for consultation. These\nreferrals can be made by emailing ___\nor by calling ___.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Significant motion artifact on postcontrast imaging limits evaluation for\nfocal solid organ lesions.\n\nLower Thorax: The lung bases are excluded from view.\n\nLiver: The imaged portions of the liver are normal in size and contour. There\nis a 2.2 cm T2 hyperintense right hepatic lobe lesion likely representing a\nhepatic cyst or biliary hamartoma, which is similar compared to prior CT\nabdomen and pelvis (___:03). There is no hepatic steatosis.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is within normal limits.\n\nPancreas: Imaged portions of the pancreas are normal in bulk without evidence\nof pancreatic ductal dilatation. A 2 mm nonenhancing, T2 hyperintense lesion\nis seen in the pancreatic tail (___), likely representing a side-branch\nIPMN.\n\nSpleen: The spleen is partially excluded from view. The imaged portions\ndemonstrate signal intensity without evidence of focal lesions.\n\nAdrenal Glands: Partially imaged bilateral adrenal glands are normal in size\nand shape.\n\nKidneys: The kidneys are normal in size and position. Subcentimeter cortical\nand parapelvic cysts are seen bilaterally. T2 hypointense 1.5 cm\nnonenhancing, intrinsically T1 hyperintense lesion in the lower pole of the\nleft kidney is compatible with a hemorrhagic/proteinaceous cyst (03:21,\n10:72). There is no hydronephrosis or perinephric abnormality.\nThere is no definite evidence of a solid or enhancing lesion in the kidneys.\n\nGastrointestinal Tract: A moderate sized hiatal hernia is partially imaged. \nVisualized portions of small and large bowel demonstrate normal wall thickness\nand caliber without evidence of obstruction.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. The major abdominal\naortic branches are patent. There is a single left and single right renal\nartery. The portal vein is patent.\n\nOsseous and Soft Tissue Structures: There is no bone marrow signal abnormality\nor focal osseous lesion. The abdominal wall is within normal limits", "output": "1. Motion degraded study limits evaluation of focal solid organ lesion.\n2. 1.5 cm intrinsically T1 hyperintense cyst in the lower pole of the left\nkidney, is most consistent with a proteinaceous hemorrhagic cyst\n3. No concerning focal renal lesion.\n4. 2 mm pancreatic tail lesion likely represents a side branch IPMN. See\nrecommendations below.\n5. Partially imaged moderate sized hiatal hernia.\n\nRECOMMENDATION(S):\nFor management of pancreatic cyst(s) up to 5 mm in patients in less than ___\nyears of age, a non-contrast MRCP follow-up is recommended in ___ years. If\nremaining no larger than 5 mm at that point no subsequent followup is needed.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Images are overall degraded by motion and respiratory artifact.\n\nLower Thorax: Minimal dependent atelectasis is appreciated within bilateral\nlung bases. No pleural or pericardial effusion.\n\nLiver: The background hepatic parenchyma exhibits normal signal. The 1.8 cm\narterially enhancing lesion seen in segment 2 that was previously described is\nnot as easily appreciable in the current study. A questionable correlate of\nthe lesion is seen in series 19, image 12. Unchanged appearance of the\nsegment ___ cyst. No new hepatic lesions are seen. The main portal vein is\npatent. There is similar appearance of the loculated perihepatic fluid\nparticularly in ___'s pouch.\n\nBiliary: There is similar appearance of mild intrahepatic biliary ductal\ndilatation with dependent pneumobilia. The gallbladder contains sludge, and\nthere is fundal irregularity, which may be related to adenomyomatosis,\nunchanged compared to prior. A CBD stent is in situ, unchanged in appearance\ncompared to previous. Multiple filling defects within the CBD stent likely\nrepresent gas locules.\n\nPancreas: The pancreas is slightly atrophic. The main pancreatic duct is\ndilated and irregular, measuring up to 8 mm similar compared to previous. \nThere may be obstruction secondary to the CBD stent.\n\nSpleen: Normal appearance of the spleen, with no focal lesions.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable, with no focal\nlesion.\n\nKidneys: Normal appearance of bilateral kidneys. There are bilateral\nperipelvic cysts. No solid lesions. No hydronephrosis.\n\nGastrointestinal Tract: The imaged alimentary tract is within normal limits,\nwith normal small bowel caliber and wall thickness.\n\nLymph Nodes: A necrotic precaval lymph node is overall similar in appearance\ncompared to previous, measuring 2.0 x 3.7 cm.\n\nVasculature: The abdominal vasculature is patent.\n\nOsseous and Soft Tissue Structures: Normal bone marrow signal. Mild\nscoliosis.", "output": "1. Study is limited by respiratory motion artifact. The segment 2 lesion\npreviously described is only vaguely appreciated, but is grossly unchanged\ncompared to prior, and likely represents a perfusion anomaly.\n2. CBD stent in situ with persistent mild dilatation of the main pancreatic\nduct as well as mild central intrahepatic biliary ductal dilatation and\npneumobilia. There may be partial obstruction of the pancreatic duct from the\nCBD stent.\n3. Loculated perihepatic ascites, unchanged.\n4. Similar appearance of an enlarged necrotic precaval lymph node." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, the bilateral lung bases\nare grossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is no\nevidence of hepatic steatosis. There is crowding of vessels in the posterior\nright hepatic lobe, which could suggest mild atrophy. A 1.6 x 0.9 cm\nwedge-shaped focus of arterial enhancement, which normalizes on the more\ndelayed phases and demonstrates no correlate on the T2 weighted images, is\ncompatible with a transient hepatic intensity difference. There is no\nsuspicious hepatic lesion.\n\nHepatic arterial anatomy is conventional. The portal and hepatic veins are\npatent.\n\nBiliary: The gallbladder surgically absent. A 2.5 x 1.6 cm fluid intensity\nstructure in the gallbladder fossa is compatible with remnant gallbladder\nneck, which contains a few tiny stones. There is an adjacent 0.8 x 0.8 cm,\nenhancing soft tissue focus (series 10, image 56), which may represent a small\nlymph node or granulation tissue.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is normal in size, measuring 11.5 cm in length, and normal\nin signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are normal in sizes and\nshape.\n\nKidneys: There is a 1.1 x 0.9 cm simple cyst in the upper pole of the left\nkidney, and another tiny cyst in the lower pole. There is no hydronephrosis\nor perinephric abnormality.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There are multiple prominent periportal lymph nodes, the largest\nmeasuring 2.6 x 1.4 cm (series 12, image 56), likely reactive to the\nunderlying liver disease. There are also mildly prominent left para-aortic\nlymphatic channels.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: Note is made of osseous hemangiomas in the\nT10 and T11 vertebral bodies. No suspicious osseous lesion is identified. \nThe abdominal wall is within normal limits.", "output": "1. No evidence of hepatic steatosis currently. No gross morphologic changes\nof cirrhosis, though crowding of the vessels in the posterior right hepatic\nlobe may suggest mild atrophy. No suspicious hepatic lesion.\n\n2. Surgically absent gallbladder. 2.5 x 1.6 cm remnant gallbladder neck,\nwhich contains a few tiny stones. Subcentimeter adjacent enhancing soft\ntissue focus, which may represent a small lymph node or granulation tissue." }, { "input": "Lower Thorax: The visualized lung bases are unremarkable.\n\nLiver: There is no hepatic steatosis. Arterially enhancing foci in the\nperiphery of the right lobe, the caudal aspect of segment 5 and in subcapsular\nsegment 4A (series 1101, image 37, series 1101, image 87 and series ___,\nimage 44) are less apparent on additional phase of imaging and likely\nrepresent transient hepatic intensity differences. No suspicious hepatic\nlesions.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is surgically absent. There is a re-demonstrated gallbladder\nremnant in the gallbladder fossa which contains multiple tiny stones. The\nlesion also contains a 8 mm enhancing focus, which may represent a small lymph\nnode or granulation tissue.\n\nPancreas: The pancreas is normal in size and signal intensity.\n\nSpleen: The spleen is normal in size and signal.\n\nAdrenal Glands: The adrenal glands are unremarkable, bilaterally.\n\nKidneys: Tiny T2 hyperintense lesions in the kidney, bilaterally are\nconsistent with simple cysts. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach is normal. Visualized loops of small and\nlarge bowel are unremarkable.\n\nLymph Nodes: Prominent porta hepatis lymph nodes are likely reactive. There\nis no retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: Multiple vertebral body hemangiomas are\nstable.", "output": "1. No evidence of malignancy. No hepatic steatosis.\n2. Unchanged appearance of the remnant gallbladder. A subcentimeter\nenhancing focus likely represents a small lymph node or granulation tissue." }, { "input": "Lower Thorax: The lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nLiver: The hepatic parenchyma demonstrates normal signal intensity on T1 and\nT2 weighted sequences. There are ill-defined transient hepatic intensity\ndifferences (series 10, image 37, 46, 59). No focal hepatic mass is detected.\n\nBiliary: A remnant gallbladder is again demonstrated, containing multiple\nsmall stones (series 3, image 25). There is no intra extrahepatic bile duct\ndilation. No ductal stones are detected.\n\nPancreas: The pancreas demonstrates normal signal intensity and bulk, without\nduct dilation or focal lesion.\n\nSpleen: The spleen size is within normal limits. There are no focal splenic\nlesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis.\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal lesion.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy. \nProminent left para-aortic nodes are again demonstrated, unchanged over\nmultiple prior examinations (series 16, image 70).\n\nVasculature: The abdominal aorta, celiac trunk, SMA, and renal arteries are\npatent and normal in caliber. Conventional hepatic arterial anatomy is\ndemonstrated. The portal and hepatic veins are patent. There is an accessory\nleft renal artery (series 10, image 61). The IVC is patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection. There is an 11 mm lower thoracic vertebral body\nhemangioma (series 2, image 34).", "output": "1. No focal hepatic lesion. No hepatic steatosis.\n2. Unchanged nonspecific prominent retroperitoneal lymph nodes, none meeting\nsize criteria for adenopathy.\n3. Remnant gallbladder containing multiple small stones. No intra or\nextrahepatic bile duct dilation, and no ductal stones." }, { "input": "Lower Thorax: There is a trace right pleural effusion. The bases of the lungs\nare otherwise clear. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: Centered in segment 4, there is a dominant heterogeneous mass with\nill-defined borders. The mass measures approximately 11 x 10.3 x 11.6 cm. It\nis slightly hyperintense on the T2 weighted images, and demonstrates\nprogressive enhancement. It is inseparable from the gallbladder wall,\nparticularly in the central portion of the gallbladder, which is indented due\nto mass effect from the surrounding tumor. Portions of the mass are\nnonenhancing, suggesting there is some central necrosis. There is associated\ncapsular retraction and irregularity. Additionally, there are innumerable\nsatellite lesions throughout the liver, in both the right and left lobes. The\nlargest is in the periphery of segment ___ and measures 2.7 x 2.7 cm (4, 16). \nThe lesions all have similar characteristics. There are none that have the\nclassic appearance of an abscess.\n\nThe hepatic arterial anatomy is conventional, other than the presence of an\naccessory left hepatic artery. The portal veins are patent. There is a\nperipheral hepatic vein thrombus in a branch of the middle hepatic vein\nadjacent to the dominant mass (16, 32). The segment of thrombus in short,\nmeasuring approximately 14 mm.\n\nBiliary: There is mild left intrahepatic biliary duct dilation related to the\nmass. The common bile duct is normal in caliber without dilation. There is\nno evidence of choledocholithiasis. No significant abnormal enhancement is\nnoted around the intrahepatic bile ducts to suggest ongoing active\ncholangitis.\n\nAs described earlier, the dominant mass in the liver is inseparable from the\ngallbladder wall. The gallbladder remains distended. In the neck of the\ngallbladder, there is a unchanged 2.9 cm stone. There is no significant wall\nthickening or pericholecystic inflammatory changes to suggest acute\ncholecystitis. Overall, the configuration of the gallbladder is very similar\nto that from the CT on ___.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or solid mass. In the tail of the\npancreas, there are three sub-5-mm cystic lesions (4, 23 and 25). In the body\nof the pancreas, there is one 5 mm cystic lesion (4, 29). These likely\nrepresent side branch IPMNs. There is no evidence of active pancreatitis.\n\nSpleen: The spleen is normal in size, measuring 11.2 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. In the left kidney, there is a 3.7\ncm cyst. Other subcentimeter cysts are noted bilaterally. There are no\nworrisome renal lesions, hydronephrosis, or perinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is a small amount of ascites.\n\nLymph Nodes: There are multiple enlarged partially necrotic periportal lymph\nnodes measuring up to a 35 x 25 mm (17, 63). These are highly suspicious for\nmetastatic disease. Additionally, there are numerous retroperitoneal and\nretrocrural lymph nodes. The largest measures 10 mm in the short axis and\nalso are concerning for metastatic disease. Along the inferior left lobe of\nthe liver, there are multiple irregular soft tissue nodules. The largest\nmeasures 22 x 16 mm (17, 65). This is concerning for extrahepatic/omental\ndisease.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is mild atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild stranding in the anterior abdominal wall is likely from changes related\nto the recent biopsy. There is no large hematoma. The soft tissues are\notherwise unremarkable.", "output": "1. Dominant mass in segment 4 of the liver, which has characteristics most\nsuggestive of cholangiocarcinoma. There is evidence of metastatic disease,\nwith innumerable satellite lesions, omental/extrahepatic nodules, and\nlymphadenopathy, as described above. There is no definite evidence of a liver\nabscess.\n2. Mild left intrahepatic biliary duct dilation related to the dominant mass.\nNo choledocholithiasis or active cholangitis.\n3. Cholelithiasis with a single stone in the neck of the gallbladder. The\ngallbladder is distended and partially encased by the dominant mass. The\nconfiguration is similar to the prior CT, there are no significant\ninflammatory changes to suggest active cholecystitis.\n4. Short hepatic vein thrombus, as described above.\n5. Sub-5-mm pancreatic cystic lesions, which are most compatible with side\nbranch IPMNs.\n6. Small amount of ascites.\n7. Trace right pleural effusion." }, { "input": "Liver: There are numerous hepatic lesions with CSF signal and no definite\nenhancement within the limitations of no subtraction images. The largest\nlesion measures 1.7 cm. These are likely are cysts, some of which demonstrate\nseptations. The liver is otherwise unremarkable without steatosis.\n\nBiliary: No biliary ductal dilatation. The gallbladder is unremarkable.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The right adrenal gland is unremarkable. There is a 1 cm left\nadrenal nodule the remains indeterminate as there is no drop of signal on the\nT1 out of phase.\n\nKidneys: The kidneys are unremarkable except for a few cysts. There is no\nhydronephrosis.\n\nGastrointestinal Tract: The known gastric malignancy is not demonstrated. No\nintestinal obstruction or ascites in the upper abdomen.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes.\n\nVasculature: The hepatic vasculature is patent\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions visualized.", "output": "The hepatic findings on recent CT most likely correspond to cysts.\n\n1 cm indeterminate left adrenal nodule. This could be reassessed on routine\nfollow-up oncologic imaging given that statistically incidental adrenal\nnodules are likely benign." }, { "input": "Lower Thorax: The visualize bilateral costophrenic angles are clear. There is\nno pleural effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is mild\ndiffuse hepatic steatosis, with more pronounced fatty deposition in the region\nof the porta hepatis. There are scattered subcentimeter T2 hyperintense\nlesions in the imaged portions of the liver, incompletely characterized in the\nabsence of intravenous contrast but likely representing cysts or biliary\nhamartomas.\n\nBiliary: The gallbladder is normal in appearance. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas normal in signal. There is no pancreatic ductal\ndilatation.\n\nSpleen: The spleen is normal in size. Incidental note is made of an small\naccessory spleen inferiorly\n\nAdrenal Glands: There is a 2.8 x 1.9 cm nodule in the left adrenal gland which\ndemonstrates signal loss on the out of phase images, in keeping with intra\nvoxel fat, representing an adenoma. The right adrenal gland is within normal\nlimits.\n\nKidneys: The kidneys are symmetric in size. There are scattered tiny cortical\ncysts in both kidneys. There is no hydronephrosis.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: The bone marrow is normal in signal. The\nabdominal wall is within normal limits.", "output": "1) 2.8 x 1.9 cm adenoma in the left adrenal gland.\n\n2) Mild diffuse hepatic steatosis." }, { "input": "Lower Thorax: Trace right pleural effusion is noted.\n\nLiver: The liver parenchyma is homogeneous with no evidence of focal lesion.\n\nBiliary: There is mild dilation of the extrahepatic and central intrahepatic\nbile ducts, likely physiologic in the setting of prior cholecystectomy.\n\nPancreas: Unremarkable with no main duct dilation and no evidence of focal\nlesion.\n\nSpleen: Normal size and enhancement.\n\nAdrenal Glands: Normal size and shape bilaterally.\n\nKidneys: Both kidneys are unremarkable aside from a small right parapelvic\ncyst and bilateral millimetric cortical cysts. There is no hydronephrosis.\n\nGastrointestinal Tract:\n\nVisualized bowel is grossly unremarkable aside from colonic diverticulosis. \nThere is moderate ascites, unchanged from prior CT today.\n\nThe known 6.1 x 5.7 x 3.0 cm soft tissue mass in the right subdiaphragmatic\nregion demonstrates T2 hyperintensity, diffusion restriction and avid arterial\nenhancement. This is contacting the external surface of the liver and is\nlikely peritoneal in location. There is associated arterial hyperenhancement\naround the liver surface subjacent to the lesion, likely reactive but it is\ndifficult to exclude invasion.\n\nThere is heterogeneous, ill-defined enhancement in the greater omentum,\nparticularly at the right (1202:60) and left superior (1202:32) aspects,\ncorresponding with soft tissue density stranding on CT and highly concerning\nfor metastatic disease.\n\nLymph Nodes: No enlarged lymph nodes within the field-of-view.\n\nVasculature: No abdominal aortic aneurysm. Patent hepatic vasculature.\n\nOsseous and Soft Tissue Structures: Small T2 hyperintensities in the T7 and T8\nvertebral bodies are likely hemangiomas. No aggressive bone lesions are\nidentified. Abdominal soft tissues are unremarkable aside from mild\nsubcutaneous edema.", "output": "1. A 6.1 cm right subdiaphragmatic mass, consistent with metastasis.\n2. Multiple areas of abnormal greater omental enhancement, highly suspicious\nfor metastatic disease.\n3. Moderate ascites, stable from prior CT today." }, { "input": "The liver is normal in size and contour without evidence of hepatic steatosis.\nThe hazy hypo and attenuating focus within segment 8 as seen on recent CT is\nnot apparent on the precontrast T2 weighted images as a indistinct and region\nof T2 hyperintense signal (08:10. On precontrast T1, there is a central region\nof hypointensity with the periphery being relatively occult (17:31. During the\narterial phase, there is a halo of hyperenhancement (___) within the\nperiphery which subsequently equilibrates. The lesion is so called on the\nsubsequent post contrast sequences. There is no associated differential fat\nwithin this region or restricted diffusion. Overall the findings are most\nsuggestive of a small focal nodular hyperplasia. A 6 mm cyst is noted within\nthe segment 3 of the liver (08:18). No additional focal lesion is seen.\n\nThe biliary tree, pancreas, spleen, adrenal glands and left kidney are\nunremarkable. The right kidney is somewhat under rotated with the pelvis\noriented anteriorly rather than medially. There is small amount of fluid\nwithin the a pair renal fat anteriorly, adjacent to the renal hilum and\ntracking superiorly to the lateral aspect of the second portion the duodenum\n(08:26). This is of unclear etiology. There is no hydronephrosis or renal\nparenchymal abnormality. No perinephric stranding is seen along the remainder\nof the kidney.\nPelvis: Trace amount of free pelvic fluid is noted, nonspecific finding in a\nyoung female. There is a 2.5 cm cyst associated with the left ovary. This is\nsimple in appearance and warrants no and imaging followup. The raw right ovary\nis unremarkable. The uterus is notable for is susceptibility artifact along\nthe anterior lower uterine segment, suggestive of prior cesarean section.\nThere is also susceptibility artifact along the lower abdominal wall in a\ntransverse incision distribution.\n\nThere are 2 enhancing abdominal wall masses associated with the right rectus\nmuscle just above the level of the incision (20:67). The more inferior and\nlateral mass has ___ of 3.4 by 2.9 x 4.8 cm. It is intermediate T2\nsignal within the peripherally low signal and centrally heterogeneous signal.\nIt is intermediate on T1 weighted images with mildly enhancing. The more\nsuperior and medial lesion has similar signal and enhancement characteristics\nwith ___ of 1.7 x 2.2 x 2.8 cm. The intervening right abdominal rectus\nmuscle is atrophied and replaced with fat. There is some stranding within the\nsubjacent peritoneum.", "output": "Segment 8 indeterminate lesion on the recent CT has MRI characteristics most\nsuggestive of a small focus of focal nodular hyperplasia. While the features\nare most consistent with FNH, the CT appearance is nonspecific. Follow up in\n___ months can be obtained with a hepatobiliary agent (Eovist) which could be\nmore definitive in confirming the diagnosis of FNH.\n2 enhancing mass is associated with the right abdominal rectus muscle adjacent\nto the cesarean section incision. These have imaging characteristics most\nsuggestive of desmoids." }, { "input": "Lower thorax: The lungs are essentially clear. No pericardial or pleural\neffusion.\n\nLiver: Liver demonstrates homogeneous intensity without significant increase\nin signal on in and out of phase imaging suggesting no significant steatosis. \nNo concerning focal hepatic lesions are demonstrated.\n\nBiliary: No intrahepatic or extrahepatic biliary dilatation.\n\nPancreas: The pancreas demonstrates homogeneous intensity without focal\nlesions. No pancreatic ductal dilatation. No peripancreatic ductal fat\nstranding.\n\nSpleen: The spleen demonstrates homogeneous intensity without focal lesion or\nenlargement.\n\nAdrenal Glands: The left adrenal gland is diffusely thickened without discrete\nmass. Within the medial limb of right adrenal gland is a 1.1 cm with a drop\nin signal intensity on out of phase imaging when compared to in phase imaging\nlikely representing an adrenal adenoma, (series 7, image 25,26).\n\nKidneys: The kidneys are normal in size and configuration. There are numerous\ncortical T2 hyperintense lesions which likely represent simple renal cysts. \nThe largest is located at the inferior right kidney and measures 2.9 x 2.1 cm.\nWithin the mid left kidney is a 9 mm T1 hyperintense and T2 hypointense renal\nlesion likely representing a hemorrhagic cyst. Within the mid left kidney is\na 1.6 x 1.0 cm angiomyolipoma, (series 1303 image 101).\n\nGastrointestinal Tract: Moderately-sized hiatal hernia otherwise the stomach\nis unremarkable. A colonic mass at the hepatic flexure demonstrates\nhyperenhancement and restricted diffusion, (series 1302, image 135) (series 6,\nimage 28) which likely represents a known colonic mass. The sigmoid colon\ndemonstrates few scattered diverticulosis without evidence of acute\ndiverticulitis.\n\nReproductive organs: The endometrium demonstrates heterogenous intensity and\nmeasures up to 3.0 cm.\n\nLymph Nodes: There are conspicuous mesenteric lymph nodes unchanged since CT\nabdomen and pelvis dated ___, (series 9, image 14). No\nretroperitoneal lymphadenopathy is demonstrated.\n\nVasculature: No aortic aneurysms demonstrated\n\nOsseous and Soft Tissue Structures: No suspicious focal osseous lesions is\ndemonstrated", "output": "1. A hyperenhancing colonic mass is demonstrated at the hepatic flexure likely\nrepresenting known colon cancer.\n2. A thickened, heterogenous endometrium is concerning for malignancy.\n3. Within the mid left kidney is a 9 mm, T1 hyperintense and T2 hypointense\nrenal lesions which likely represents a hemorrhagic cyst.\n4. Within the medial limb of the right adrenal gland is a 1.1 cm lesion which\nlikely represents an adrenal adenoma.\n\nRECOMMENDATION(S): Follow-up endometrial biopsy is recommended unless there\nhas been prior interrogation of the endometrium." }, { "input": "Liver: There is diffuse hepatic steatosis with calculated fat fraction 9.6%. \nThere is no focal hepatic lesion. There is no ascites. Gallbladder is not\nvisualized.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThere is no evidence of biliary filling defect.\n\nPancreas: There is fatty atrophy of pancreatic parenchyma. There is no\nevidence of pancreatic ductal dilatation or solid pancreatic mass. Few small\ncystic lesions pancreatic head/neck largest measuring 5 mm (04:28) are likely\nsmall side branch IPMN.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: Right adrenal nodule measuring 2.1 x 2.6 cm is similar to\nprior CT examination and demonstrates signal loss on opposed phase imaging\nconsistent with intra voxel fat.\n\nKidneys: Kidneys are symmetric in size in shape. There is symmetric renal\nenhancement and excretion of intravenous contrast. Nonenhancing T1\nhypointense, T2 hyperintense cortically based lesion in the left interpolar\nlesion is consistent with cyst.\n\nGastrointestinal Tract: Imaged bowel loops are normal in caliber and wall\nthickness.\n\nLymph Nodes: There are no enlarged abdominal lymph nodes.\n\nVasculature: Abdominal aorta is normal course and caliber. The hepatic,\nportal, splenic, and superior mesenteric veins are patent.\n\nOsseous and Soft Tissue Structures: There is severe levoconvex scoliosis. On\nfat saturated T2 weighted imaging, there are foci of increased T2 signal\nwithout correlate on CT from ___. Finding likely represents normal\nintervertebral disc signal presenting with atypical appearance given marked\nscoliosis.", "output": "1. Unchanged right adrenal nodule with signal loss on out of phase imaging\nconsistent with adenoma.\n2. Few small cystic lesions in the pancreatic head/neck, largest measuring 5\nmm likely represent small IPMN.\n3. No biliary ductal abnormality.\n4. Hepatic steatosis.\n\nRECOMMENDATION(S): MRI followup in ___ year to evaluate stability of\nsubcentimeter pancreatic cystic lesions." }, { "input": "Lower thorax: Limited assessment of lung bases are clear. No large pleural\nor pericardial effusion.\n\nLiver: The liver is homogeneous in attenuation and smooth in contour. No\nfocal hepatic lesion. The gallbladder is unremarkable.\n\nBiliary: No intra or extrahepatic biliary duct dilatation.\n\nPancreas: Within normal limits. No pancreatic duct dilatation. No\nperipancreatic fluid collection. No focal pancreatic lesion.\n\nSpleen: Homogeneous in attenuation and normal in size measuring 9.8 cm.\n\nAdrenal Glands: Within normal limits.\n\nKidneys: Symmetric in size. No hydronephrosis or perinephric fluid\ncollection. No focal lesions.\n\nGastrointestinal Tract: The stomach is unremarkable. Visualized small and\nlarge bowel are within normal limits without dilatation or wall thickening. \nThe rectum is normal without wall thickening or abnormal enhancement. Again\nseen is tethering of bowel of the level of the cervix, unchanged since prior\nexamination. No evidence of obstruction.\n\nPelvis: No free fluid. The bladder is well distended and unremarkable. The\ndistal ureters are within normal limits. A 0.5 x 0.5 cm (11:34) nonenhancing\nT2 hyperintense follicular cyst is seen within the right ovary. Similar\nappearing follicular cysts are seen within the left ovary. No worrisome\nadnexal mass. A 1.3 x 1.2 cm (11:27) T2 hyperintense nonenhancing cystic\nlesion adjacent to the right ovary is consistent with a para ovarian cyst.\nPatient is status post supracervical hysterectomy with associated postsurgical\nchanges with small amount of fluid within the cervix. A stable 0.9 x 0.5 cm\n(11:36) mildly T2 hyperintense nonenhancing lesion within anterior cervix is\nconsistent with a nabothian cyst. A 0.4 x 0.4 cm (13:111) T1 hyperintense\nnonenhancing area along the superior aspect of the cervix is in close\nproximity to adjacent T1 hyperintense loops of small bowel and is likely\nlocated within bowel.\n\nLymph Nodes: No retroperitoneal, mesenteric, or periportal lymph node\nenlargement. No pelvic sidewall lymph node enlargement. Multiple normal\nappearing inguinal lymph nodes are present.\n\nVasculature: Visualized aorta is normal in caliber without aneurysmal\ndilatation. The celiac axis, SMA, ___, and renal arteries are patent. The\ncommon, external, and internal iliac arteries are patent. Main portal vein,\nSMV, and portal veins are patent.\n\nOsseous and Soft Tissue Structures: No abnormal bone marrow signal. Patient\nis status post resection of right lower quadrant endometrioma with partial\nresection of the right internal and external oblique muscles with placement of\nsurgical mesh. Subtle enhancement along the surgical cavity anterolaterally\nhas mildly decreased since prior examination and is consistent with\npostsurgical changes and granulation tissue. Visualized soft tissues are\notherwise unremarkable.", "output": "1. Status post supracervical hysterectomy with small amount of fluid within\ncervix and stable postsurgical changes including tethering of adjacent bowel\nloops. No obstruction.\n2. Postsurgical changes in a patient who is status post partial resection of\nright external and internal oblique muscles with mesh placement for prior\nendometrioma.\n3. No definite evidence of recurrence or residual endometriosis.\n4. Stable 0.9 cm nabothian cyst.\n5. Stable 1.3 cm right parovarian cyst." }, { "input": "ABDOMEN: The duodenum, jejunum, and ileal small bowel loops demonstrate\nnormal fold pattern, wall thickness and caliber. No abnormal fluid\ncollections or significant free fluid. No significant lymphadenopathy in the\nmesentery by size criteria. The terminal ileum, cecum, and ileocecal valve are\npreserved. Although the appendix is not definitively identified, no\ninflammatory changes are seen in the right lower quadrant. Stool is present\nthroughout the colon, correlating with constipation. No abnormal colonic wall\nthickening, enhancement or adjacent colonic stranding. There is fecalization\nof the distal small bowel loops, a finding that can be seen in malabsorption.\nTransit of oral contrast to the right colon is preserved.\n\nPartially included liver and spleen are unremarkable. Gallbladder is within\nnormal limits. No intrahepatic or extrahepatic biliary ductal dilatation. \nNormal pancreas. Both adrenal glands are within normal limits.\n\nThere is incidental note made of a horseshoe kidney with a parenchymal band\nconnecting the inferior poles of the kidneys. Mild bilateral\npelvocaliectasis. The ureters are normal in caliber and opacification. No\nworrisome renal masses are seen. No perinephric fluid collections or\nsignificant retroperitoneal adenopathy.\n\nPELVIS: Uterus is age appropriate. No free fluid in the pelvis. Physiologic\nfollicles are in both normal-sized ovaries. Urinary bladder is distended and\nunremarkable. No significant pelvic or inguinal adenopathy by size criteria.\n\nOverlying soft tissues and visualized osseous structures are within normal\nlimits.\n\n2D and 3D reformationg were essential in providing multiple perspectives for\nthe dynamic series.", "output": "1. Normal small bowel fold pattern, caliber, and wall thickening. No\nevidence of hyperenhancement or focal abnormality.\n2. Stool is seen throughout the colon without abnormal wall thickening or\nadjacent inflammatory change.\n3. Incidental horseshoe kidney with a parenchymal band joining the inferior\npoles of the kidneys and pelvocaliectasis." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: Liver demonstrates homogeneous signal intensity throughout. There is\nno significant drop in signal on opposed phase imaging to suggest hepatic\nsteatosis (which was seen on the prior CT). Subcentimeter cyst or biliary\nhamartoma is noted in the left hepatic lobe. No concerning hepatic lesions\nare identified.\n\nBiliary: There is no biliary dilation. Gallbladder wall remains slightly\nthickened, suggestive chronic cholecystitis.\n\nPancreas: The pancreas is unremarkable in appearance. No focal lesions are\nidentified. There is no main duct dilation.\n\nSpleen: Spleen is normal in size, without focal lesions. Along the peripheral\ninferior margin of the spleen, there is an irregular area of heterogeneous T2\nsignal intensity, which is slightly hyperintense on T1 weighted imaging\n(03:21). This is a nonspecific finding, that could reflect prior hemorrhage\nor infarction. This appears new from the prior CT performed on ___.\n\nAdrenal Glands: Adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal is size and shape. No focal lesions\nidentified. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable in appearance. There is\nan intraluminal mass within the second portion of the duodenum that measures\n2.7 x 2.0 x 1.3 cm (03:34). It is hypointense on T2 weighted imaging. There\nis peripheral enhancement, although no central enhancement is demonstrated. \nThere is no restricted diffusion.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy. Mild\ninfiltration of the mesenteric fat surrounding several lymph nodes is\nsuggestive of mesenteric panniculitis.\n\nVasculature: Abdominal aorta is not aneurysmal. Mild narrowing at the origin\nof the common hepatic artery is noted, which may be due to atherosclerosis. \nNo calcifications or seen on the prior CT performed on ___. Superior\nmesenteric and bilateral renal arteries are patent.\n\nOsseous and Soft Tissue Structures: No focal osseous lesions are identified. \nThe soft tissues are unremarkable.", "output": "1. 2.7 x 2.0 x 1.3 cm well-circumscribed T2 hypointense intraluminal mass in\nthe second portion of the duodenum demonstrating rim enhancement. Findings\nare suggestive of a benign lesion such as a leiomyoma or intraluminal GIST. \nBrunner's gland hamartoma is felt to be less likely.\n2. Heterogeneous signal intensity along the inferior margin of the spleen,\ncould represent a sequela of prior hemorrhage or infarction.\n3. Persistent mild gallbladder wall thickening, may be due to chronic\ncholecystitis." }, { "input": "Limited assessment of solid visceral without IV contrast.\n\nLower thorax: Lung bases are clear.\n\nLiver: Noncontrast appearance of liver is normal in signal and morphology.\n\nBiliary: Uncomplicated cholelithiasis. No features of acute cholecystitis. \nNo intrahepatic or extrahepatic bile duct dilatation.\n\nPancreas: The pancreatic neck, body, and tail are again largely replaced by\nmultiple cysts of variable size. The largest cystic lesion, located within the\nproximal pancreatic body, is largely unchanged incise, now measuring 4.6 x 5.6\nx 3.7 cm in AP, transverse, and craniocaudal ___, previously 4.5 x 5.6\nx 3.7 cm (series 4, image 26). The second largest lesion localized to the mid\npancreatic body measures up to 3.0 x 2.9 by 3.7 cm, previously 2.7 x 2.9 x 3.4\ncm (series 4, image 25). The third largest lesion localized to the pancreatic\nneck measures 2.0 x 2.0 x 1.8 cm, previously 1.8 x 1.8 1.7 cm (series 4, image\n23). Innumerable additional smaller cystic lesions are not significantly\nchanged in sizes. There are no papillary projections/nodular solid components\npresent in association with the cystic lesions described above. The main\npancreatic duct does not appear dilated.\n\nSpleen: The spleen is not enlarged (10 cm).\n\nAdrenals: There is nodular thickening of the adrenal glands bilaterally,\nstable.\n\nKidneys: There are simple bilateral renal cortical cysts. Kidneys otherwise\nunremarkable. No hydronephrosis.\n\nBowel: Pancolonic diverticulosis. No findings of diverticulitis. Visualized\nloops of small bowel normal.\n\nVasculature: Abdominal aorta demonstrates features of atherosclerosis but\nremains normal in caliber.\n\nLymph nodes: No lymphadenopathy.\n\nOsseous: There is no abnormal marrow signal or focal suspicious osseous\nlesion.\n\nPeritoneum: No free fluid.", "output": "1. No adverse interval change. Overall stable appearance of the size or\nextent of cystic pancreatic lesions described above. No change in morphology.\n\n2. Cholelithiasis. Nodular thickening of the adrenal glands. Colonic\ndiverticular disease.\n\nRECOMMENDATION(S): Continued surveillance suggested in ___ years time." }, { "input": "Diffuse dropout of signal within the liver on T1 out-of-phase images is\nconsistent with fatty deposition. There are two focal T2 bright lesions with\nprogressive fill-in on post-contrast images, one at the dome measuring 14 mm,\ncorresponding to the abnormality on recent CT (6:9). The second is located\njust adjacent to the IVC and measures 8 mm (6:29). Both lesions are most\ncompatible with hepatic hemangiomas.\n\nThe hepatic and portal veins are patent. Hepatic arterial anatomy is\nconventional. There is no intra or extrahepatic biliary ductal dilatation.\nThere is an ill-defined mass at the gastroesophageal junction measuring\napproximately 2.7 x 1.8 cm (11:31) with multiple adjacent enlarged\ngastrohepatic lymph nodes measuring up to 1.6 cm (10:42).\n\nThe gallbladder is absent. The pancreas, spleen, and adrenals are normal. This\nvisualized small and large bowel are normal. There is no ascites. Note is made\nof a hemangioma in the lateral aspect of a lower thoracic vertebral body\n(2:29). There are no osseous lesions concerning for malignancy or infection.", "output": "1. Ill-defined mass at the gastroesophageal junction with gastrohepatic\nlymphadenopathy.\n2. Two hepatic hemangiomas, one correlating to the abnormality noted on CT.\nNo hepatic metastasis detected." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver demonstrates homogeneous signal intensity and smooth contour. A\n1.4 x 0.8 cm mildly T2 hyperintense progressive peripherally enhancing lesion\nin segment VIII is compatible with a hemangioma. Previously questioned linear\nabnormality segment IV B, adjacent to the falciform ligament, corresponds to\nan area of focal fatty change (7:31, 9:62). An additional area of focal fatty\nchange is seen more peripherally in segment IV B (07:31). Two subcentimeter\nT2 hyperintense nonenhancing lesions within segment VI likely represents cysts\nor biliary hamartomas (04:26). No suspicious hepatic lesions are identified.\n\nBiliary: The gallbladder is surgically absent. Mild intra and extrahepatic\nbiliary ductal dilatation is compatible with post cholecystectomy status. No\nfilling defect is identified within the biliary tree.\n\nPancreas: Pancreas demonstrates homogeneous signal intensity normal bulk. No\nenhancing pancreatic lesions, pancreatic ductal dilatation, or peripancreatic\nstranding.\n\nSpleen: Spleen is normal in size and demonstrate homogeneous signal\ncharacteristics.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Kidneys are normal in size and demonstrate symmetric enhancement. No\nenhancing lesions, hydronephrosis, or perinephric abnormality.\n\nGastrointestinal Tract: Patient is status post gastric pull-through. Imaged\nloops of large and small bowel are normal in course and caliber. There is\ncolonic diverticulosis.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber. Borderline hepatic veins\nare patent. Superior mesenteric vein and splenic vein patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified.", "output": "1. No suspicious hepatic lesions are identified.\n2. The previously questioned area in hepatic segment IVB is compatible with\nfocal fatty change." }, { "input": "Lower Thorax: The partially imaged lung bases are unremarkable.\n\nLiver: The liver is normal in contour. No focal lesions. The portal veins\nand hepatic veins are patent.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. The\ngallbladder contains a small gallstone without gallbladder distension or\nedema.\n\nPancreas: There is a cystic lesion in the medial pancreatic tail measuring up\nto 4 mm likely reflecting a side branch intraductal papillary mucinous\nneoplasm (series 5, image 17). No other focal lesions identified. The\npancreas is normal in signal intensity and enhancement. No main pancreatic\nduct dilation.\n\nSpleen: No focal lesions. No splenomegaly.\n\nAdrenal Glands: Two abutting nodules measuring up to 10 mm in the left adrenal\ngland are unchanged size. No definite loss of signal on out of phase relative\nto inphase imaging to diagnose a lipid rich adenoma.\n\nKidneys: The kidneys are normal and symmetric in size, shape, and nephrogram.\nMultiple small simple cysts. No concerning lesions. No hydronephrosis.\n\nGastrointestinal Tract: Patient is status-post total colectomy and end\nileostomy. ___ pouch noted. There is a serpiginous region of\nenhancement inferior to the ostomy which likely reflects a small venous\nstructure or postsurgical change. No surrounding edema or collection. There\nare postoperative changes in the anterior abdominal wall. There is no small\nbowel edema or obstruction. The ostomy appears unremarkable. The stomach is\nunremarkable.\n\nLymph Nodes: No mesenteric lymphadenopathy. Presacral lymph nodes measuring\nup to 8 mm short axis are unchanged.\n\nVasculature: No abdominal aortic aneurysm. There is an accessory or replaced\nleft hepatic artery arising from the left gastric artery.\n\nPelvis: Large bladder diverticulum. The bladder wall is trabeculated. There is\nincreased T2 signal centered in the left aspect of the prostate in the region\nof hypoattenuation seen on CT 8 months prior (series 4, image 25), possibly\nsequela of treatment for prostate cancer.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. There are\nmultiple sacral Tarlov cysts. There is a right lower quadrant end ileostomy\nand there are postoperative changes in the anterior abdominal wall, as\ndescribed above. Marked degenerative changes of the lumbar spine with\nprominent osteophyte formation (series 1402, image 107)", "output": "1. No etiology identified for the patient's reported symptoms. There is a\nright lower quadrant end ileostomy with associated postoperative changes, but\nno hernia, significant inflammation, or abscess.\n2. Two nodules measuring up to 10 mm in the left adrenal gland are unchanged\nsize and are not definitively characterized as lipid rich adenomas. These\nlesions are likely benign, however standard recommendation is adrenal protocol\nCT for washout kinetic assessment in 12 months\n3. There is increased T2 signal centered in the left aspect of the prostate in\nthe region of hypoattenuation seen on CT 8 months prior. While this may\nreflect sequela of prostate cancer treatment, recommend correlation with\nsymptoms and possible dedicated prostate imaging for prostatitis/abscess.\n4. Presacral lymph nodes measuring up to 8 mm short axis are unchanged.\n5. A 4 mm cystic lesion in the pancreatic tail likely reflects a side branch\nintraductal papillary mucinous neoplasm. For management of pancreatic cyst(s)\nup to 5 mm in patients ___ years of age or older, no follow-up is required.\n6. Cholelithiasis.\n\nRECOMMENDATION(S): Abutting nodules measuring up to 10 mm in the left adrenal\ngland are unchanged in size and are not definitively characterized as lipid\nrich adenomas. These lesions are likely benign, however standard\nrecommendation is adrenal protocol CT for washout kinetic assessment in 12\nmonths" }, { "input": "Lower Thorax: No pleural or pericardial effusion. Diaphragmatic lymph node\nmeasuring 7 mm is noted (03:12 and 11:21), not enlarged. Additional scattered\nepicardial/diaphragmatic lymph nodes are also not enlarged (e.g. 11:19, 17,\n22).\n\nLiver: There is diffuse moderate hepatic steatosis (fat fraction 13.0%). No\nconcerning focal liver lesion. Widening of the pre-portal space is noted.\n\nBiliary: There is no intra- or extrahepatic biliary ductal dilation. Aside\nfrom minimal fundal adenomyomatosis, the gallbladder is unremarkable.\n\nPancreas: There is a 3 mm cyst in the neck of the pancreas (03:31 02:15). \nOtherwise, the pancreas demonstrates normal homogeneous signal intensity. \nThere is no main pancreatic ductal dilation.\n\nSpleen: There is no splenomegaly or focal splenic lesion.\n\nAdrenal Glands: There is a 19 mm right adrenal adenoma (6:47 and 17). The\nleft adrenal gland is normal.\n\nKidneys: There are bilateral renal cortical cysts without suspicious features\nmeasuring up to 15 mm in the right kidney. The renal parenchyma otherwise\ndemonstrates normal, symmetric enhancement and signal bilaterally. No\nhydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. \nRe-identified is a left quadrant ostomy with a parastomal hernia containing\nseveral small bowel loops which are only partially visualized but appear\ngrossly unremarkable without evidence of obstruction. Non-dilated bowel loops\nare normal in course and caliber without evidence of wall thickening, abnormal\nenhancement, or obstruction. The colon is not seen. There is no ascites.\n\nLymph Nodes: There are prominent upper abdominal lymph nodes for example at\nthe portocaval station (03:29) and in the peripancreatic region (03:29), as\nwell as at the porta hepatis (03:33). No additional pathologically enlarged\nretroperitoneal mesenteric lymph nodes are seen.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. Major proximal tributaries are patent. Left gastric\nartery arises separately from the anterior abdominal aorta. Hepatic artery\nanatomy appears conventional. The IVC is normal in caliber and patent. The\nhepatic veins are patent. Patent portal vein, SMV, and splenic vein.\n\nOsseous and Soft Tissue Structures: No suspicious foci of abnormal marrow\nsignal are seen.", "output": "1. No concerning focal liver lesions.\n2. Widening of the pre-portal space is noted, which can be an MRI sign of\nearly cirrhosis.\n3. Diffuse moderate hepatic steatosis (fat fraction 13.0%).\n4. 3 mm cyst in the neck of the pancreas. Recommend follow-up MRCP in ___ year.\n5. Left lower quadrant ostomy with a parastomal hernia containing an increased\nlength of small bowel compared with the prior study of ___ small-bowel\nloops within the hernia sac are only partially visualized but appear grossly\nunremarkable without evidence of obstruction.\n6. 19 mm right adrenal adenoma.\n\nRECOMMENDATION(S): ___ year follow-up MRCP." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: The liver is not cirrhotic. There is enlargement of the pre portal\nspace. There is mild hepatic steatosis (fat fraction 13%). No focal\nconcerning meeting OPTN 5 criteria.\n\nBiliary: No intra or extra biliary duct dilatation. There is a focal area of\nfundal adenomyomatosis.\n\nPancreas: The pancreas is normal in signal and bulk. No main duct dilatation.\n\nSpleen: The spleen is homogeneous and normal in size measuring 9.7 cm. There\nis a 6 mm hyper T2 lesion in the spleen; this represents either cyst or\nhemangioma.\n\nAdrenal Glands: The left adrenal is unremarkable. Unchanged 19 mm right\nadrenal adenoma.\n\nKidneys: The kidneys are unremarkable besides few bilateral cysts, the largest\nin the interpolar right kidney measuring 17 mm. No hydronephrosis.\n\nGastrointestinal Tract: No bowel obstruction. Redemonstration of a left\nquadrant ostomy with a parastomal hernia containing several small bowel loops\nwith no signs of obstruction. No ascites.\n\nLymph Nodes: Prominent porta hepatis lymph node measuring up to 15 mm).\n\nVasculature: No abdominal aortic aneurysm. The right hepatic artery is\nreplaced from the SMA.\n\nOsseous and Soft Tissue Structures: No concerning liver lesion.", "output": "1. Widening of the pre portal space which could represent signs of early\ncirrhosis. Mild hepatic steatosis.\n2. No concerning focal liver lesion.\n3. Uncomplicated left parastromal hernia.\n4. Right adrenal adenoma." }, { "input": "Lower Thorax: The lower thorax is unremarkable. There is no pericardial or\npleural effusion.\n\nLiver: The liver is cirrhotic with a nodular morphology. There is no evidence\nof signal dropout on out of phase imaging to suggest diffuse hepatic\nsteatosis. No focal hepatic lesions are seen.There is a diminutive appearance\nof the main portal vein measuring 6 mm (14:69). The right anterior portal\nvein measures 2 mm, the right posterior portal vein measures 3 mm, and the\nleft portal vein measures 6 mm. There is no evidence of thrombosis. The\nsplenic vein and SMV are patent.\n\nBiliary: The gallbladder is present. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity without pancreatic ductal\ndilatation or peripancreatic fluid.No pancreatic lesions are seen.\n\nSpleen: The spleen measures mildly enlarged at 13.1 cm.\n\nAdrenal Glands: The adrenal glands are normal in shape and size.\n\nKidneys: The kidneys demonstrate normal corticomedullary differentiation and\nare symmetric and normal in size without hydronephrosis.No renal lesions are\nseen.\n\nGastrointestinal Tract: The visualized large and small bowel demonstrate\nnormal thickness and caliber.\n\nLymph Nodes: There is no lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in size. Perigastric,\nperiesophageal and mesenteric varices are seen. There are large splenic\nvarices including a large splenorenal shunt (02:20). The celiac axis and SMA\ndemonstrate conventional anatomy. Incidental note is again made of a\npersistent left IVC which joins the left renal vein and empties into the right\nsided IVC.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen. \nThe body wall is within normal limits.", "output": "Cirrhotic liver morphology with sequela of portal hypertension including\nsplenomegaly and perigastric, periesophageal, and mesenteric varices including\na large splenorenal shunt. The celiac axis and SMA demonstrate conventional\nanatomy. The main and right portal veins, and to a lesser extent left portal\nvein, are diminutive without evidence of thrombosis. The SMV and splenic vein\nare patent. No focal hepatic lesions are seen.\nIncidental note is again made of a persistent left IVC which joins the left\nrenal vein and empties into the right sided IVC." }, { "input": "Lower Thorax: Mild subsegmental atelectasis is seen at the lung bases. There\nis no pleural or pericardial effusion.\n\nLiver: The liver is nodular, in keeping with cirrhosis, with areas of\nconfluent fibrosis. The main portal vein appears attenuated and contains an\neccentric linear filling defect (___) concerning for a nonocclusive\npartial thrombus. The left portal vein is not visualized. The proximal and\ndistal portions of the TIPS stent appear patent. There is absence of contrast\nwithin the mid portion of the stent but this may be artifactual secondary to\nslow flow. The entire splenic vein again appears thrombosed up to the portal\nconfluence, without extension into the confluence. The SMV is patent. \nMultiple thrombosed splenorenal varices are again noted in the left upper\nquadrant, with blooming secondary to prior coil embolization. The right\nhepatic vein distal to the TIPS again appears thrombosed, while the middle and\nleft hepatic veins are patent.\n\nThere is an area of restricted diffusion in segment 6 of the liver measuring\n10mm (se 1004:60 / se 7: 30 / se 700:10). It is hypoenhancing on the delayed\nphase without a correlate on T2 images. This may represent an area of early\ninfarct. An infectious focus is less likely. Trace ascites is noted around\nthe inferior edge of the spleen and gallbladder.\n\nBiliary: There is mild central intrahepatic biliary ductal dilatation with\nincreased wall enhancement, with extension of the peribiliary enhancement into\nsegments 5 and 6. The CBD is not dilated Small stones are seen within the\ngallbladder. The gallbladder wall appears minimally thickened, which is\nlikely secondary to ascites.\n\nPancreas: The pancreatic parenchyma demonstrates homogeneous signal intensity\nwithout focal lesions or ductal dilatation.\n\nSpleen: The spleen is enlarged measuring 15.9 cm, increased in size compared\nto ___.\n\nAdrenal Glands: The adrenal glands are normal in size and shape bilaterally.\n\nKidneys: The kidneys are partially visualized and appear unremarkable. The\nleft kidney is displaced inferiorly from splenomegaly. There is no\nhydronephrosis or suspicious focal lesions.\n\nGastrointestinal Tract: The visualized large and small bowel appear\nunremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. Small varices are\nnoted at the GE junction and gastric fundus.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions.", "output": "1. Partial occlusive thrombus within the main portal vein. No propagation of\nthe known splenic vein thrombus.\n2. Mild enhancement of the intrahepatic bile ducts within segment 5 and 8\ncompatible with mild cholangitis. There is a 10 mm focus of restricted\ndiffusion in segment ___ represent an early infarct or less likely an\ninfectious focus.\n3. Unchanged thrombosed right hepatic vein radicals distal to the TIPS.\n4. Limited evaluation for TIPS patency on this exam due to possible flow\nartifacts. Patency would be better evaluated with Doppler ultrasound.\n5. Cirrhotic morphology of the liver with splenomegaly, trace ascites, and a\nsmall gastric and esophageal varices. The patient is status post coil\nembolization of large splenorenal varices." }, { "input": "The liver demonstrates a nodular cirrhotic morphology. There are multiple T2\nhyperintense T1 hypointense areas of confluent fibrosis seen in the right\nlobe. No concerning hepatic lesion is demonstrated. There is no intra or\nextrahepatic biliary dilatation. No gallstones are demonstrated.\n\nThe portal and hepatic veins are patent. Conventional hepatic arterial\nanatomy is demonstrated. Gastroesophageal and splenorenal varices are noted.\n\nThe pancreas demonstrates normal signal and bulk. There is no pancreatic\nductal dilatation. There is a 4 mm cystic lesion in the pancreatic tail\n(series 6, image 33).\n\nThe spleen is enlarged measuring 16.5 cm. There is associated mass-effect on\nthe left kidney. There is no hydronephrosis involving either kidney.\n\nA trace of perihepatic ascites is noted. There is no lymphadenopathy. The\nvisualized loops of small and large bowel are unremarkable. No osseous lesion\nis demonstrated.", "output": "1. Cirrhotic liver with features of portal hypertension (splenomegaly, trace\nascites, and varices).\n2. No focal hepatic lesion is demonstrated.\n3. 4 mm cystic lesion in the pancreatic tail in keeping with side branch IPMN." }, { "input": "The liver demonstrates a macronodular cirrhotic morphology. There are multiple\nT2 hyperintense T1 hypointense areas with progressive reticular enhancement\nconsistent with confluent fibrosis. No concerning hepatic lesion is\ndemonstrated. There is no intra or extrahepatic biliary dilatation. The\ngallbladder contains biliary sludge but no gallstones.\n\nThe portal and hepatic veins are patent. Conventional hepatic arterial\nanatomy is redemonstrated. An accessory left renal artery is incidentally\nnoted. Few small gastroesophageal and splenorenal varices are noted.\n\nThe pancreas demonstrates normal signal and bulk. There is no pancreatic\nductal dilatation. Dual pancreatic drainage is noted. There is a stable 5 mm\ncystic lesion in the pancreatic tail (6:30).\n\nThe spleen is enlarged measuring 16.8 cm, which is unchanged. There is\nassociated mass-effect on the left kidney. There is no hydronephrosis\ninvolving either kidney. No suspicious renal mass is detected.\n\nThere is diffuse severe diverticulosis without inflammatory changes. A trace\nof perihepatic ascites is noted. There is no lymphadenopathy. The visualized\nloops of small bowel are unremarkable.\n\nThe bone marrow signal is normal. A healed rib fracture is noted in the right\nanterior chest wall.", "output": "1. No focal hepatic lesion detected.\n2. Cirrhotic liver with unchanged sequela of portal hypertension including\nsplenomegaly and small gastroesophageal and splenorenal varices.\n3. Stable 5 mm pancreatic tail cyst statistically most likely to represent a\nside branch IPMN. This can be followed on surveilance imaging for the liver.\n4. Diffuse colonic diverticulosis. Biliary sludge with otherwise normal\ngallbladder." }, { "input": "Lower Thorax: There are no significant abnormalities at the lung bases. No\npleural effusions are present.\n\nLiver: Again demonstrated is a macro nodular, cirrhotic morphology of the\nliver with areas of T2 hyperintensity and T1 hyperintensity, consistent with\nfibrosis. There are no suspicious hepatic lesions. The portal vein is\npatent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder contains layering sludge or microcalculi.\n\nPancreas: Again seen is a previously described pancreatic tail cystic lesion,\nmeasuring 3 mm (05:26). A second 3 mm cystic lesion in the pancreatic body is\nalso noted, not particularly well identified on the prior examination (05:26).\nAgain noted is incomplete pancreatic divisum with a dorsal dominant duct.\n\nSpleen: The spleen is markedly enlarged, measuring up to 17 cm.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There are bilateral T2 hyperintensities consistent with simple cysts,\nstable since the prior examination. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach, and visualized portions of the small and\nlarge bowel are unremarkable, aside from significant colonic diverticulosis.\n\nLymph Nodes: No pathologically enlarged lymph nodes are identified.\n\nVasculature: The aorta and its major branches are patent. Incidentally noted\nis a left hepatic artery that arises in left gastric artery. Again seen are\nsplenorenal varices.\n\nOsseous and Soft Tissue Structures: There is normal T1 signal in the bone\nmarrow. No suspicious osseous lesions are identified.", "output": "1. No suspicious focal hepatic lesions are seen that are concerning for ___.\n2. Multiple subcentimeter pancreatic cystic lesions, most likely IPMNs. \nThese can be evaluated at follow-up performed for hepatic surveillance.\n3. Stable sequelae of hepatic cirrhosis and portal hypertension as described\nabove." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is shrunken and diffusely nodular, compatible with patient's\nknown liver cirrhosis. There is progressive linear enhancement within the\nperiphery of the right hepatic lobe, compatible with confluent hepatic\nfibrosis. No evidence of hepatic steatosis. There is a focal nodular area of\narterial enhancement within the right inferior hepatic lobe measuring 3 mm\n(series 1101, image 102) that does not persist on the more delayed phases and\nwithout a correlate on the T2 weighted images, most likely transient hepatic\nintensity difference. There are no suspicious enhancing hepatic mass lesions\nmeeting OPTN Class 5 criteria for HCC.\n\nBiliary: Gallbladder is present containing small gallstones. No gallbladder\nwall thickening or pericholecystic fluid. There is no intrahepatic or\nextrahepatic biliary duct dilatation. The common bile duct tapers normally\ntowards the ampulla without obstructing filling defects.\n\nPancreas: Pancreas demonstrates normal signal intensity on the T1 weighted\nimages and enhances homogeneously on the postcontrast images without\nsuspicious solid mass lesion. Stable tiny T2 hyperintense cystic lesions\nwithin the anterior pancreatic body and tail measuring up to 3 mm (series 7,\nimage 31 and 32) most likely side-branch IPMNs. No dilatation of the main\npancreatic duct. No peripancreatic inflammatory changes or fluid collections.\n\nSpleen: Splenomegaly measuring 18 cm in craniocaudal dimension. Otherwise\nenhances homogeneously without focal mass lesion.\n\nAdrenal Glands: The adrenal glands are normal bilaterally without focal\nnodules.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There is adequate excretion of contrast on\nthe more delayed phases. There is a tiny simple renal cortical cyst in the\nupper pole of the left kidney. No suspicious renal masses or hydronephrosis\nbilaterally. No perinephric abnormality.\n\nGastrointestinal Tract: The stomach and visualized small bowel in the upper\nabdomen are within normal limits. There is diffuse colonic diverticulosis\nwithout signs of diverticulitis. Trace amount of perisplenic free fluid.\n\nLymph Nodes: A few stable slightly prominent porta hepatis lymph nodes, likely\nreactive due to underlying chronic liver disease. No suspicious mesenteric or\nretroperitoneal lymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta and its major branches are patent. Incidental\nnote is made of an accessory left hepatic artery arising from the left gastric\nartery. There are multiple perisplenic varices. The splenic vein, SMV,\nportal vein and hepatic veins are patent. Small esophageal varices.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. Liver cirrhosis and fibrosis with stigmata of portal hypertension\nincluding splenomegaly with perisplenic varices and small esophageal varices.\n\n2. No suspicious enhancing hepatic mass lesion meeting OPTN Class 5 criteria\nfor HCC. There is a tiny 3 mm nodular area of arterial enhancement within the\nright hepatic lobe that does not persist on the more delayed phases and\nwithout a correlate on the T2 weighted images, most likely transient hepatic\nintensity difference. Attention to this finding on follow-up imaging is\nrecommended.\n\n3. Stable tiny T2 hyperintense cystic lesions within the pancreas, most\nlikely side-branch IPMNs. These can be evaluated on follow-up imaging." }, { "input": "Lower Thorax: The imaged lung bases are clear without pleural or pericardial\neffusion.\n\nLiver: The liver demonstrates a markedly nodular appearance in keeping with\ncirrhosis. Confluent linear bands of enhancement are consistent with fibrosis.\nNo suspicious hepatic lesions.\n\nBiliary: No intra or extrahepatic biliary dilation. The gallbladder contains\ngallstones without wall edema or pericholecystic fluid.\n\nPancreas: Several stable cysts are noted in the pancreas, the largest\nmeasuring 3 mm in the tail (03:31, 30). The main pancreatic duct is not\ndilated. Pancreatic parenchyma is otherwise within normal limits.\n\nSpleen: Spleen is enlarged measuring 17 cm in the craniocaudal dimension. No\nfocal lesions.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The kidneys are symmetric in size with preserved corticomedullary\ndifferentiation. No suspicious lesions or hydronephrosis.\n\nGastrointestinal Tract: Extensive colonic diverticulosis is demonstrated. \nThe imaged stomach and small bowel are unremarkable.\n\nLymph Nodes: Mesenteric and retroperitoneal lymph nodes are not enlarged.\n\nVasculature: The abdominal aorta is normal in caliber. Hepatic vascular\nanatomy is conventional. The splenic, SMV, portal and hepatic veins are\npatent. Splenic varices are present. The left renal vein appears slightly\nnarrowed as it crosses over the aorta and underneath the SMA (14:57).\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. \nDegenerative changes of the lumbar spine are noted. Soft tissues are\nunremarkable.", "output": "1. Cirrhotic and fibrotic liver with sequelae of portal hypertension including\nsplenomegaly, splenic and small paraesophageal varices.\n2. No lesions meeting OPTN 5 criteria for hepatocellular carcinoma.\n3. Unchanged small T2 hyperintense pancreatic cysts, most likely side branch\nIPMNs. Recommend continued follow-up on subsequent imaging.\n4. Cholelithiasis without evidence of cholecystitis." }, { "input": "Lower Thorax: The lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is top-normal. There artifacts from sternal wires\n(series 3, image 14).\n\nLiver: The hepatic parenchyma demonstrates normal signal intensity on T1 and\nT2 weighted sequences. No focal hepatic lesion is detected.\n\nBiliary: There is a subcentimeter gallstone within an otherwise normal\ngallbladder (series 6, image 20). No ductal stones are present. There is no\nintra or extrahepatic bile duct dilation.\n\nPancreas: The pancreas demonstrates normal signal intensity and bulk, without\nduct dilation or focal solid mass. Cystic lesions within the pancreatic tail\nand uncinate process measure up to 7 mm and are unchanged since ___ (series\n6, image 20, 25), likely side branch IPMN.\n\nSpleen: The spleen size is normal. There are no focal splenic lesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. There is a 4 mm right interpolar hemorrhagic cyst (series 11\nimage 30). Again seen is a 9 mm partially exophytic left lower pole lesion\ndemonstrating similar T2 signal intensity as the surrounding renal cortex,\nwith mild enhancement (series 1301 image 35, series 6, image 14), unchanged in\ncomparison to the ___ examination. No new renal lesion is detected.\n\nGastrointestinal Tract: The stomach and intra-abdominal and intrapelvic loops\nof small and large bowel remain normal in caliber, without focal mass.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy, and no\nascites.\n\nVasculature: The abdominal aorta demonstrates mild atherosclerotic plaque,\nwithout flow limiting stenosis or dissection. The celiac trunk, SMA, renal\narteries, and iliac branches are patent and normal in caliber. There is an\naccessory left upper pole renal artery (series 1301, image 49, 53). The\nportal and hepatic veins, SMV, and splenic vein appear patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. Unchanged 9 mm enhancing left lower pole renal mass in comparison to the ___ MRI.\n2. Subcentimeter pancreatic cystic lesions, likely side-branch IPMN, are\nunchanged since ___. No dedicated followup required per department\nguidelines.\n3. Cholelithiasis." }, { "input": "Examination is limited by motion on precontrast images. There is only one\npost-contrast phase with non breath hold technique, as the patient experienced\ndifficulty with breath holding and declined planned post-contrast sequences.\n\nLower thorax: Left lower lobe lung nodule (8:6) is again seen. The lung bases\nare otherwise grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: Macronodular contour is again seen without evidence of a discrete mass.\nThere is moderate right hepatic lobe atrophy with compensatory left lobe\nhypertrophy. Mildly increased signal intensity along the posterior right lobe\non T2-weighted sequences may reflect an underlying confluent fibrotic process.\nThe liver T1 signal intensity is borderline for steatosis.\n\nGallbladder and biliary system: The patient is status post cholecystectomy.\nThere is no significant intra or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.There is classic pancreatic ductal anatomy without dilatation.\n\nSpleen: The spleen size is top normal. There is no focal splenic lesion.\n\nKidneys and adrenals: A 2.6 x 1.8 cm cystic lesion arising from the upper\npole of the right kidney demonstrates predominantly high signal intensity on\nT2 weighted sequences, with multiple internal thin septations but no definite\nnodularity, and no appreciable nodular enhancement (series 15, image 15). A 1\ncm simple cyst in the right lower pole and several subcentimeter simple cysts\nin the left kidney appear unchanged. There is no collecting system\nobstruction. The adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: Moderate attenuation of the right portal venous branches is similar\nto CT examination from ___. The abdominal vasculature is otherwise normal and\nwidely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "1. Macronodular contour of the liver with moderate right hepatic lobe atrophy.\nMild fibrosis across the posterior right lobe.\n2. Moderate attenuation of the right portal branches, stable since ___.\n3. No concerning hepatic mass, with the examination limited by motion artifact\nand incomplete post-contrast imaging." }, { "input": "The lung bases are grossly clear. Prominent esophageal varices are again seen.\nThe previously seen right lower lobe pulmonary nodule is not visualized on\ntoday's study. There is no ascites.\n\nThe liver is nodular in contour and fibrotic, consistent with known cirrhosis.\nNo enhancing lesion is identified. A geographic, subcapsular area of\nenhancement in segment VI is likely perfusional. Enhancement adjacent to\nmultiple cysts are also suggestive of perfusion anomalies. Again seen are\nmultiple simple cysts throughout the liver, grossly unchanged in size and\ndistribution, as well as a patent dilated portal vein. The gallbladder is\nnormal. There is no significant intra or extrahepatic biliary ductal\ndilatation. There is no evidence of choledocholithiasis or stricture. \nNumerous pancreatic cystic lesions are again seen, grossly unchanged in size,\nallowing for differences in planes of scanning. These measure 2.2 x 2.5 cm in\nthe pancreatic neck (6:23, previously 2.1 x 2.5 cm), 6 mm in the body (6:22,\npreviously 5 mm), and 8 mm in the tail (6:25, previously 9 mm). There appears\nto be edema of the pancreatic tissue which was present previously but is\nincreased on today's exam. The spleen remains enlarged, measuring 18.2 cm,\nwith numerous gamna-gandy bodies and unchanged splenic cysts. The adrenal\nglands and kidneys are normal bilaterally. The visualized bowel loops and\nmesentery are within normal limits. There is no significant mesenteric or\nretroperitoneal lymphadenopathy. The abdominal vasculature is widely patent.\nThe osseous structures are unremarkable.", "output": "1. No concerning enhancing hepatic lesion identified. Numerous cysts are\nunchanged in size and configuration.\n2. Unchanged pancreatic cystic lesions. The pancreatic neck lesion is\nsuggestive of an IPMN or serious cystadenoma, as before. There appears to be\nedema of the pancreatic tissue which was present previously but is increased\non today's exam. This raises the question of pancreatitis, but seems less\nlikely given presence to a lesser degree on prior imaging.\n3. Unchanged cirrhotic liver and sequela of portal hypertension, including\nsplenomegaly and esophageal varices.\n4. Previously seen right lower lobe pulmonary nodule not visualized on\ntoday's exam." }, { "input": "Lower Thorax: There is a small right pleural effusion which has decreased in\nsize compared to the previous CT scan dated ___. The lung bases\nare clear. No pericardial effusion.\n\nLiver: The liver is atrophic with nodular contours. There are peripheral\nreticular T2 hyperintense markings with progressive enhancement consist with\ncirrhosis. There is no chemical shift on the in or out of phase sequences to\nsuggest the presence of hepatic steatosis or iron deposition. Innumerable T2\nhyperintense, non-enhancing foci scattered throughout the liver parenchyma in\nkeeping with cysts are unchanged. There is no nodularity or soft tissue\ncomponent. The overall size and morphology is unchanged compared to the\nprevious exam. There are no new solid arterially enhancing lesions with\nwashout kinetics. In segment 5, there is a punctate arterially enhancing\nfocus with no washout or T2 correlate most in keeping with a trans a hepatic\nintensity difference (1101:86). There is an arterioportal venous shunt in\nsegment 8 (1101:58). No ascites\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is contracted. There is cholelithiasis\nbut no evidence of cholecystitis.\n\nPancreas: Multiple cystic lesions in the neck and body are stable in size and\nmorphology. This includes: an 8 mm cyst in the neck (06:30), 6 mm cyst in\nthe body (06:38), and the largest cystic lesion in the neck measuring\napproximately 12 x 23 mm (06:28). There is no nodularity are duct dilatation.\nThe previously seen edematous changes of the pancreas have resolved. There is\nno sequela of chronic pancreatitis.\n\nSpleen: Splenomegaly measuring up to 18.8 cm is grossly unchanged compared to\nthe previous exam. Numerous Gamna-Gandy bodies as well as a peripheral\ncalcified cystic within the spleen is unchanged compared to the previous exam.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid or cystic lesions. \nNo hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. Mild\nmural thickening in the hepatic flexure may be related to portal colopathy.\n\nLymph Nodes: Multiple prominent lymph nodes measuring up to 14 mm in the porta\nhepatis are unchanged compared the previous exam. No significant mesenteric\nor retroperitoneal lymphadenopathy by size criteria.\n\nVasculature: There are numerous portosystemic shunts including\ngastroesophageal varices and a patent paraumbilical vein. The splenic,\nsuperior mesenteric, and portal veins appear congested but unchanged compared\nto the previous exam.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. Cirrhosis with sequelae of portal hypertension. No concerning lesions\nmeeting OPTN criteria. The nodule seen on ultrasound is not identified on MR.\n___ this lesion is best assessed on ultrasound, follow-up ultrasound is\nrecommended in 6 months.\n2. Unchanged pancreatic cystic lesions. The pancreatic neck lesion is\nsuggestive of an IPMN or serous cystadenoma. The cystic lesions in the body\nare most in keeping with side-branch IPMN. Follow-up MRCP in ___ year is\nrecommended.\n3. Resolution of the previous seen interstitial edematous pancreatitis." }, { "input": "Lower Thorax: Lung bases are grossly unremarkable, without evidence of pleural\neffusions.\n\nLiver: The liver is nodular, in keeping with known cirrhosis. Multiple simple\ncysts in the liver, the largest of which measures 3.0 x 2.9 cm in the hepatic\ndome. No suspicious arterially enhancing lesions are identified.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. Minimal\ngallbladder wall edema is likely related to third spacing. Cholelithiasis.\n\nPancreas: Pancreas demonstrates normal intrinsic signal intensity throughout. \nThere are multiple T2 hyperintense lesions scattered throughout the pancreas,\nthe largest of which is a multiloculated cystic lesion measuring 2.6 x 1.4 cm\nin the pancreatic neck (7:22), which is similar in size to the prior study ;\nthis likely represents an intraductal papillary mucinous neoplasm (IPMN),\nalthough a serous cystadenoma is not excluded.\n\nA cluster of microcysts seen in the pancreatic head measures 2.0 x 1.3 cm\n(7:29), increased from 1.7 x 1.1 cm ; there is suggestion of central T2\nhypointense fibrous components vs scar, and findings are suggestive of a\nserous cystadenoma. A unilocular cystic lesion in the body of the pancreas\nmeasures 1.2 x 0.9 cm, previously 0.7 x 0.6 cm. Other smaller cystic lesions\nare all subcentimeter in size and not significantly changed. There is no\npancreatic ductal dilation.\n\nSpleen: Spleen is enlarged measuring up to 17.0 cm, not significantly changed\nfrom the prior study in ___ (2:23). There is a 1.1 x 0.9 cm cyst\nalong the superolateral aspect of the spleen (7:14). Gamna Gandy bodies are\nre-demonstrated.\n\nAdrenal Glands: Adrenal glands are normal.\n\nKidneys: The kidneys are normal in size and shape and demonstrate homogeneous\nenhancement throughout. No focal parenchymal masses, hydronephrosis, or\nperinephric abnormality.\n\nGastrointestinal Tract: Stomach is unremarkable in appearance. Imaged small\nand large bowel loops demonstrate normal caliber throughout. The previously\ndescribed area of ill-defined enhancement in the left upper quadrant posterior\nto the splenic vein is stable in appearance (series 12, image 56). There is\nmild edema and fat stranding in the right upper quadrant, likely reflecting\nthird spacing.\n\nLymph Nodes: A slightly prominent portocaval node measures 1.4 cm, which is\nlikely reactive (series 12, image 54). There is no retroperitoneal or\nmesenteric lymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta is normal in caliber. Celiac artery is patent,\nwith conventional hepatic arterial anatomy. SMA and bilateral renal arteries\nare patent. There is nonocclusive thrombus the proximal left portal vein,\nwith significantly reduced clot burden compared to the prior study in ___. Additionally, the right portal venous branches are newly\natretic/diminutive, likely reflecting the sequela of prior thrombosis. \nExtensive paraesophageal and upper abdominal varices are noted.\n\nOsseous and Soft Tissue Structures: Marrow signal intensity is preserved. \nSoft tissues are unremarkable.", "output": "1. Cirrhotic liver morphology, without suspicious arterially enhancing\nlesions.\n2. Sequela of portal hypertension including splenomegaly and varices.\n3. Significantly decreased portal venous clot burden since ___, with\nminimal residual clot in the proximal left portal vein.\n4. Interval growth of a cluster of microcysts in the pancreatic head measuring\n2.0 x 1.3 cm, with imaging features favoring a serous cystadenoma.\n5. Stable dominant 2.6 x 1.4 cm multiloculated cystic lesion in the pancreatic\nneck, likely an IPMN, although a serous cystadenoma is not excluded.\n6. Cholelithiasis.\n7. No significant interval change in the nonspecific left upper quadrant low\nlevel enhancement, possibly representing lymphoid tissue versus fibrosis." }, { "input": "Lower Thorax: The visualized lung bases are grossly clear.\n\nLiver: The liver demonstrates a nodular contour consistent with history of\ncirrhosis. Numerous T2 hyperintense lesions are again seen, consistent with\nhepatic cysts. A 7 mm arterially enhancing lesion in hepatic segment VII is\nstable in size without correlate on remaining sequences. This lesion does not\ndemonstrate concerning features such as washout or pseudocapsule. Other\nmultiple small foci of non-masslike enhancement are most compatible with\ntransient hepatic intensity differences. There is trace perihepatic ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. There is\ncholelithiasis without evidence of acute cholecystitis. Gallbladder wall\nedema probably edema/third spacing secondary to chronic underlying liver\ndisease\n\nPancreas: A multicystic lesion arising from the head/neck of the pancreas is\nstable measuring 2.0 x 1.5 cm (03:29). A cystic lesion in the pancreatic body\nmeasuring 2.7 x 1.6 cm is also a stable a (03:22). Additional, smaller\nlesions scattered throughout the pancreas are overall unchanged. There are no\nsolid components or abnormal enhancement. No main pancreatic duct dilation.\n\nSpleen: Splenomegaly is unchanged measuring approximately 18.4 cm is\nunchanged. A T2 hyperintense lesion with a hypointense rim (03:16) likely\nrepresents a posttraumatic cyst. A stable tiny mildly T2 hyperintense lesion\nin the inferior aspect of the spleen (04:17) is unchanged. Gamma Gandy bodies\nare again noted. A small accessory spleen is again visualized.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal and symmetric in size with normal nephrograms.\nNo suspicious renal lesion identified. No hydronephrosis.\n\nGastrointestinal Tract: The partially imaged small and large bowel are\nunremarkable.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Since ___ the burden of nonocclusive thrombus within\nthe left portal vein has mildly decreased (1002:45). However the burden of\nnonocclusive thrombus at the proximal main portal vein/superior mesenteric\nvein confluence has increased (1002:70). The remaining hepatic vasculature is\npatent. There are persistently large paraesophageal varices and upper\nabdominal collaterals.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion or evidence\nof acute fracture. Stable multilevel degenerative changes are again noted. \nThe", "output": "1. Cirrhotic liver morphology with splenomegaly and extensive\nabdominal/paraesophageal varices.No lesion meeting OPTN 5 criteria for\nhepatocellular carcinoma.\n2. Mild interval decrease in left portal vein nonocclusive thrombus. Interval\nincrease in main portal vein/SMV confluence nonocclusive thrombus.\n3. Stable cystic pancreatic lesions. As previously noted, lesion in\npancreatic head/neck could represent side branch IPMN or serous cystadenoma. \nRemaining lesions likely represent side branch IPMN.\n4. Stable hepatic cysts.\n5. Cholelithiasis without evidence of acute cholecystitis." }, { "input": "Lower Thorax: Within limits of evaluation by MRI, the bilateral lung bases are\ngrossly clear.\n\nLiver: The liver demonstrates a nodular contour. Numerous T2 hyperintense\nlesions are again seen, consistent with hepatic cysts. A 7 mm arterially\nenhancing lesion in hepatic segment VI/VII adjacent to a relatively large cyst\nhas slightly increased in size, previously 5 mm on MRIs of the liver from ___ and ___, not demonstrating washout or pseudocapsule. \nOther multiple small foci of non-masslike enhancement are most compatible with\ntransient hepatic attenuation differences. There is no lesion meeting OPTN 5\ncriteria for hepatocellular carcinoma. Trace perihepatic ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. \nCholelithiasis. The gallbladder is not significantly distended. Diffuse\ngallbladder wall edema probably reflects third spacing in the setting of\nchronic liver disease.\n\nPancreas: A multicystic lesion arising from the neck of the pancreas measures\n2.0 x 1.3 cm, unchanged. A multicystic lesion in the pancreatic body\nmeasuring 2.7 x 1.6 cm is also unchanged. Additional, smaller lesions\nscattered throughout the pancreas are overall unchanged. These likely\nrepresent side-branch IPMNs, though the one in the pancreatic neck could also\nrepresent a microcystic serous cystadenoma. There are no solid components or\nabnormal enhancement. No main duct dilation.\n\nSpleen: Splenomegaly measuring approximately 18.4 cm is unchanged. A T2\nhyperintense lesion with a hypointense rim (series 3, image 12) likely\nrepresents a posttraumatic cyst. A subcentimeter, mildly T2 hyperintense\nlesion in the inferior aspect of the spleen (series 2, image 25) is unchanged\nand compatible with a hemangioma. Gamma Gandy bodies are again noted. \nIncidental note is made of a small accessory spleen.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal and symmetric in size with normal nephrograms.\nNo suspicious renal lesion identified. No hydronephrosis.\n\nGastrointestinal Tract: The stomach and partially imaged loops of large and\nsmall bowel are unremarkable.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Compared to prior MRI of the liver from ___, the\noverall amount of nonocclusive portal vein thrombus is grossly unchanged, but\nthere has been forward movement of thrombus, which now extends from the main\nportal vein (just distal to the confluence) into the left portal vein. The\nhepatic veins are patent. There are large esophageal varices and upper\nabdominal collaterals.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion or evidence\nof acute fracture.", "output": "1. Compared to prior MRI of the liver from ___, the overall amount\nof nonocclusive portal vein thrombus is grossly unchanged, but there has been\nforward movement of thrombus, which now extends from the main portal vein\n(just distal to the confluence) into the left portal vein.\n2. No hepatic lesion meeting OPTN 5 criteria for hepatocellular carcinoma. A\n7 mm arterially enhancing lesion in segment VI/VII appears slightly increased\nin size, without washout or pseudocapsule. Recommend attention on follow-up.\n3. Cirrhosis with evidence of portal hypertension including trace perihepatic\nascites, splenomegaly with Gamma Gandy bodies, large esophageal varices, and\nlarge upper abdominal collaterals.\n4. Numerous unchanged cystic pancreatic lesions as described, likely\nrepresenting side-branch IPMNs, though the one in the pancreatic neck could\nrepresent a microcystic serous cystadenoma." }, { "input": "The study is somewhat degraded by patient motion artifact.\n\nLower Thorax: Lung bases are grossly clear. No pleural or pericardial\neffusion.\n\nLiver: Liver is normal in morphology with smooth contour. Multiple T2\nhyperintense cysts or biliary hamartomas are seen in both hepatic lobes. No\nsuspicious hepatic lesion is identified, within the limitations of this\nnoncontrast enhanced study.\n\nBiliary: Gallbladder is within normal limits. There is no intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: Multiple pancreatic cystic lesions are identified. The largest of\nthese is located in the pancreatic head/neck junction, and measures 1.5 x 1.6\ncm. An additional 1.2 x 0.9 cm cystic lesion is seen within the distal\nbody/tail of the pancreas. Other smaller cystic lesions are also noted. None\nof the cystic lesions demonstrate concerning features, within the limitations\nof this non-contrast study.\n\nSpleen: Spleen is normal in size with homogeneous signal characteristics.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Kidneys are normal in size. Multiple T2 hyperintense cortical cysts\nare seen bilaterally. There is no evidence of hydronephrosis or perinephric\nabnormality.\n\nGastrointestinal Tract: Imaged loops of large and small bowel are normal in\ncourse and caliber. The appendix is well seen and normal appearing.\n\nPelvis: Limited views of the pelvis demonstrate a 1.7 x 2.3 cm T2 hyperintense\ncyst in the region the right adnexa.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: Degenerative changes are seen involving\nthe lumbar spine. No suspicious osseous lesion is identified.", "output": "1. Multiple pancreatic cystic lesions, measuring up to 1.6 cm in the\npancreatic head/neck junction. Follow-up MRCP in 6 months recommended to\ndocument stability.\n2. A 2.3 cm cystic lesion in the right adnexal is incompletely characterized. \nIf clinically indicated, further evaluation with pelvic ultrasound could be\nperformed.\n\nRECOMMENDATION(S):\n1. Follow-up MRCP in 6 months for reassessment of the pancreatic cystic\nlesions.\n2. Pelvic ultrasound for characterization of a right adnexal cystic lesion." }, { "input": "Lower Thorax: Grossly unremarkable.\n\nLiver: Visualized hepatic parenchyma appears normal in signal and morphology. \nScattered hepatic cysts or biliary hamartomas are present.\n\nBiliary: No intra or extrahepatic biliary ductal dilatation with the common\nbile duct top normal in size for age measuring up to 8 mm. Gallbladder is\nnormal.\n\nPancreas: The pancreas is slightly atrophic. Main pancreatic duct is normal\nin caliber. Multiple cystic lesions which are homogeneously hyperintense on\nT2 weighted imaging are re-demonstrated, the largest within the head/neck\nmeasures 1.4 x 1.6, as seen previously. Additional pancreatic cystic lesion\nwithin the distal body/tail measuring 0.9 x 1.1 cm also is unchanged. No\ninternal nodularity or septation.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable without discrete lesion.\n\nKidneys: Visualized kidneys demonstrate punctate simple cysts without\nhydronephrosis.\n\nGastrointestinal Tract: Visualized stomach and loops of small and large bowel\nare unremarkable.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal caliber.\n\nPelvis: Limited imaging of the pelvis demonstrates an 1.8 x 1.4 cm right\nadnexal cyst, perhaps minimally decreased in size from the prior exam.\n\nOsseous and Soft Tissue Structures: Multilevel mild degenerative changes are\nseen in the imaged thoracolumbar spine with mild grade 1 L4 on L5\nanterolisthesis.", "output": "1. Unchanged cystic lesions throughout the pancreas, the largest in the\nhead/neck junction measuring 1.4 x 1.6, similar to the prior exam. Findings\nare most likely reflective of side branch IPMN. Follow-up MRCP is suggested\nin ___ years.\n2. Redemonstration of right adnexal cystic lesion measuring up to 1.8 x 1.4 cm\non the current exam, slightly decreased in size from the prior exam. Annual\npelvic ultrasound can be performed to assess stability of this lesion, if\nclinically indicated.\n\nRECOMMENDATION(S):\n1. Follow-up MRCP is suggested in ___ years.\n2. Annual pelvic ultrasound follow-up of right adnexal cystic lesion, if\nclinically indicated." }, { "input": "Transplanted liver is normal in size, contour and signal. No focal hepatic\nlesion is identified. The biliary tree is unchanged in configuration with\nstable short-segment narrowing at the level of the anastomosis. There is no\nupstream dilation.\n\nNew compared to the prior examination, there is a solid mass within the\nposterior aspect of the left mid kidney. This has diameter of 1.8 cm (10:55),\nis T2 hyperintense, T1 hypointense, and demonstrates signal drop on out of\nphase chemical shift imaging as compared to in phase. This lesions is\ninitially arterially hyperenhancing relative to the renal parenchyma and\nsubsequently washing out. There is minimal associated restricted diffusion. \nImaging features are compatible with renal cell carcinoma, clear cell subtype.\n\nThe pancreas, spleen, and adrenal glands are unremarkable in appearance. There\nis no ascites or lymphadenopathy.\n\nVenous structures of the upper abdomen are patent. Arterial anatomy is\nconventional.", "output": "1. Normal MRI appearance of the transplanted liver and associated biliary\ntree. No evidence of hepatic focal lesion.\n\n2. New 1.8 cm solid mass lesion within the posterior left mid kidney. Signal\nand enhancement characteristics are highly suggestive of renal cell carcinoma,\nclear cell subtype.\n\nNOTIFICATION: Unexpected finding of the left renal mass was communicated to\nthe ordering clinician via the radiology dashboard." }, { "input": "The lung bases are grossly clear.\n\nIn the upper pole of the left kidney posteriorly, again seen is a round\ndiscrete mass which measures 1.6 x 1.4 x 1.3 cm, unchanged in size compared to\n___. This mass is homogeneously isointense on T2-WI with\nrespect to the renal cortex and hyperintense to the renal cortex on\nT1-weighted in-phase images with uniform mild signal drop on out of phase\nimages indicative of the presence of intravoxel fat. This mass demonstrates\navid enhancement on the corticomedullary phase appearing isointense to the\nrenal cortex with washout on more delayed post-contrast images. No definite\nrestricted diffusion is seen within this lesion. This lesion is entirely\nendophytic with the margin of the lesion located at least 3 mm from the renal\nsinus fat. The right kidney is normal. No hydronephrosis is present. No new\nrenal mass is identified.\n\nThe transplant liver is normal in signal intensity without evidence of focal\nmass. The gallbladder is normal. There is no significant intra or extrahepatic\nbiliary ductal dilatation. There is no evidence of choledocholithiasis or\nstricture. The pancreas is normal in signal intensity without evidence of\nfocal mass or ductal dilatation. The spleen is normal in appearance. The\nadrenal glands are normal. The visualized bowel loops and mesentery are\nwithin normal limits. There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\n\nThe abdominal vasculature is widely patent. There are single renal arteries\nand veins bilaterally which are patent.\n\nThe osseous structures are unremarkable.", "output": "Left upper pole renal mass measuring 1.6 x 1.4 x 1.3 cm, unchanged in size\ncompared to ___, with evidence of intravoxel fat, isointensity\nto the renal cortex on T2-WI, and avid corticomedullary enhancement with\nwashout on delayed phase sequences. Imaging features may reflect a renal cell\ncarcinoma, clear cell subtype, or an angiomyolipoma with minimal fat, though\ngrowth of this lesion since ___ would be unusual for an angiomyolipoma." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: Patient is status post liver transplant. The transplanted liver\ndemonstrates normal morphology and signal intensity. No suspicious focal\nliver lesion identified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPancreas: Visualized pancreas demonstrates normal signal intensity on T1\nweighted images and enhances homogeneously. Pancreatic duct is normal in\ncaliber.\n\nSpleen: The spleen is normal in size, measuring 12.7 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: A previously seen round mass in the upper pole of the left kidney is\nincreased in size compared with prior, measuring 1.8 x 2.1 x 2.2 cm, compared\nwith 1.6 x 1.7 x 1.7 cm previously. This mass is T1 isointense, T2 iso to\nhypointense, and demonstrates avid arterial hyperenhancement (1101:22), with\nwashout on delayed phases (1102:22, 1103:22). The foci of intrinsic T2\nhyperintensity display delayed enhancement but there is no well defined\ncentral scar. The mass has mild signal dropout on out of phase imaging\ncompared with in phase imaging, indicative of intravoxel fat (3a:25, 3b:26),\nand displays restricted diffusion. The right kidney is normal in appearance,\nwith no suspicious mass. There is no hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. There are\nbilateral single renal arteries.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Interval increase in size of an atypical left upper pole kidney mass,\nmeasuring 1.8 x 2.1 x 2.2 cm, compared with 1.6 x 1.7 x 1.7 cm previously. \nThe signal intensity features of the lesion are potentially compatible with\nfat poor angiomyolipoma. However, due to rate of growth the mass is\npotentially worrisome for malignancy, in which case the most likely diagnostic\nconsiderations are either clear cell renal cell carcinoma, or oncocytic\nneoplasm(the latter less likely due to intravoxel fat). This lesion would be\namenable to percutaneous biopsy.\n2. Normal appearance of the transplanted liver. No suspicious focal hepatic\nlesion.\n\nRECOMMENDATION(S): Consideration of percutaneous biopsy of left upper pole\nkidney mass.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 23:35 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: The lung bases are grossly clear.\n\nLiver: Patient is status post liver transplant. The transplanted liver shows\nnormal signal intensity and morphology. There is no suspicious focal liver\nlesions identified.\n\nBiliary: The gallbladder is surgically absent. There is no intra or\nextrahepatic biliary dilatation.\n\nPancreas: The pancreas demonstrates normal signal intensity on T1 weighted\nimages and enhances homogeneously. The main pancreatic duct is normal in\ncaliber.\n\nSpleen: The spleen is normal in size measuring 12.6 cm and enhances\nhomogeneously. No focal splenic lesions.\n\nAdrenal Glands: Adrenal glands are normal bilaterally.\n\nKidneys: Demonstration of the previously described rounded mass in the upper\npole of the left kidney, that has slightly increased in size when compared to\nprior study currently measuring 2.5 x 2.1 x 2.6 cm (AP x transverse x\ncraniocaudal ___, compared to 1.8 x 2.1 x 2.2 cm. The mass is\nisointense on T1 weighted images, and isointense to slightly hyperintense on\nthe T2 weighted images with avid arterial hyperenhancement that washes out on\nthe delayed phases. The mass has mild signal drop on the out of phase imaging\ncompared with the in phase imaging, indicative of intravoxel fat. There is\nalso restricted diffusion. No other abnormal enhancing mass in the left\nkidney. The right kidney is normal in appearance with normal signal intensity\nand morphology. No hydronephrosis bilaterally. There are bilateral single\nrenal arteries seen.\n\nGastrointestinal Tract: Visualized portions of the small and large bowel are\nunremarkable.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. There are\nbilateral single renal arteries.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal or focal\nsuspicious osseous lesions.", "output": "1. Interval increase in size of 2.5 x 2.1 x 2.6 cm avidly enhancing lesion\nwithin the upper pole of the left kidney. The imaging characteristics and\ninterval increase in size favors a clear cell renal cell carcinoma however a\nfat poor angiomyolipoma remains on the differential diagnosis. This lesion is\namenable to percutaneous biopsy.\n\n2. Normal appearance of transplanted liver. No suspicious focal hepatic\nlesions.\n\nRECOMMENDATION(S): Consideration of percutaneous biopsy of left upper pole\nkidney mass." }, { "input": "The lung bases are grossly clear. There is no ascites.\n\nThere has been interval progression of disease since the previous exam. At\nleast ___ new lesions are now identified involving the right hepatic lobe.\nThese are subcentimeter in size. There has also been interval enlargement of\nsome of lesion seen previously. Furthermore, some of the lesions only seen on\ndiffusion weighted imaging previously but not on post-contrast images, are now\nall clearly identified on post-contrast imaging. The largest met seen is a\nrounded extension immediately inferomedial to the previous liver resection at\nthe junction of segments 7 and 8, this measures 1.8 x 1.6 cm. The next\nlargest is a peripheral lesion in segment 7 more inferiorly measuring 1.7 x\n1.3 cm. Both of these lesions could be seen on diffusion-weighted imaging on\nthe prior exam but have increased in size.\n\nThe gallbladder is normal. There is no significant intra or extrahepatic\nbiliary ductal dilatation. The pancreas is normal in signal intensity without\nevidence of focal mass or ductal dilatation. The spleen is normal in\nappearance. The adrenal glands and kidneys are normal bilaterally. The\nvisualized bowel loops and mesentery are within normal limits. There is no\nsignificant mesenteric or retroperitoneal lymphadenopathy. The abdominal\nvasculature is widely patent. The osseous structures are unremarkable.", "output": "Interval progression of disease with enlargement of pre-existing lesions and\ndevelopment of a least ___ new lesions within the liver. No evidence of extra\nhepatic metastatic disease. Recommend that continued followup examination be\nagain performed using hepatobiliary contrast (Eovist) for better conspicuity\nof the hepatic lesions." }, { "input": "Lower Thorax: There is mild atelectasis in the bilateral lung bases.\n\nLiver:\nThere are ill-defined patchy areas of arterial enhancement and increased T2\nsignal, which is likely post treatment effect and is in the distribution of\nthe recent Y-90 radioembolization. The portal vein and hepatic vein are\npatent.\n\nThere are multiple peripherally-enhancing masses in the liver:\n\nA segment VII 4.3 x 3.4 cm mass demonstrates peripheral nodular arterial\nenhancement (1101:40) which persist on delayed sequences. This mass is larger\nsince MRI ___, previously measuring 3.5 x 3.2 cm. This mass\ndemonstrates less central enhancement and less restricted diffusion since\n___.\n\nA segment VII 3.4 x 1.8 cm mass demonstrates peripheral nodular arterial\nenhancement (1101:61). This is minimally changed in size ___. It\nexhibits less central enhancement and less restricted diffusion since ___.\n\nA segment IV mass measures 1.6 x 1.3 cm (1101:58) and demonstrates peripheral\nnodular enhancement. This is minimally changed from ___.\n\nA segment VII 1.3 x 1.0 cm mass (1101:69) demonstrates no enhancement and is\nminimally changed since ___.\n\nOther peripherally enhancing masses in the right hepatic lobe are minimally\nchanged from prior MRI.\n\nNo new discrete mass is detected.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. There is\nsludge within an otherwise normal gallbladder. No ductal stones are detected.\n\nPancreas: The pancreas enhances homogenously without concerning pancreatic\nlesion or pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size. There is no concerning lesion.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: Duplicated right collecting system is again noted. There is no\nhydronephrosis, ___ abnormality, or concerning renal lesion.\n\nGastrointestinal Tract: The stomach is normal. Visualized small and large\nbowel loops are normal.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is patent without aneurysm or significant\nplaque.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion.", "output": "Post treatment of multiple liver metastases, with two lesions demonstrating\ndecreased restricted diffusion since ___, and smaller lesions\nappearing stable in size. The largest lesion demonstrates slight interval\nenlargement but less diffusion restriction, likely post-treatment effect;\ncontinued short-term MRI surveillance recommended. No new mass or definite\nevidence of disease progression." }, { "input": "Limited assessment of the lung bases are clear. No pleural effusion.\nVisualized heart is unremarkable without pericardial effusion.\n\nThe liver is homogeneous in signal intensity and smooth in contour. No\nconcerning hepatic lesions identified, no lesions identified in the area of\nconcern noted on prior abdominal ultrasound.\n\nThere is no intra or extrahepatic biliary duct dilatation. There appears to\nbe diffuse ___ enhancement. The gallbladder is within normal limits\nwithout filling defects to suggest gallstones. The spleen and adrenal glands\nare unremarkable. The pancreas is normal in signal intensity without\npancreatic ductal dilatation or enhancing lesion. T2 hyperintense cysts in\nthe left kidney are present, the largest measures 2.6 x 2.4 cm in the lower\npole. The kidneys are otherwise unremarkable without hydronephrosis or renal\nmasses.\n\nLimited assessment of the esophagus is unremarkable without hiatal hernia.\nVisualized stomach, small bowel, and colon are within normal limits. There is\nno ascites. There is no retroperitoneal or mesenteric lymph node enlargement.\nVisualized aorta is normal in caliber without aneurysmal dilatation. The\nceliac axis, SMA and bilateral renal arteries are patent. There is\nconventional hepatic arterial anatomy. The portal vein and splenic vein are\npatent. The bone marrow signal is grossly unremarkable.", "output": "1. No concerning focal hepatic lesions, specifically, no lesions identified\nin the area of concern noted on prior abdominal ultrasound. It is unclear\nwhether these represented regions of focal fatty sparing which are now less\nevident as the liver does not appear particularly fatty.\n\n2. Notable periductal or biliary wall enhancement, of uncertain clinical\nsignificance. This is most commonly seen in relation to infection or\ninflammation of the biliary tree. Clinical correlation is advised.\n\nRECOMMENDATION(S): Given the patient's age and lack of visibility on this MR\nexamination, the hepatic lesions seen on the prior sonography are unlikely to\nbe of clinical significance; however, if desired for followup, suggest that\nfollow-up be performed using ultrasound, given that they were best visualized\nusing that modality of imaging." }, { "input": "There are numerous T1 hypointense, mildly T2 hyperintense lesions scattered\nthroughout the liver which do not demonstrate central enhancement on\npostcontrast imaging. Some have a slight rim of peripheral enhancement. Two\nsuch lesions are at the junctions of segments VII and VIII (1102: 42, 39)\nmeasuring 9 mm and 5 mm. There are smaller lesions with similar signal\ncharacteristics all seen in segment VIII (1102:44, 54, 62). 6 mm focus of\nenhancement within segment V may represent small hemangioma.\n\nThere are nonenhancing T1 hypointense lesions within the posterior medial\naspect of the spleen and the inferior aspect of the spleen (1102:57,82). These\nlesions are not visible on T2 weighted images.\n\nThe pancreatic parenchyma has normal signal intensity and enhancement without\nevidence of pancreatic ductal dilatation.\n\nThere is thickening of the left adrenal gland. There is symmetric renal\nenhancement and excretion of intravenous contrast. There is no evidence of\nrenal mass or hydronephrosis. There is a retroaortic left renal vein. The\nhepatic, portal, splenic, and superior mesenteric veins are patent.\n\nIn the left paraspinal musculature, there is a peripherally enhancing T1\nhypointense, T2 hyperintense collection measuring 11 x 14 mm (1102:116).", "output": "1. Numerous hepatic and splenic cystic lesions largest measuring 9 mm. Given\ndecrease in size and conspicuity of many of these lesions compared to recent\nCT as well as presence of left paraspinal fluid collection, resolving micro\nabscesses are favored. Cystic metastases may have a similar appearance, but\nare considered less likely.\n2. Peripherally enhancing fluid collection in the left paraspinal musculature\nmeasuring 11 x 14 mm (1102:116) concerning for additional microabscess.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 11:19 AM, 30 minutes after discovery of the findings." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver demonstrates normal contours without morphological signs of liver\ncirrhosis. There is no significant drop of signal on the out of phase imaging\nas compared to the in-phase imaging to suggest hepatic steatosis. There are\nmultiple scattered T2 hyperintense nonenhancing lesions, the largest in\nsegment III (series 8, image 29) measuring 11 x 11 mm, compatible with\ncysts/biliary hamartomas. 15 mm T2 hyperintense lesion within the segment\nV/VIII (series 8, image 22) that demonstrates peripheral discontinuous nodular\nenhancement that progressively fills in on the more delayed phases, compatible\nwith a hemangioma. There are no suspicious enhancing hepatic mass lesions.\n\nBiliary: Gallbladder is present without gallstones. No gallbladder wall\nthickening or pericholecystic fluid. There is no intrahepatic or extrahepatic\nbiliary duct dilatation. The common bile duct tapers normally towards the\nampulla without obstructing filling defects.\n\nPancreas: Pancreas demonstrates normal signal intensity onthe T1 weighted\nimages and enhances homogeneously. There is mass effect of the pancreatic\ntail by the large splenic mass, however no clear invasion. No suspicious\nsolid or cystic mass lesion. The main pancreatic duct is not dilated. No\nperipancreatic inflammatory changes or fluid collections.\n\nSpleen: There is a large 11 x 9.4 x 11 cm splenic mass lesion that is that is\nheterogeneously isointense to to the background splenic parenchyma on the T2\nweighted images with multiple irregular areas of hypointense signal centrally.\nIt does hypointense areas demonstrate drop of signal on the in-phase imaging\nas compared to the out of phase imaging, compatible with hemosiderin. On the\npostcontrast images, there is heterogeneous avid arterial enhancement that\npersists on the more delayed phases without enhancement of the more central\nirregular areas.\n\nAdrenal Glands: The right adrenal gland is normal. The left adrenal gland is\npushed anteriorly and superiorly by the large splenic mass, however is\notherwise unremarkable.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There are no suspicious renal masses or\nhydronephrosis bilaterally.\n\nGastrointestinal Tract: Significant mass effect on the stomach by the large\nsplenic mass, however is otherwise unremarkable. There is a clear fat plane\nbetween the stomach and the large splenic mass. The visualized portions of\nthe small bowel and colon in the upper abdomen are normal in caliber. There\nis no free fluid in the upper abdomen.\n\nLymph Nodes: No suspicious mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria\n\nVasculature: Abdominal aorta and its major branches are patent. The splenic\nvein, SMV, portal vein and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "11 cm splenic mass lesion with avid heterogeneous enhancement on the\npostcontrast images suggestive of a sclerosing angiomatoid nodular\ntransformation (___). It causes mass effect on the stomach and pancreatic\ntail, however no invasion." }, { "input": "Lower Thorax: Please refer to CT chest performed concomitantly for findings in\nthe thorax.\n\nHepatobiliary: Again seen is a mass involving the left hepatic duct extending\ninto the common hepatic duct, as seen previously and consistent with known\ncholangiocarcinoma. The mass is again seen extending up to the confluence of\nthe right and left hepatic ducts causing severe atrophy of the left hepatic\nlobe, worse in segment IV and mild prominence of right hepatic duct. The\nextent of the mass is difficult to compare craniocaudally due to differences\nin slice selection but appears not significantly changed measuring 3.1 cm in\nlength. Abnormal T2 signal and enhancement throughout the left hepatic lobe\nsecondary to biliary obstruction is again seen.\n\nPrevious 2.8 cm satellite lesion in segment II is best seen on the\npostcontrast images and appears contiguous with the abnormal signal in the\nleft hepatic lobe. The 4 mm lesion seen on prior endoscopic ultrasound in\nsegment IV is not well demonstrated, perhaps due to severe atrophy with signal\nabnormality of this segment and small size of the lesion. There is\npneumobilia as expected post CBD stent. Cholelithiasis and background hepatic\nsteatosis are again seen.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable except for a few cysts. No\nhydronephrosis\n\nGastrointestinal Tract: No bowel obstruction or ascites in the upper abdomen.\n\nLymph Nodes: There are a few prominent periportal and peripancreatic lymph\nnodes measuring up to 1.2 cm, nonspecific..\n\nVasculature: Again seen is left portal vein occlusion by the tumor. The main,\nright portal, middle and right hepatic veins are patent. The left hepatic\nvein is likely involved by tumor, as on prior. There is conventional celiac\nbranching.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions demonstrated.\nPostoperative changes are seen in the anterior abdominal wall.", "output": "Redemonstration of cholangiocarcinoma involving the left hepatic lobe which\nappears grossly stable. Similar vascular involvement by tumor. The segment\nIV lesion seen on endoscopic ultrasound is difficult to see likely due to\nsevere atrophy, small size of the lesion and diffuse signal abnormality\nsecondary to biliary obstruction.\n\nStable borderline peripancreatic and periportal lymph nodes. No new\nmetastatic disease." }, { "input": "Lower Thorax: Limited assessment of the lung bases shows no pleural effusion. \nSmall pericardial lymph nodes are nonspecific (5:4, 5:7).\n\nHepatobiliary: Since the prior MRI performed on ___, there has\nbeen interval Y-90 radioembolization of the left hepatic lobe. There is a\nlarge lobulated intraductal soft tissue mass occupying the entire common\nhepatic duct and extending superiorly to the hepatic duct confluence. This\nmeasures approximately 2.9 x 2.9 x 5.0 cm TV x AP x CC, significantly enlarged\ncompared to ___, where it appeared as an ill-defined infiltrative\nmass that was difficult to measure (5:25, 3:19). Distal margin of the tumor\nis just above the medial insertion of the cystic duct (05:31), which is above\nthe superior margin of the CBD stent. As a result, the degree of diffuse\nintrahepatic biliary dilatation has significantly progressed compared to the\nprior exam.\n\nEvaluation of the hepatic parenchyma is notable for a segment II satellite\nlesion measuring 3.3 x 2.5 cm, decreased in size from the prior exam where it\nmeasured 4.0 x 2.8 cm (1102:47). Diffuse surrounding hyperenhancement\nthroughout the left hepatic lobe is consistent with prior Y-90 treatment\n(1101:40).\n\nHowever, there is also a similar degree of wedge-shaped late arterial\nhyperenhancement on involving the right hepatic lobe, predominantly segments\nVII and VI (1101:64). Within this area of background hyperenhancement are\nmultiple rounded lesions measuring up to 0.9 cm that demonstrate hyperintense\nor intermediate-hyperintense signal on T2 weighted imaging with relatively\nlittle or no central enhancement post-contrast (05:15, 05:19; series 1101,\nimages 45, 52, 53). These findings in the right hepatic lobe are all new from\n___, and are suspicious for cholangitis complicated by hepatic\nmicroabscesses in the setting of worsening biliary obstruction.\n\nInnumerable smaller foci of arterial hyperenhancement seen throughout\nintervening segments VIII and V without a definite correlate on other\nnoncontrast phases or delayed postcontrast phases are nonspecific and may\nrepresent additional areas of cholangitis or transient hepatic intensity\ndifferences. Some representative examples are seen on series 1101, images 36,\n51, 94.\n\nPancreas: There is normal intrinsic T1 hyperintense signal throughout the\npancreas. No focal parenchymal lesions or ductal dilation.\n\nSpleen: Spleen is normal in size, without focal lesions.\n\nAdrenal Glands: Normal in size and shape.\n\nKidneys: Kidneys are normal in size and shape. No solid parenchymal lesions\nare identified. A simple cyst in the lower pole of the right kidney measures\nup to 2.3 cm. Additional millimetric simple cysts in the lateral interpolar\nregion of the right kidney. There is no hydronephrosis.\n\nGastrointestinal Tract: Stomach is unremarkable. There is no bowel\nobstruction or ascites.\n\nLymph Nodes: A node measuring up to 1.1 cm was previously 0.7 cm (1101:67). A\n1 cm peripancreatic node is stable (1101:67). A 1 cm aortocaval node is\nstable (1101:100). There is no new mesenteric adenopathy.\n\nVasculature: Abdominal aorta is not aneurysmal. Celiac artery, superior\nmesenteric artery, and bilateral renal arteries are patent. An accessory\nrenal artery is noted on the left. Left portal vein is chronically occluded. \nRight anterior and right posterior portal veins are patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are\nidentified. Soft tissues are unremarkable.", "output": "1. Interval progression of disease with significant enlargement in a now 5 cm\nobstructing intraductal mass occupying most of the common hepatic duct,\nextending from the hepatic duct confluence to the level of the cystic duct\ninsertion/superior margin of the CBD stent.\n2. This has resulted in worsening intrahepatic biliary dilation, with\ninnumerable new subcentimeter T2 hyperintense lesions in the right hepatic\nlobe likely representing hepatic microabscesses in the setting of background\ncholangitis. While new tumor/neoplastic involvement of the right hepatic lobe\nis felt to be less likely, this is not entirely excluded.\n3. Decreased size of a now 3.3 cm segment II satellite lesion post Y-90.\n4. Chronically occluded left portal vein.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 16:00, 5 minutes after\ndiscovery of the findings." }, { "input": "Lower Thorax: Limited evaluation of the lung bases is notable for trace\nbilateral pleural effusions and bibasilar atelectasis. Small pericardial\neffusion.\n\nLiver: Several subcentimeter T2 hyperintense nonenhancing liver lesions,\nlikely small cysts or hamartomas. Multiple geographic predominantly\nperipheraly T2 hyperintense enhancing solid lesions at the hepatic dome and\ninvolving segment two posteriorly appear to have a nodular contour that bulges\nalong the hepatic capsule, corresponding to the areas of arterial enhancement\non recent CT. Largest lesion measures 7.3 x 4.2 cm at the hepatic dome (8:7).\nFindings are suspicious for metastatic disease.\n\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. Common bile\nduct stent is noted with left-sided pneumobilia. There are numerous\ngallstones with mild gallbladder wall thickening. Gallbladder is\nnondistended. There are few tiny punctate gallstones within the cystic duct.\n\nPancreas: There are few T2 hyperintense nonenhancing pancreatic cystic\nlesions, likely side branch intraductal papillary mucinous neoplasm (IPMN),\nlargest measuring 0.2 cm within the pancreatic body for which no additional\nfollowup is warranted based on patient's age (08:29). No solid pancreatic\nmass.\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: There are bilateral T2 hyperintense simple renal cysts. Within the\ninterpolar region of the left kidney there is a 0.8 x 0.8 cm T2 hypointense\nlesion which is heterogeneously T1 hyperintense and is incompletely evaluated\n(08:35). The kidneys are otherwise homogeneous in signal intensity. No\nhydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: There is an enlarged celiac lymph node measuring up to 12 mm.\nRetroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: Limited evaluation due to non breath hold sequencing. No\nabdominal aortic aneurysm. Celiac axis, SMA, and bilateral renal arteries are\npatent. Hepatic vein, main portal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: There is diffuse T2 hyperintense signal\nwithin the upper thoracic vertebral body (07:32) which is incompletely\ncharacterized. Soft tissues are unremarkable.", "output": "1. Findings worrisome for hypervascular hepatic metastases with an abnormal\nceliac axis lymph node measuring 1.2 cm.\n2. Incompletely evaluated upper thoracic vertebral body, suspicious for\nmetastatic involvement.\n3. No hepatic abscess.\n4. Cholelithiasis without evidence of acute cholecystitis.\n5. Small bilateral pleural effusions and pericardial effusion." }, { "input": "The liver is normal in signal intensity on the T2 weighted images. Two\nsub-centimeter T2 hyperintense lesions at the dome (4:5) and posteriorly in\nsegment VII (04:10) as well as a 1.9 x 1.7 cm T2 hyperintense lesion in\nsegment VII and a 1.8 x 1.7 cm T2 hyperintense lesion in segment VII (04:15)\nhave all been characterized as hemangiomas on MRI ___, stable. No\nnew lesion is identified on this non-contrast examination. The gallbladder is\nnormal with no evidence of stones. There is no intra or extrahepatic biliary\nductal dilatation.\n\nThe pancreas is normal in signal intensity on the T2 weighted images. Two\ncystic lesions in the pancreatic tail measuring 3 mm and 5mm (4:19, 20) as\nwell as a 6 mm cystic lesion in the pancreatic head (04:25) are unchanged from\n___, most likely side branch IPMNs. Again noted is pancreas\ndivisum. The main pancreatic duct is irregular. After secretin administration,\nthe pancreatic duct within the neck, body, and tail properly respond to\nsecretin with a normal amount of a upstream dilation. A 1.8 cm segment of the\npancreatic duct within the head does not respond to secretin with a 5 mm\nsegment of more focal narrowing as well as a 5 mm segment of more focal\nnarrowing at the papilla (7:10). High signal within the second and third parts\nthe duodenum are consistent with excretion of pancreatic juices into the\nbowel.\n\nThe spleen, adrenal glands, kidneys and visualized bowel loops are\nunremarkable. No enlarged lymph nodes are identified. There is no ascites in\nthe upper abdomen. No bone marrow signal abnormality is seen.", "output": "1. Pancreas divisum. 1.8 cm segment of pancreatic duct within the head does\nnot respond normally to secretin, with two 5 mm segments of more focal\nnarrowing at the site of narrowing seen on recent MRI and at the minor\npapilla. Normal upstream pancreatic duct dilation but slight persistent\ndilation at 10 minutes. Normal amount of fluid excretion into the duodenum. \nThe findings are more in keeping with diffuse chronic pancreatitis than a\ndominant stricture.\n2. T2 hyperintensities in the liver have been previously characterized as\nhemangiomas on MRI ___.\n3. Sub-centimeter pancreatic cystic lesions are most likely side branch IPMNs.\nAs per MRI report ___, MRI follow up is recommended in 6 months.\n\nNOTIFICATION: Findings #1 was discussed at the pancreatic multi disciplinary\nconference by Dr. ___ on ___." }, { "input": "Lower thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are nodular and there\nare diffuse reticular markings hyperintense on T2 with progressive\nenhancement, in keeping with cirrhosis and reticular fibrosis. No concerning\nsolid or cystic lesions. No evidence of an abscess or microabscess. Multiple\nnodules scattered throughout the liver parenchyma demonstrate intrinsic high\nT1 signal without worrisome enhancement features, consistent with regenerative\nnodules. The largest nodules are located in segments V and VIII and measure up\nto 11 and 8 mm respectively. There is chronic thrombosis of the left portal\nvein with resultant left hepatic lobe atrophy. There is an accessory left\nhepatic artery arising from the left gastric artery and a replaced right\nhepatic artery arising from the superior mesenteric artery. The medial segment\nof the left hepatic lobe is supplied by the left hepatic artery arising from\nthe common hepatic artery. There is a small amount of ascites.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nSpleen: Splenomegaly measuring up to 15 cm. Non-enhancing T1 and T2\nhypointense foci are consistent with calcifications.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. Bilateral subcentimeter cysts are\nunchanged compared to the previous exam. The largest cyst measures 12 x 8 mm\nand is located in the interpolar region of the left kidney. There are no\nconcerning solid or cystic lesions. No hydronephrosis or hydroureter.\n\nGI tract: The GI tract is of normal caliber throughout. There is sigmoid\ndiverticulosis without any evidence of diverticulitis.\n\nLymph nodes: There is a stable prominent porta hepatitis lymph node measuring\nup to 18 mm in short axis diameter. No significant mesenteric or\nretroperitoneal by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.", "output": "1. Cirrhosis with splenomegaly and ascites. Multiple regenerative nodules but\nno concerning masses meeting OPTN criteria for HCC.\n2. Chronic thrombosis of the left portal vein with resultant atrophy of the\nleft hepatic lobe.\n\n3. No hepatic abscess or microabscesses.\n\n4. Variant hepatic arterial anatomy with accessory left and replaced right\nhepatic arteries as described above." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: The liver has a nodular contour. This is in keeping with the provided\nhistory of cirrhosis. There is progressive reticular enhancement throughout\nthe liver, compatible with fibrosis. There is no background hepatic\nsteatosis.\n\nThere are multiple foci of non-masslike arterial hyperenhancement in both\nlobes of the liver. These are located mostly in the periphery of the liver. \nThe largest is in the dome of the liver and measures 12 mm (1201, 111). The\nsecond largest is more subtle along segment 5 and measures 10 mm (1201, 31). \nThe others all measure less than 1 cm (1201; 46, 94, 105, and 108). These\nhave a possible subtle correlate on the T2 weighted images, though no\ncorrelate on the delayed post-contrast images. These most likely represent\nperfusional abnormalities or small areas of mild subclinical focal\ncholangitis. No lesions meet OPTN-5 criteria for hepatocellular carcinoma.\n\nThere is a replaced left hepatic artery from the left gastric artery. \nAdditionally, there is a replaced right hepatic artery from the SMA. The\nmedial segment of the left hepatic lobe is supplied by the common hepatic\nartery. Again, the left portal vein is not visualized, compatible with\nchronic thrombosis. The left lobe is atrophied. The remainder of the portal\nveins are patent. The hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The bile\nducts are regular and smooth. There is no mass or choledocholithiasis. The\ngallbladder is normal without wall thickening or evidence of stones. There is\nvery trace pericholecystic fluid, which is nonspecific.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is borderline enlarged, measuring 12.8 cm. Several\ncalcifications are noted within the spleen. These are unchanged from the\nprior CT.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are few subcentimeter simple\ncysts. There are no worrisome renal lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There are few prominent periportal lymph nodes, though none meet\nsize criteria for pathologic enlargement. They are presumably reactive. \nThere is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or atherosclerotic plaque.\n\nPelvis: Again, there is a partially imaged T2 hyperintense mass in the left\nadnexa, which was better assessed on the recent CT of the abdomen and pelvis\ncommon was better characterized on the prior MRI of the pelvis. It appears\ngrossly unchanged from the CT.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nAgain, there is a wide mouth abdominal wall hernia containing loops of small\nbowel, as well as a loop of the transverse colon. This is unchanged from the\nprior exam. There is no evidence of obstruction or strangulation.", "output": "1. Cirrhotic liver. No lesions meet OPTN-5 criteria for hepatocellular\ncarcinoma.\n2. Non masslike foci of arterial hyperenhancement in the periphery of the\nliver are nonspecific, and may be perfusional or may represent mild\nsubclinical focal cholangitis.\n3. Normal appearance of the biliary tree.\n4. Unchanged chronic thrombosis of the left portal vein.\n5. Borderline splenomegaly.\n6. No ascites.\n7. Partially imaged left adnexal lesion, better characterized on prior\nstudies" }, { "input": "Lower Thorax: A left infrahilar lesion correlates with the large calcified\nlymph node conglomerate seen on the recent chest CT. Otherwise, the lung\nbases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is cirrhotic and fibrotic in appearance with areas of\nconfluent fibrosis (series 1103, image 47). No suspicious enhancing lesions\nmeeting OPTN criteria for HCC. Chronic thrombosis of the left portal vein is\nre- demonstrated. The right and main portal veins are patent.\n\nBiliary: No intra or extrahepatic biliary dilatation. The gallbladder is\ndecompressed.\n\nPancreas: The pancreas is normal in size and signal intensity. No focal\nlesions. No pancreatic ductal dilatation. No peripancreatic stranding.\n\nSpleen: The spleen is mildly enlarged measuring 13.0 cm. Several\nsubcentimeter low intensity foci within the spleen are compatible with\ngranulomas seen on the prior CT. No new focal lesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape bilaterally.\n\nKidneys: Subcentimeter simple cysts are seen within the kidneys bilaterally. \nOtherwise, the kidneys enhance symmetrically. No enhancing lesions. No\nhydronephrosis. No perinephric stranding.\n\nGastrointestinal Tract: The stomach and partially visualized small and large\nbowel are within normal limits.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. There are replaced\nright and left hepatic arteries, arising from the SMA and left gastric\nrespectively.\n\nOsseous and Soft Tissue Structures: There is a large ventral wall hernia\ncontaining non obstructed loops of bowel. There is a new cystic lesion within\nthe subcutaneous tissues of the right flank measuring 3.6 x 3.0 cm with a thin\nenhancing rim (series 7, image 36), which is indeterminate in etiology. No\nsuspicious enhancing osseous or soft tissue lesions.", "output": "1. Cirrhotic and fibrotic liver, but no suspicious enhancing lesions meeting\nOPTN criteria for HCC.\n2. Chronic thrombosis of the left portal vein.\n3. Splenomegaly.\n4. New cystic lesion within the subcutaneous tissues of the right flank\nmeasuring up to 3.6 cm. This is indeterminate in etiology.\n5. Large ventral hernia containing nonobstructed loops of bowel.\n6. Partially imaged cystic left adnexal structure, which is better evaluated\non the MR pelvis with the same date.\n\nRECOMMENDATION(S): Clinical correlation for the cystic lesion within the\nsubcutaneous tissues of the right flank. Ultrasound and/or aspiration can be\nconsidered if needed." }, { "input": "Lower thorax: Limited evaluation notable for partially visualized left hilar\nlesion, better characterized on ___ chest CT as calcified\nlymphadenopathy from prior granulomatous exposure.\n\nLiver: Cirrhotic liver morphology. Few transient hepatic intensity\ndifferences noted. No hepatic steatosis. No suspicious mass. No ascites.\n\nBiliary: No biliary duct dilatation. Gallbladder is unremarkable.\n\nPancreas: Unremarkable. No suspicious mass.\n\nSpleen: 0.8 cm nonenhancing splenic calcification as seen on ___ CT.\nOtherwise unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Subcentimeter renal cysts noted, few of which are hemorrhagic or\nproteinaceous. No hydronephrosis. No suspicious mass.\n\nGastrointestinal Tract: Worsening of inflammation from acute diverticulitis\nalong the sigmoid and bladder dome with adjacent left lower quadrant\nperitoneal thickening and hyper enhancement due to peritonitis, and worsening\nphlegmonous changes along the superior bladder dome (05:36; 04:19). No air to\nsuggest overt colovesical fistula. No drainable collection. Extensive\nadhesions between the uterus, bladder, left adnexa, and adjacent bowel noted.\nThere is a gas containing sigmo-sigmoid fistula with adjacent pocket of gas\nadjacent to tethered small bowel loops (06:21; 05:31). No intestinal\nobstruction.\n\nPelvis: The uterus is retroflexed measuring 9 x 4 x 4.3 cm with C-section scar\nand IUD in appropriate position. No fibroids noted. The endometrium is\nnormal in thickness measuring 3 mm. Junctional zone is within normal limits. \nNondistended vagina and cervix are unremarkable. Trace pelvic free fluid is\nlikely physiologic.\n\nRight ovary is unremarkable with a small hydrosalpinx. A 1.8 cm physiologic\nleft follicular ovarian cyst is noted (04:17). No left hydrosalpinx. A\nmultiloculated 7.9 x 5.9 cm cystic lesion within left adnexa is compatible\nwith a peritoneal inclusion cyst (05:20).\n\nLymph Nodes: Few prominent peripancreatic and retroperitoneal lymph nodes are\nlikely reactive. Bilateral subcentimeter inguinal lymph nodes are likely\nreactive. Pelvic sidewall lymph nodes are nonenlarged.\n\nVasculature: Patent vasculature. There is a replaced right hepatic artery to\nthe SMA and a replaced left hepatic artery to the left gastric. Chronic left\nportal vein thrombus is again noted. Right portal vein, main portal vein,\nSMV, and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: Evidence of prior ventral hernia repair\nwith persistent large recurrent bowel containing ventral hernia.", "output": "1. Acute sigmoid diverticulitis with progression of phlegmonous changes along\nsuperior bladder dome, left-sided peritonitis, extensive adhesions with\ntethering of small bowel loops, and sigmo-sigmoid fistula. No obstruction or\ndrainable collection.\n2. Cirrhosis. No HCC. Chronic left portal vein thrombosis.\n4. 7.9 cm left pelvic peritoneal inclusion cyst.\n\nRECOMMENDATION(S): The impression and recommendation above was entered by\nDr. ___ on ___ at 12:15 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Lower thorax: The visualized lower lungs are unremarkable. No pericardial or\npleural effusion.\n\nLiver: The liver is normal in size and shape. Hepatic steatosis estimated in\n21.5%. Status post radiofrequency ablation with cavities identified in\nsegments V, VI and VII. An arterially enhancing nodule measuring 0.9 cm in\nsegment II is unchanged (1201:34), with no correlate in T2 or\ndiffusion-weighted sequences. No new suspicious lesions are identified.\n\nBiliary: The gallbladder is not distended and has no indwelling stones. No\nintrahepatic or extrahepatic biliary dilation.\n\nPancreas: The pancreas is atrophic. No focal lesions are identified, no\npancreatic duct dilation or surrounding inflammatory changes.\n\nSpleen: The pancreas is normal in size and shape with homogeneous signal and\nno focal lesions.\n\nAdrenal Glands: Both adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetrical in size with multiple scattered simple\ncysts bilaterally measuring up to 1.5 cm. No suspicious lesions, stones or\nhydronephrosis.\n\nGastrointestinal Tract: The stomach, duodenum, small bowel are unremarkable\nand undistended. Scattered colonic diverticulosis with no associated\ninflammatory signs.\n\nPelvis: The urinary bladder is within normal limits. Large Naboth cyst\nmeasuring 1.8 cm (8:30).\n\nLymph Nodes: No retroperitoneal, mesenteric, pelvic or inguinal\nlymphadenopathy.\n\nVasculature: All major vessels in the abdomen and pelvis are normal in caliber\nand patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions or acute\nfractures.", "output": "Status post ablation in segments V, VI and VII. Stable subcentimeter\narterially enhancing nodule in segment II. No new lesions identified.\nModerate hepatic steatosis." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology. There is drop in signal on\nout of phase imaging compared with in phase imaging suggestive of moderate\nsteatosis. There are 3 ablation cavities, one in the periphery of segment V,\none in segment VII, and one at the border of segments VI/VII. There is no\nresidual internal nodular enhancement in the region of these cavities to\nsuggest residual or recurrent disease. A subcentimeter focus of arterial\nenhancement in segment II is unchanged and does not have correlate on\nadditional phases. There are few additional punctate foci of arterial\nenhancement without definite correlate on additional phases, likely transient\nhepatic intensity differences (1201:92, 68, 47). No new concerning liver\nlesions.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas is atrophic however demonstrates normal signal intensity on\nT1 weighted images and enhances homogeneously. Pancreatic duct is normal in\ncaliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis. There are bilateral simple renal cysts measuring\nup to 1.5 cm in the right kidney.\n\nBowel: The stomach is unremarkable. Postsurgical configuration of the bowel\nin the midline of the anterior abdomen is not significantly changed. There is\nmesenteric stranding surrounding this region which is similar to prior and\nconsistent with postsurgical change. There are colonic diverticula without\nevidence of acute diverticulitis.\n\nPelvis: The bladder and distal ureters are unremarkable. Again seen is a\nlarge nabothian cyst measuring 1.6 cm. Uterus is otherwise unremarkable. No\nadnexal abnormality. No free fluid in the pelvis.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nOsseous/Soft Tissue: There are postsurgical changes along the anterior\nabdominal wall. There are subcutaneous soft tissue nodules in the bilateral\ngluteal tissues which are likely injection sites. There are degenerative\nchanges in the lower lumbar spine. A subcentimeter T2 hypointense enhancing\nlesion in the right proximal femur correlates with a sclerotic lesion seen on\nCTs dating back to ___, consistent with a benign entity given\nlong-term stability (1300:115; 8:37). There is no abnormal marrow signal or\nfocal suspicious osseous lesion. No free fluid.", "output": "1. Stable post ablation changes in the liver. No evidence of new or recurrent\nmetastatic disease.\n2. Moderate hepatic steatosis.\n3. Diverticulosis." }, { "input": "Limited evaluation of the lung bases demonstrates bilateral small pleural\neffusions and adjacent atelectasis. There is a large amount of abdominal\nascites.\n\nLiver: The liver is small in size and nodular in appearance compatible with\ncirrhosis. There are no suspicious enhancing hepatic lesions. There is no\nintrahepatic bile duct dilation.\n\nGallbladder: There is mild gallbladder wall edema compatible with third\nspacing.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nfocal mass or ductal dilatation. There is classic pancreatic ductal anatomy.\n\nSpleen: The spleen is enlarged measuring up to 16.5 cm in length.\n\nKidneys and Adrenals: The adrenal glands are normal. There is a sub 5 mm T2\nhyperintense focus in the right kidney (series 6, image 36) compatible with a\ncyst. There is a lesion in the left kidney (series 5b image 48) which\ndemonstrates increased T1 signal without enhancement compatible with a\nhemorrhagic cyst.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: There are prominent periportal lymph nodes, likely reactive.\n\nVessels: Note is made of a replaced right hepatic artery which arises from the\nsuperior mesenteric artery (SMA). Note is made of prominent paraesophageal\nvarices.\n\nBones: The osseous structures are unremarkable.", "output": "1. Hepatic cirrhosis with large amount of abdominal ascites. No suspicious\nhepatic lesions.\n2. Splenomegaly with paraesophageal venous varices compatible with portal\nhypertension.\n3. Note is made of a replaced right hepatic artery which arises from the SMA. \nThe portal vein is patent." }, { "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver: Normal in size. Parenchyma is normal in signal and enhancement. No\nsolid mass. No evidence of hepatic steatosis on the dual-echo GRE images.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nis absent.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.\n\nSpleen: Normal in size, signal, and enhancement. Incidentally noted is a 16\nmm splenule\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Right kidney is normal in size, signal, and\nenhancement without solid mass. There are several right-sided peripelvic\ncysts\n\nAbutting the left renal collecting system there is a 4.7 x 5.2 x 5.3 cm cystic\nstructure with complex internal signal characteristics most consistent with\nhemorrhage (low T2 signal material posteriorly which shows high signal on T1\nweighted images and no significant enhancement).\n\nAt the junction of the upper pole and interpolar region on the left anteriorly\nthere is a 8 x 9 x 4 mm cortical cystic lesion which shows intermediate signal\non T2 weighted images and very high signal on T1 weighted images without\nsignificant enhancement most consistent with a proteinaceous or hemorrhagic\ncysts. There is mild medial perinephric stranding, likely reactive. Proximal\nleft ureter is thickened enhancing, may be reactive, clinically correlate to\nexclude UTI.\n\nGastrointestinal Tract: No evidence of obstruction. No mass.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Portal veins and hepatic veins are\npatent.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal.", "output": "Limited exam demonstrates that there are 2 lesions in the left kidney:\n\nThere is a 0.9 cm left renal proteinaceous/hemorrhagic cyst, without\nassociated enhancement.\n\nThere is a 4.7 x 5.2 x 5.3 cm hemorrhagic cyst abutting the left renal\ncollecting system, without evidence of enhancement. Follow-up with ultrasound\nto determine size stability or decreasing size is recommended.\n\nThickened and enhancing proximal visualized left ureter, may be reactive,\nclinically correlate to exclude UTI." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial pleural\neffusion. The heart size is normal.\n\nThe liver contour is markedly nodular, in keeping with known history of\ncirrhosis. Ill-defined areas of increased signal intensity on T2 weighted\nsequences (series 3, image 19), corresponding to reticular contrast\nenhancement on delayed sequences (series 13, image 35), denotes confluent\nfibrosis. A 3 mm nonenhancing or hypoenhancing focus at the junction of\nsegments II and III for (series 11, image 20), seen only on a single\npost-contrast phase, appears equivocally low in signal intensity on T2\nweighted sequences (series 7, image 19), possibly a small granuloma. No\nconcerning hepatic mass is detected. Conventional hepatic arterial anatomy is\ndemonstrated. The portal and hepatic veins are patent.\n\nThe spleen is mildly enlarged (series 13, image 37). Extensive perigastric and\nparaesophageal varices (series 13 image 20, series 11, image 38) denote\nchronic portal hypertension.\n\nThe pancreatic parenchyma demonstrates normal signal intensity and bulk.\nMultiple cystic lesions are seen throughout the uncinate process, body and\ntail, measuring up to 4 mm, likely represent side branch IPMN, denoted by very\nhigh internal signal intensity on T2 weighted sequences (series 7, image 30,\n33, 28). The main pancreatic duct is normal in caliber.\n\nThe adrenal glands are normal. Arising from the upper and lower poles of the\nright kidney are 3 mm and 7 mm simple cysts (series 3, image 34, 33), denoted\nby very high internal signal intensity on T2 weighted sequences, low signal\nintensity on T1 weighted precontrast images, without appreciable internal\ncontrast enhancement. Arising from the lower pole of the left kidney is a 6 mm\nlesion which demonstrates low signal intensity on T2 weighted sequences,\nslightly increased signal intensity on T1 weighted precontrast images, with no\ndefinite enhancement, incompletely images on this study, but likely\nrepresenting a small hemorrhagic cyst (series 7, image 41, series 8, image\n84). There is no collecting system obstruction.\n\nThe abdominal aorta, celiac trunk, SMA, renal arteries are patent and normal\nin caliber.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "1. Cirrhotic liver with confluent fibrosis. No concerning hepatic mass.\nConventional hepatic arterial anatomy.\n2. Mild splenomegaly with extensive perigastric and paraesophageal varices,\ndenoting chronic portal hypertension.\n3. Multiple cystic lesions throughout the pancreatic uncinate process, body\nand tail, measuring up to 4 mm, likely side branch IPMN. ___ year followup MRCP\nrecommended per departmental guidelines." }, { "input": "Lower Thorax: Unremarkable.\n\nLiver: The liver demonstrates homogeneous enhancement with smooth contours. \nThere is no hepatic steatosis. The previously described lesion on the\nultrasound has no correspondence on the MRI. There is no concerning focal\nlesion.\n\nBiliary: No intra or extra biliary duct dilatation. The gallbladder is\nunremarkable.\n\nPancreas: Unremarkable.\n\nSpleen: The spleen is homogeneous and measures 12 cm.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Unremarkable besides a 8 mm cortical cyst at the inferior pole of the\nright kidney.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No abdominal adenopathy.\n\nVasculature: No abdominal aortic aneurysm. The hepatic veins and portal veins\nare patent.\n\nOsseous and Soft Tissue Structures: Unremarkable.", "output": "An indeterminate liver lesion seen on recent US has no correlate on MRI. No\nconcerning hepatic lesion.\n\nRECOMMENDATION(S): Resume regular US surveillance for HCC." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: There is mild hepatic steatosis. The liver is otherwise unremarkable.\n\nBiliary: Gallbladder is unremarkable. There is no intra or extrahepatic\nbiliary duct dilation.\n\nPancreas: Limited views of the pancreas are unremarkable.\n\nSpleen: Spleen is normal in size.\n\nAdrenal Glands: The adrenal glands are thickened bilaterally with areas of\nnodularity in the right superior limb and left lateral limb. Both of these\nareas of discrete nodularity demonstrate diffuse drop of signal on\nout-of-phase imaging consistent with intravoxel fat.\n\nKidneys: Note is made of a few scattered cortical cysts with the largest in\nthe right upper pole measuring 2.4 cm. The kidneys are otherwise\nunremarkable. No hydronephrosis.\n\nGastrointestinal Tract: There is no bowel obstruction.\n\nLymph Nodes: No abdominal lymphadenopathy is seen.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesion.", "output": "1. Bilateral adrenal hyperplasia.\n2. Mild hepatic steatosis." }, { "input": "The lung bases are grossly clear. There is no ascites.\n\nLiver: The liver demonstrates mild heterogeneous signal dropout on T1 out of\nphase relative to T1 in phase sequences, denoting steatosis. Fatty sparing is\npresent around the gallbladder (3:15, 17). Additional geographic areas of\nfatty sparing are identified in the left hepatic lobe measuring up to 1.4 cm\n(3:14). No enhancing hepatic lesion is identified. There is no intra or\nextrahepatic bile duct dilatation.\n\nGallbladder: The gallbladder is normal without stones or wall thickening.\n\nPancreas: The pancreas enhances homogeneously. There is classic pancreatic\nductal anatomy with non dilated main pancreatic duct.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nKidneys and Adrenals: The adrenal glands are normal bilaterally. A 1.0 cm\nnonenhancing, T1 hyperintense lesion at the anterior interpolar aspect of the\nleft kidney is consistent with a hemorrhagic cyst (03:20, 13:36). The kidneys\notherwise enhance symmetrically. There is no hydronephrosis.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: No pathologically enlarged abdominal lymph nodes are identified.\n\nVessels: The abdominal vasculature including the right, left, and main portal\nveins is widely patent.\n\nBones: The osseous structures are unremarkable.", "output": "1. Mild heterogeneous hepatic steatosis with several areas of focal fatty\nsparing within the left hepatic lobe and adjacent to the gallbladder.\n2. No concerning hepatic mass.\n3. 1.0 cm hemorrhagic cyst in the left kidney." }, { "input": "There is motion degradation throughout the examination with the patient having\ndifficulty breath-holding. Study is however a diagnostic in evaluating the\nlesion of concern within segment VIII. This structure has approximate maximal\ndiameter of 2.4 cm with a lobulated contour. It is almost occult on pre\ncontrast sequences, with minimal intralesional fat, as evidenced by drop of\nsignal on out of phase chemical shift imaging as compared to in phase. After\nadministration of gadolinium, there is avid arterial hyperenhancement (9:22),\nwhich quickly fades and remains only subtly hyperintense to surrounding liver\nparenchyma. On delayed hepatobiliary phase of imaging, there is retained\ncontrast within this lesion, indicative of presence of hepatocytes. This\nappearance is most suggestive of focal nodular hyperplasia.\n\nThere is no additional focal hepatic lesion. No hepatic steatosis is noted.\nGallbladder and biliary tree are normal in appearance. The pancreas, spleen,\nadrenal glands and kidneys are unremarkable. The study is not intended to\nevaluate the bowel, although no evidence of colitis is noted within the\nvisualized segments. There is no ascites or lymphadenopathy.", "output": "2.4 segment VIII hepatic lesion demonstrates imaging features most consistent\nwith focal nodular hyperplasia." }, { "input": "Examination limited by motion artifacts. Limited non breath hold sequences\npostcontrast were obtained.\n\nLower Thorax: No pleural effusion, no suspicious nodule.\n\nLiver: Liver demonstrate steatosis. There is no focal lesion.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are unremarkable. The\ngallbladder is unremarkable.\n\nPancreas: Redemonstration of a lesion involving the head of the pancreas\nmeasuring 26 x 31 mm and a celiac axis lymph node measuring 30 x 26 mm, they\nare isointense to slightly hyperintense on T2, isointense to slightly\nhypointense on T1, they demonstrate restriction of diffusion and mild\nenhancement. They are both seen compressing and narrowing the main portal\nvein directly beyond the level of the confluence of the SMV and the main\nportal vein on a distance of 2.5 cm, with the splenic vein seen coursing\ninferiorly to the celiac axis lymph node.\n\nThe pancreatic duct is not assessed with MRCP today, but we suspect narrowing\nsecondary to those 2 masses on approximately 1 cm at the level of the head of\nthe pancreas (series 8, image 34 and 35), although there is no upstream\ndilation.\n\nSpleen: There is no focal lesion, the spleen is normal in size and shape.\n\nAdrenal Glands: Left adrenal demonstrating diffuse loss of signal on out of\nphase imaging, without any focal lesion. Most likely this is in keeping with\nleft adrenal hyperplasia. The right adrenal is normal.\n\nKidneys: Multiple bilateral cysts are seen, largest measuring 22 mm at the\ninferior pole of right kidney.\n\nGastrointestinal Tract: Grossly unremarkable\n\nLymph Nodes: There is a 2.9 cm celiac axis lymph node described above. There\nis an 8 mm lymph node (series 9, image 25) in the gastrohepatic ligament. 10\nmm lymph node seen posteriorly to the main celiac axis lymph node (series 9,\nimage 30). The known right retrocrural lymph node is not well seen on today's\nexamination. There are multiple additional small lymph nodes in the\nretroperitoneum better seen on diffusion imaging (series 11, image 80, 83, 85,\n86, 87), they measure less than 8 mm.\n\nVasculature: Normal aspect of the IVC and the subhepatic vein. As described\nabove, narrowing of the main portal vein to directly beyond the level of the\nconfluence of the SMV and main portal veins on 2.5 cm. Celiac artery, SMA and\nrenal arteries are unremarkable.\n\nOsseous and Soft Tissue Structures: No worrisome lesion. Previously noted\nbilobed lesion inferiorly to the right kidney are not seen anymore today,\nthese were most likely small post-biopsy hematomas that have resolved in the\ninterval.", "output": "1. Biopsy-proven pancreatic PNET grade 2 lesion with enlarged metastatic\nceliac axis lymph node. These 2 lesions are compressing and narrowing the\nmain portal vein directly just beyond its confluence.\n\n2. Multiple subcentimeter short axis retroperitoneal lymph nodes and\ngastrohepatic lymph nodes. They remain nonspecific given their size.\n\n3. Interval resolution of lesions noted previously anteriorly to the right\nkidney, likely small hematomas.\n\n4. Left adrenal thickening is most likely in keeping with hyperplasia" }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nThe liver, pancreas, spleen, adrenal glands, kidneys, stomach and\nintra-abdominal loops of small and large bowel are normal. There is no\nmesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThe bladder, uterus, and adnexa are within normal limits. There is no\nintrapelvic lymphadenopathy or free fluid.\n\nThere are no bony lesions concerning for malignancy or infection.\n\nMR ANGIOGRAM:\n\nThe abdominal aorta, celiac trunk, SMA, ___, and renal arteries are patent and\nnormal in caliber. An accessory right renal artery is present (series 10,\nimage 43). Portal and hepatic veins are patent. Conventional hepatic arterial\nanatomy is demonstrated.\n\n3D postprocessing was performed on an independent workstation, including the\ncreation of 3D maximum intensity projection images, which support these\nfindings.", "output": "No arterial or venous abnormalities. No bowel abnormalities. No MR correlate\nfor known history of severe abdominal pain." }, { "input": "In segment VII of the liver, a 14mm lesion of high signal\nintensity is identified on T2-weighted imaging (series 3, image 28) that does\nnot enhance post administration of contrast (series 200, image 19). The\nappearances are consistent with a simple hepatic cyst. No other focal liver\nlesion identified. The gallbladder is visualized and is normal. The spleen\nis visualized and is normal. Both adrenals are normal. The pancreas is\nunremarkable.\n\nThe right kidney is visualized and is normal. The right kidney measures 10.2\ncm in maximum length.\n\nThe left kidney is normal in size measuring 11 mm. There is gross left sided\nhydronephrosis noted, and involves all of the calices as well as the renal\npelvis. There is renal cortical thickness preservation over the upper pole\nbut some cortical thinning over the inter and lower poles of the left kidney.\nA delayed nephrogram is noted on the left side, and no excretion is seen into\nthe left renal pelvis or collecting system by the end of the examination.\nBeyond the left renal pelvis, the left ureter is not visualized. No fluid\ndistended ureter is seen beyond the left UPJ.\n\nNo obstructing mass is seen at the left UPJ. A left lower pole accessory renal\nartery is seen draping along the anterior/medial aspect of the distended left\nrenal pelvis, but without visualization of the ureter distal to this, it is\ndifficult to tell if the accessory lower pole renal artery is the actual cause\nof the UPJ obstruction.\n\nAn accessory lower pole renal artery is also seen supplying the right kidney.\n\nThe bowel where visualized is normal.\n\nNo evidence of any lymphadenopathy. No evidence of any free fluid.\n\nSome degenerative change is noted in the spine with a dextroconcave scoliosis.\n\nThe bladder is unremarkable.\n\n2D and 3D reformations provided multiple perspectives for the dynamic series,\nparticularly in assessment of the left lower pole accessory renal artery.", "output": "1. Left ureteropelvic junction obstruction with delayed left nephrogram,\nwithout excretion into the renal pelvis or filling of left ureter during the\nexamination. A left lower pole accessory renal artery drapes along the\nanterior/medial aspect of the distended renal pelvis (series 102, images\n___ -- without visualization of the ureter distal to this, it is difficult\nto determine if this accessory renal artery may represent a crossing vessel\naccounting for the UPJ obstruction. No mass identified in the expected\nlocation of the UPJ.\n\n2. Normal right kidney and ureter." }, { "input": "Lower thorax: Lung bases are clear.\n\nLiver: Views of the liver are unremarkable. No focal lesion is seen. There\nis no ascites.\n\nBiliary: Gallbladder is unremarkable. No stones are identified. There is no\nintra or extrahepatic biliary duct dilation.\n\nPancreas: Pancreas is grossly unremarkable. There is no pancreatic duct\ndilation.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. There is no hydronephrosis. \nThere is no focal renal lesion.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable. Appendix is normal (series 4, image 47 through\n49).\n\nPelvis: Intrauterine gestation noted with limited evaluation of fetal anatomy.\nTwo fibroids are present measuring 3.6 x 3.3 cm in the subserosal left fundus\nand 5.9 x 5.2 cm in the intramural posterior lower uterus, unchanged from ___. Fibroid signal is homogeneous T2 hypointense without evidence of\ndegeneration. The ovaries are unremarkable. There is a small amount of pelvic\nfree fluid.\n\nLymph Nodes: There is no mesenteric, retroperitoneal, or pelvic sidewall\nadenopathy.\n\nVasculature: Flow voids are preserved.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. There\nis no superficial soft tissue abnormality.", "output": "1. No acute intra-abdominal process. Normal appendix.\n2. Grossly stable fibroid uterus. No evidence of fibroid degeneration.\n3. Intrauterine gestation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:54 am, 5 minutes after\ndiscovery of the findings." }, { "input": "Corresponding to the abnormal area on CT and ultrasound is an approximately\n2.9 cm area of dropout of signal on out of phase imaging, compatible with\nfocal increased fat on a background of hepatic steatosis. There is no\ncorrelate on T2 and the area does not demonstrate relative hyper or\n___. There is some fatty sparing around the gallbladder. The\nliver otherwise enhances normally without evidence of solid lesion. There are\ntwo scattered subcentimeter biliary hamartomas present.\n\nReplaced right hepatic artery. There is no intrahepatic or extrahepatic\nbiliary ductal dilatation. The gallbladder is normal.\nNormal characteristics of the pancreas, adrenal glands, spleen, and kidneys.\nThere is no free fluid. Visualized loops of bowel are normal. The lung bases\nare clear. Normal bone marrow signal.", "output": "Abnormality on CT and ultrasound corresponds with a region of nodular focal\nfat deposition on a background of diffuse hepatic steatosis. No suspicious or\nsolid lesions are identified." }, { "input": "Lower Thorax: The visualized segments of the lower lungs are unremarkable. No\npleural effusions. Mild pericardial effusion, within physiological limits.\n\nLiver: The liver is smaller in size with mildly nodular contours and\nheterogeneity of signal throughout. After contrast injection, a diffuse\nperfusion disturbance is noticed. Tiny subcentimeter cyst in segment III. \nThere are no other identifiable focal lesions. There is associated large\nintra-abdominal ascites. The portal and hepatic veins are unremarkable.\n\nBiliary: The gallbladder is normal in size and shape. No calculi are seen in\nits lumen. The intra and extrahepatic biliary ducts are normal in caliber.\n\nPancreas: Slightly smaller in size with heterogeneous appearance of the\nparenchyma. No focal lesions are seen. The pancreatic duct is mildly\ndilated..\n\nSpleen: The spleen is mildly enlarged with maximal diameter of 13.7 in\ncraniocaudal extension.\n\nAdrenal Glands: Both adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal and symmetric in size, with normal and\nsymmetric nephrogram. Small bilateral simple cortical cysts seen measuring up\nto 0.5 cm, for example in the left mid third (05:32). There is a larger\nnodule in the inferior pole of the left kidney measuring 3.0 cm (05:47).\n\nGastrointestinal Tract: The stomach, duodenum and visualized segments of\nsmall enlarged bowel are unremarkable and nondistended.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy is identified.\n\nVasculature: The aorta and its branches are normal in caliber.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions in the\nvisualized skeleton.", "output": "Evidence of cirrhosis associated to expected splenomegaly and ascites. No\nfocal liver lesions are identified.\nHeterogeneous pancreas with mild dilation of the pancreatic duct. As per\nclinical note, calcifications are described on CT evaluation, making these\nfindings consistent with chronic pancreatitis." }, { "input": "Lower Thorax: Visualized lung bases are unremarkable. No pleural or\npericardial effusion.\n\nLiver: Visualized portions of the liver are normal contour. No hepatic\nsteatosis. A 1.2 cm cyst is noted in segment VI and 0.8 cm cyst in segment\nII.\n\nBiliary: Cholelithiasis. No intrahepatic biliary duct dilatation. The common\nbile duct is dilated measuring 1.1 cm but tapers down to the ampulla. No\nobvious obstructing lesion.\n\nPancreas: Multiple cystic lesions are noted scattered throughout the pancreas.\nFor example, in the head of the pancreas, there is an 8 mm cystic lesion\n(05:13). A 1.3 cm cystic lesion is noted in the distal tail of the pancreas. \nVentral to this, there is a 7 mm cystic lesion (05:13). No internal\nseptations or nodularity seen. Main pancreatic duct is normal in size.\n\nSpleen: Spleen is normal size. In the lower pole of the spleen, there is a\n1.1 cm cystic lesion (05:15).\n\nAdrenal Glands: Nodular thickening of the left adrenal gland is noted without\na discrete lesion, unchanged. Right adrenal gland is normal.\n\nKidneys: In the upper pole of the right kidney extending to the hilum, there\nis a 2.8 x 3.2 x 4.3 cm T1 hypointense and T2 hyperintense lesion which\ndemonstrates avid heterogeneous arterial enhancement with progessive central\nfill-in on delayed images. No definite internal fat is noted in this lesion. \nFindings are most consistent with a clear cell carcinoma. Anterior to the\ninferior aspect of the mass, there is a 1.6 x 1.5 cm enhancing lesion\nfollowing blood pool, representing an aneurysm. It is difficult to determine\nwhether this is related to the tumor or adjacent to it.\n\nIn the interpolar region of the left renal hilum centrally, there is a 3.8 x\n4.0 x 3.6 cm heterogeneous, predominantly T1 and T2 isointense renal mass\nrelative to the cortex. Some areas of heterogeneous T1 hyperintense signal on\nin-phase sequences appear to drop signal on out-of-phase imaging becoming more\nhomogeneous in appearance, consistent with the presence of intravoxel fat. \nPredominantly avid arterial peripheral enhancement with progressive central\nfill in on delayed imaging is seen. The mass splays the renal collecting\nsystem but does not result in hydronephrosis. Findings are most consistent\nwith a clear cell carcinoma.\n\nMultiple scattered simple appearing cortical cysts are demonstrated in both\nkidneys. In the upper pole of the right kidney, there is a 2.0 x 1.4 cm\ncortical cyst and a 1.0 x 1.0 cm cyst in the lower pole. In the upper pole of\nthe right kidney, there is a 7 mm cortical cyst.\n\nGastrointestinal Tract: Visualized bowel loops are unremarkable.No free\nfluid.\n\nLymph Nodes: No enlarged lymph nodes.\n\nVasculature: There are two left renal arteries and one right renal artery. \nConventional renal vein anatomy. The renal arteries and veins are patent. \nAbdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: Bone marrow signal intensity is normal.", "output": "1. 4.3-cm right upper pole renal mass extending to the hilum most likely\nreflective of a renal cell carcinoma, clear cell subtype. A 1.6-cm right renal\nartery aneurysm is demonstrated, anterior to the lower aspect of this renal\nmass.\n2. 4.0-cm left central renal mass within the hilum appears to contain\nintravoxel fat with heterogenous avid enhancement most likely reflective of a\nsynchronous renal cell carcinoma, clear cell subtype.\n3. Renal vasculature is patent. Two left renal arteries are demonstrated.\n4. Multiple cystic lesions in the pancreas likely representing side-branch\nIPMN, largest measuring 1.3 cm.\n5. The common common bile duct is dilated with no obvious obstructing lesion. \nFindings could relate to sphincter of Oddi dysfunction. Correlation with\nliver function tests and consideration for dedicated MRCP is recommended.\n6. Cholelithiasis.\n\nRECOMMENDATION(S): Dilated common bile duct with no obvious obstructing\nlesion. Correlation with liver function tests and consider dedicated MRCP." }, { "input": "Lower Thorax: Lung bases are clear.\n\nLiver: The liver is normal in morphology and signal intensity. There are T2\nintermediate multilobulated hyperintense lesions in segment VII and V which\ndemonstrate subtle rim enhancement in segment VII and peripheral and central\nenhancement in segment V. These measure 0.8 x 0.8 cm and 2.3 x 1.8 cm,\nrespectively (series 5, image 7, 19). While these are smaller compared to the\nprior MRI from ___ when they measured up to 1.9 cm and 2.5 cm,\nrespectively, they have recurred compared to the CT scan from ___. No\nnew lesions are seen. A few scattered simple cysts versus biliary hamartomas\nare again seen and unchanged, the largest measuring 0.9 cm in segment II. \nThere is no perihepatic ascites.\n\nBiliary: The gallbladder is unremarkable without evidence of stones. There is\nno intra or extrahepatic biliary duct dilation.\n\nPancreas: The pancreas is normal in morphology and signal intensity. There is\nno main pancreatic duct dilation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. There are few scattered sub\ncentimeter cortical cyst. There is no suspicious renal lesions. There is no\nhydronephrosis.\n\nGastrointestinal Tract: There is no hiatal hernia. There is no bowel\nobstruction. Ileostomy noted in the left lower quadrant.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. There is a single renal artery bilaterally. The portal vein\nand hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There is no worrisome bony lesion. There\nis a T2 hyperintense lesion in the T9 vertebral body which is unchanged and\nlikely represents a hemangioma.", "output": "Recurrence of metastatic lesions in segment VII and V since ___,\nmeasuring 0.8 and 2.3 cm, respectively." }, { "input": "Lower Thorax: Unremarkable.\n\nLiver: Again seen are treatment cavities, the largest seen in segment 5,\nmeasuring 6.2 cm x 3.2 cm. 2 other ablation cavities are seen in segment 8\nand 4A at the dome of the liver, measuring 3.4 cm x 4.1 cm and 1.7 cm x 2.5 cm\nrespectively. These demonstrate similar characteristics, with surrounding\nhigh T1 rim with heterogeneous central cavity, representing coagulative\nnecrosis and hemorrhagic products. Post contrast administration, there is no\nenhancement to suggest residual tumor. There is early arterial enhancement of\nthe surrounding liver parenchyma, compatible with post treatment changes. No\nnew liver lesion.\n\nScattered high T2 cysts are seen in the left lobe of the liver.\n\nPortal vein and hepatic veins are patent.\n\nBiliary: No biliary duct dilatation. The gallbladder is unremarkable.\n\nPancreas: Tiny 2 mm or less cystic structures within the head and uncinate\nprocess of the pancreas, likely side branch intraductal papillary mucinous\nneoplasms (IPMNs). This is stable compared to the previous examination.\n\nSpleen: The spleen is unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Multiple renal cysts are again seen..\n\nGastrointestinal Tract: No bowel obstruction in the upper abdomen. No\nascites. An ileostomy is seen in the left upper abdomen.\n\nLymph Nodes: No adenopathy in the upper abdomen.\n\nVasculature: The hepatic vasculature is patent.\n\nOsseous and Soft Tissue Structures: Revisualization of the T9 and T12 lesions\ncontaining high T1 signal, likely hemangiomas.", "output": "1. Post treatment cavities are seen within the liver without new metastatic\nor recurrent disease.\n\n2. Incidental findings as described above." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: There is no significant drop in signal on opposed phase imaging to\nsuggest hepatic steatosis.Trace perihepatic fluid is noted.\n\nPatient is status post ablation of two right hepatic metastases, which was\nperformed on ___:\n1. Hepatic dome (12:15): There are two adjacent ablation zones measuring 3.6\nx 3.2 cm and 2.9 x 1.6 cm, respectively. This was due to repositioning of the\nprobe during the ablation procedure for better targeting of the single\nmetastasis. Along the medial aspect of the more posteriorly located ablation\nzone, there is a 0.8 x 0.7 cm hypoenhancing lesion with associated diffusion\nrestriction, suspicious for residual/recurrent tumor (12:16, 04:36).\n2. Segment V: (12:40): Ablation cavity measuring 5.8 x 2.8 cm, unchanged from\nprior. No new areas of nodular enhancement to suggest local recurrence. \nIll-defined areas of arterial hyperenhancement surrounding the treatment\ncavity appears slightly decreased from prior, and are likely post-treatment\nrelated.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilation. \nGallbladder is unremarkable.\n\nPancreas: Again seen are sub-5 mm cystic lesions in the head and uncinate\nprocess of the pancreas, which likely represent side branch intraductal\npapillary mucinous neoplasms (IPMN). There is no main duct dilation.\n\nSpleen: Spleen is normal in size, without focal lesions.\n\nAdrenal Glands: Normal in size and shape.\n\nKidneys: Kidneys are normal in size and shape. No solid parenchymal lesions\nare identified. Subcentimeter simple cysts are noted in both kidneys. There\nis no hydronephrosis.\n\nGastrointestinal Tract: Stomach is unremarkable. There is no bowel\nobstruction or ascites.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are not enlarged by\nsize criteria.\n\nVasculature: Abdominal aorta is not aneurysmal. Celiac artery, superior\nmesenteric artery, and bilateral renal arteries are patent.\n\nOsseous and Soft Tissue Structures: No focal osseous lesions are identified. \nSoft tissues are unremarkable.", "output": "1. Findings suspicious for a 0.8 cm focus of residual/recurrent tumor along\nthe medial aspect of the segment VII ablation zone.\n2. Sub-5 mm probable pancreatic side-branch IPMNs, which can be reassessed on\nroutine surveillance studies." }, { "input": "Lower Thorax: Please refer to the separate report for the CT chest performed\nthe same day. An 8 mm right lower lobe pulmonary nodule is noted.\n\nLiver: There are expected post-ablation changes in segment ___ related to the\ninterval microwave ablation, with surrounding perfusional changes. \nPre-existing ablation zones in segment ___ and 5 are unchanged. There is\nintrinsic T1 signal around the periphery of the ablation zones but no definite\nnodular enhancement to suggest recurrence. There is a nonspecific 9 mm\narterially enhancing focus in segment 8 (series 1201, image 24), nonspecific\nbut not present on the previous study. This does not show washout or\npseudocapsule enhancement and there is no T2/diffusion abnormality. A few\nsmall T2 hyperintensities in the left hepatic lobe are consistent with benign\ncysts or biliary hamartomas.\n\nBiliary: The gallbladder is unremarkable. There is no biliary dilation.\n\nPancreas: Unremarkable. No pancreatic ductal dilation.\n\nSpleen: Normal in size and enhancement.\n\nAdrenal Glands: Normal in size and shape.\n\nKidneys: Unremarkable aside from tiny bilateral cysts. No hydronephrosis.\n\nGastrointestinal Tract: A left mid abdominal ostomy is noted. The visualized\nbowel is otherwise grossly unremarkable.\n\nLymph Nodes: No enlarged lymph nodes in the field of view.\n\nVasculature: No evidence of abdominal aortic aneurysm. Major portal and\nhepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No aggressive bone or soft tissue lesions\nidentified.", "output": "1. Post-ablation changes with no evidence of residual or recurrent tumor at\nthe periphery of the ablation zones.\n2. New nonspecific 9 mm arterially enhancing focus in segment 8 can be\nre-evaluated at next follow-up." }, { "input": "Lower Thorax: Pulmonary nodules in the lingula and posterior right\ncostophrenic sulcus are again noted. Please refer to the separate report for\nthe CT chest for further detail of thoracic findings.\n\nLiver: There a few small hepatic cysts. 3 ablation zones in the right hepatic\nlobe are stable in appearance with no recurrent solid enhancement. There are\na few stable areas of peripheral enhancement that appear related to vessels. \nPreviously demonstrated arterially enhancing focus in segment 8 is not\nvisualized on this study. No new lesions are demonstrated.\n\nBiliary: There is no biliary dilation. The gallbladder is unremarkable.\n\nPancreas: Unremarkable.\n\nSpleen: The spleen is within normal limits of size and the parenchyma is\nhomogeneous.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Tiny subcentimeter cysts are noted bilaterally. No hydronephrosis.\n\nGastrointestinal Tract: There is a left lower quadrant colostomy. Visualized\nbowel is otherwise grossly unremarkable.\n\nLymph Nodes: No lymphadenopathy in the field-of-view.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: Subcentimeter T2 hyperintense lesions in\nT9 and T12 are most consistent with hemangiomas.", "output": "1. Stable hepatic post-ablation changes with no evidence of new or recurrent\nmetastatic disease.\n2. Previously identified arterially enhancing focus in segment 8 is no longer\ndemonstrated and may have been related to early post-treatment changes." }, { "input": "Lower Thorax: The lung bases are clear. There are no pleural effusions.\n\nLiver: There is a slightly irregular 1.9 x 1.9 cm T2 hyper, T1 hypointense\nlesion in segment 8 of the liver, which demonstrates peripheral enhancement\nwithout fill-in on the post gadolinium sequences. A second lesion with\nsimilar signal characteristics is seen in segment 5, measuring 1.8 x 2.5 cm. \nThere are few scattered hepatic cysts/biliary hamartomas, the largest in\nsegment 2 measuring up to 8 mm. Background liver signal is unremarkable,\nwithout evidence of fatty infiltration or iron deposition.\n\nBiliary: There is no intra or extrahepatic biliary duct dilatation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas has normal signal intensity morphology. There are no\nfocal pancreatic lesions. The pancreatic duct is not dilated.\n\nSpleen: The spleen is not enlarged.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There are no focal renal lesions. There is no hydronephrosis.\n\nGastrointestinal Tract: The visualized bowel loops are unremarkable, without\nevidence of obstruction.\n\nLymph Nodes: There is no lymphadenopathy in the upper abdomen.\n\nVasculature: The portal veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions.", "output": "2 suspicious hepatic lesions in segments 8 and 5, concerning for metastatic\ndisease." }, { "input": "Multiple sequences are degraded by respiratory motion. The study is however\ndiagnostic in the exclusion of the renal mass. The hypoechoic structure on\nrecent ultrasound within the mid left kidney is thought to correlate with a\nprominent column of Bertin. The kidneys demonstrate normal, symmetric\ncorticomedullary signal and enhancement (allowing for motion artifact). There\nis a 7 mm T2 hyperintense, nonenhancing cyst within the medial left mid\nkidney(08:20). Otherwise there is no focal renal lesion.\n\nThere single bilateral renal arteries. The renal ostia are widely patent and\nmain renal arteries smooth in contour. The arterial vasculature of the upper\nabdomen is conventional, with no significant irregularity to suggest advanced\natherosclerotic disease.\n\nThe visualized portions of the liver are normal in signal and enhancement\nwithout focal lesion identified. There is no evidence of hepatic steatosis.\nBiliary tree is unremarkable. Pancreas, spleen and adrenal glands are\nunremarkable. There is no lymphadenopathy or ascites. Osseous structures are\nunremarkable.", "output": "No renal mass identified with the finding on recent ultrasound thought to on\nthe basis of a prominent column of Bertin. Single bilateral renal arteries\nwithout evidence of stenosis, stricture or vasculitis." }, { "input": "Limited non-contrast imaging demonstrates a significantly steatotic liver\nwithout morphologic features to suggest fibrosis or cirrhosis. There is a\nlarge hematoma along the inferior capsular margin. This appears predominately\nsubcapsular with a small component extending beyond capsule. No large hepatic\nmass is identified on the few acquired sequences. The contour of the hematoma\nalong the medial aspect of segment VII may suggest a potential site of an\nintrahepatic lesion, and location correlates with the area of abnormal\nvascularity seen by angiography (05:26). However this area is small, and\nrepeat imaging would be most diagnostic after resolution of the hematoma. \nRepeat imaging in 3 months is recommended to assess for a small underlying\nlesion.\n\nThe noncontrast appearance of the pancreas, adrenal glands and left kidney are\nunremarkable. The right kidney is displaced inferiorly by the subhepatic\nhematoma. The patient is status post splenectomy with some scarring within\nthe left upper quadrant.\n\nThere is a small volume of diffuse ascites throughout the abdomen, as well as\nsuperficial edema and trace bilateral pleural effusions. Airspace opacity at\nthe right lung base is present. Note is made of bilateral breast implants. \nThe visualized osseous structures are unremarkable.", "output": "Limited partial examination. There is no large hepatic mass associated with\nthe large hematoma. Assessment for a small mass, particularly medially within\nthe right lobe would be best accomplished with repeat MR in 3 months, after\nallowing for retraction of the large perihepatic hematoma.\n\nHepatic steatosis." }, { "input": "Lower thorax: No pleural or pericardial effusion.\n\nLiver: The liver appears homogeneous in signal intensity.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. The\ngallbladder appears within normal limits.\n\nPancreas: The pancreas appears normal in signal intensity. There is no\npancreatic ductal dilatation.\n\nSpleen: The spleen appears normal in size and signal intensity.\n\nAdrenal Glands: There is an approximately 9 x 5 mm nodule in the right adrenal\ngland. There is nodular thickening of the left adrenal gland with a discrete\nfocal nodule posteriorly measuring 9 x 6 mm. Characterization of these\nnodules is not possible due to extensive motion artifact and their small size.\n\nKidneys: There is a 2.3 cm parapelvic cyst in the upper pole of the left\nkidney.\n\nGastrointestinal Tract: The visualized portions of the gastrointestinal tract\nappear within normal limits.\n\nPelvis: A pessary is noted in the vagina.\n\nLymph Nodes: No pathologic lymphadenopathy.\n\nVasculature: The thoracic aorta is very tortuous. No abdominal aortic\naneurysm.\n\nOsseous and Soft Tissue Structures: There are degenerative changes throughout\nthe spine. Multiple lower thoracic and lumbar compression fractures were\nbetter evaluated on recent CT.", "output": "Small bilateral adrenal nodules. Due to extensive motion artifact and their\nsmall size, these cannot be definitively characterized on the current exam. \nGiven their small size, endocrine workup can be considered. If endocrine\nworkup is not performed or is negative, a ___ year follow-up MRI is recommended.\n\nRECOMMENDATION(S): Follow-up MRI in ___ year can be performed to assess\nstability of small bilateral adrenal nodules if an endocrine workup is\nunrevealing or is not elected." }, { "input": "There is unchanged appearance of a focal, nonocclusive, eccentric filling\ndefect along the superior portion of the superior mesenteric vein, proximal to\nthe confluence with the splenic vein (8:35). This is unchanged in appearance\ncompared to prior MRI. Previously-seen bowel wall thickening and mesenteric\nedema has largely resolved.\n\nThere is mild thickening of the gastric rugae predominately throughout the\ncardia, fundus and body with relative sparing of the antrum. There is no\nnodularity or discrete mass. There is normal perastaltic motion of the\nstomach on MR cine sequences.\n\nThe liver is normal in size and contour with a normal parenchymal signal.\nThere is no focal lesion. The gallbladder and biliary tree are unremarkable.\nThe pancreas, adrenal glands and kidneys are unremarkable.\n\nA splenic infarct along the inferior margin is again seen, demonstrating a\nwedge-like area of nonenhancement with mild associated capsular retraction.\n\nBilateral pleural effusions are again noted, decreased in size on the right\nand unchanged on the left. Minimal adjacent compressive atelectasis is\npresent. There continues to be loculated pericardial fluid anteriorly,\nunchanged from recent CT and measuring up to 2 cm in thickness (11:2),\nappearing T2-hyperintense and T1-hypointense, without significant complexity\nor surrounding hyperenhancement.\n\nThe osseous structures are unremarkable.", "output": "1. Unchanged chronic nonocclusive SMV thrombus.\n2. Mild, smooth gastric fold thickening is nonspecific, and could represent\nmild gastritis. No concerning mass. Correlate with endoscopy findings and\nbiopsy.\n2. Near-resolution of previously-seen small bowel wall and mesenteric edema.\n3. Chronic small splenic infarct.\n4. Improved right pleural effusion. Stable small pericardial and left pleural\neffusions." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: There is signal loss on the out of phase sequence as opposed to the in\nphase sequence consistent with hepatic steatosis (fat fraction = 7%). The\nliver contours are smooth. In the right hepatic lobe adjacent to the\ninflammatory change of the right flank, there is mild hyperenhancement on the\narterial phase which likely represents a perfusional abnormality. There is no\nevidence of a hepatic abscess. No concerning solid or cystic lesions.\n\nBiliary: Evidence of a previous cholecystectomy is noted. In the right flank\nadjacent to the liver, there is a 9 x 14 mm T1 and T2 hypointense lesion\nconsistent with a dropped gallbladder stone (5a:147, 7:31, 5b:138). Just\nanterior to this calculus, are two more 1 mm similar-appearing lesions which\nmay also represent drop stones. Surrounding these findings is marked\nenhancing soft tissue and stranding consistent with inflammatory change. \nThere is a draining sinus tract to the right anterior abdominal wall skin. A\nright pigtail catheter remains in situ. There is no new drainable collection.\nPneumobilia with mild central intrahepatic biliary duct dilatation is\nunchanged compared to the previous CT scan.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: The spleen is mildly enlarged measuring up to 13.5 cm but demonstrates\nnormal signal characteristics. There are no focal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. Bilateral cortical cysts are again\nnoted. The largest cyst arises from the upper pole of the right kidney and\nmeasures 24 mm. There are no concerning solid or cystic lesions. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. There is at least 1 dropped calculus in the right flank with a surrounding\nextraperitoneal fluid collection extending to the right anterior abdominal\nwall skin. The right pigtail catheter remains in situ. No drainable fluid\ncollection." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is heterogeneous in signal characteristics. There are\nscattered areas of signal loss on the out of phase sequence as opposed to the\nin phase sequence consistent with mild hepatic steatosis. In segment 3,\nadjacent to the falciform ligament, there is a 7 x 7 mm region of signal loss\non the out of phase sequence as opposed to the in phase sequence in keeping\nwith focal fat. This finding corresponds to the hypodense region seen on CT. \nNo concerning solid or cystic lesions. The contours are smooth. No\nmorphologic features of cirrhosis.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: The left adrenal gland is slightly nodular. There are no\nfocal lesions bilaterally.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no concerning solid or cystic\nlesions. There are bilateral cortical cysts. The largest cyst on the right\nmeasures 3.3 x 3.6 cm and is located in in the interpolar region. The largest\ncyst in the left kidney arises from the upper pole and measures 5.1 x 6.0 cm.\nAlthough incompletely imaged, there is a probable small\nproteinaceous/hemorrhagic arising from the lower pole of the right kidney. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The patient is status post esophagectomy and gastric\npull-through. The GI tract is of normal caliber throughout. No mural\nthickening or abnormal enhancement.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: There is mild narrowing at the origin of the celiac artery which\nis greater than expected for normal physiologic arcuate ligament narrowing and\nlikely related to atherosclerotic disease. Moderate calcified atherosclerosis\nis noted throughout the abdominal aorta.\n\nOsseous and Soft Tissue Structures: Fatty replacement of the vertebral bodies\nin the lower thoracic spine is likely related to post-radiation change. The\nbone marrow demonstrates normal signal characteristics. No concerning osseous\nlesions.", "output": "1. In segment 3, there is a 7 mm region of signal loss on the out of phase\nsequence as opposed to the in phase sequence in keeping with focal fat. This\nfinding corresponds to the hypodense region seen on CT. No concerning hepatic\nlesions.\n2. The liver is heterogeneous in signal characteristics. There are scattered\nareas of signal loss on the out of phase sequence as opposed to the in phase\nsequence consistent with mild hepatic steatosis." }, { "input": "Lower Thorax: Lower lung bases and pleural spaces are clear. Lower\nmediastinal structures are grossly normal.\n\nLiver: Liver demonstrates homogeneous signal intensity with no morphological\nfeatures of cirrhosis or hepatic steatosis. No focal liver lesions. Hepatic\nvasculature is patent. The gallbladder is normal in appearance.Trace ascites\nis noted.\n\nBiliary: No intra or extrahepatic ductal dilatation.\n\nPancreas: Characterized on the recently performed CT scan of the abdomen and\npelvis, there is a solid pancreatic mass involving the tail/ body of the\npancreas measuring up to 5.3 x 4.1 cm (series 13, image 17). This lesion\nremains inseparable from the posterior wall of the stomach (series 3, image\n15), splenic artery and vein with resultant collateral vessels in the left\nupper quadrant. These findings were better seen on the comparison CT abdomen\nand pelvis Along the pancreatic head and uncinate process, 2 conglomerate\ncystic pancreatic lesions are noted, superiorly measuring 2.4 x 1.4 cm (series\n2, image 22), and inferiorly measuring 2.1 x 1.4 cm (series 2, image 22). The\nmain pancreatic duct is prominent, measuring up to 3 mm.\n\nSpleen: Normal in size, measure up to 12.2 cm. No focal splenic lesions.\n\nAdrenal Glands: The left adrenal gland is bulky in appearance, however no\ndiscrete nodules identified. Right adrenal gland is normal.\n\nKidneys: No dilatation of the renal collecting system. Within the upper pole\nof the right kidney, a T1 hyperintense, T2 hypointense hemorrhagic cyst,\nmeasuring 2.0 x 1.5 cm is present. On the post contrast subtraction images\nthe lesion demonstrates several enhancing internal septa which are slightly\nthickened and irregular (series 18, image 35). Within the lower pole of the\nleft kidney there is an additional 1.2 x 1.0 cm (series 13, image 35) solid\nrenal mass which is T2 iso to slightly hypointense with respect to the renal\ncortex, T1 hypointense, demonstrating restricted diffusion and avid\nenhancement on the corticomedullary phase, appearing iso- to slightly\nhypointense to the renal cortex, with washout on delay phases. No additional\nrenal mass lesions are identified. The renal vasculature is patent. No\nnodularity is seen with perirenal space.\n\nGastrointestinal Tract: Visualized loops of small large bowel are within\nnormal limits.\n\nLymph Nodes: 12 mm aortocaval lymph node (series 21, image 92).\n\nVasculature: No aneurysmal dilatation of the abdominal aorta.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions. \nSpinal hardware is again noted at L4-5.", "output": "1. 2.0 x 1.5 cm hemorrhagic cyst within the upper pole of the right kidney\ndemonstrates several enhancing slightly thickened and irregular internal\nseptations, as described above, in keeping with a Bosniak 3 complex renal\ncyst.\n\n2. 1.2 x 1.0 cm enhancing solid mass is seen along the lower pole of the left\nkidney. Differential considerations include an oncocytic neoplasm including\nchromophobe renal cell carcinoma, and angiomyolipoma with minimal fat. Clear\ncell renal cell carcinoma is considered less likely given the iso- to\nhypointensity on T2- weighted imaging.\n\n3. Large solid pancreatic mass measuring 5.3 x 4.1 cm, as described above,\nfully characterized on the recently performed CT scan of the abdomen and\npelvis.\n\n4. Cystic lesions within the pancreatic head and uncinate process likely\nreflective of side branch IPMNs.\n\nRECOMMENDATION(S): Urological consultation." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: 1.4 x 1.2 cm segment 8 hepatic lesion (17:39) demonstrates subtle\nrestricted diffusion with progresses continuous peripheral enhancement with\nband like extension to the hepatic capsule and possible capsular retraction.\nNo associated biliary duct dilatation. There is bandlike focal fatty sparing\ncorresponding to this area of hyperenhancement which extends to the capsule.\n(05:13). The liver is otherwise homogeneous in signal intensity. No\nadditional worrisome lesions. Moderate signal drop on out of phase imaging is\nconsistent with hepatic steatosis (fat fraction 15.6%).\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The\ngallbladder is unremarkable.\n\nPancreas: Focal 0.7 cm fat lesion within the uncinate process is consistent\nwith a small lipoma or interdigitating fat (7:38). Otherwise homogeneous in\nsignal intensity without focal lesion. No pancreatic duct dilatation. No\npancreatic divisum.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Homogeneous in signal intensity without focal lesion. No\nhydronephrosis. No perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: No retroperitoneal or mesenteric lymph node enlargement.\n\nVasculature: Patent vasculature. Celiac axis, SMA, bilateral renal arteries,\nand ___ are patent. Hepatic anatomy is conventional. Hepatic veins, main\nportal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: Unremarkable.", "output": "1.4 cm segment 8 centrally non-enhancing hepatic lesion with associated\nperfusional abnormality, suspicious for hepatic abscess; clinical correlation\nfor symptoms of infection are recommended.\n\nRECOMMENDATION(S): Recommend follow up CT or MR in ___ weeks to ensure\nresolution of hepatic lesion.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:25 pm, 5 minutes after\ndiscovery of the findings.\n\n The recommendation above was entered by Dr. ___ on ___ at\n08:44 into the Department of Radiology critical communications system for\ndirect communication to the referring provider." }, { "input": "Lower Thorax: Within the limits of MRI, the lung bases are clear. There is no\npleural effusion or pericardial effusion.\n\nLiver: The liver contour is mostly smooth. There is mild loss of signal on\nout of image suggestive of mild steatosis, approximately 10%. Previously\ndemonstrated hepatic lesion in segment 8, which was biopsied and returned as\nbenign is no longer identified as was on ___. No new hepatic mass\nis identified. Subtle perfusion differences and mild T2 hyperintensity in the\narea of pre-existing lesion persists (1304:47).\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilation. The\ngallbladder contains layering material within the fundus, which may represent\nconcentrated bile, unchanged. Otherwise, there is no MR evidence of acute\ncholecystitis.\n\nPancreas: The signal and bulk of the pancreas is within normal limits. The\nmain pancreatic duct is not dilated. No focal lesion is seen.\n\nSpleen: The spleen is normal in size and signal intensity. No focal lesion is\nseen.\n\nAdrenal Glands: Bilateral adrenal glands are normal in shape and signal\nintensity. No focal lesion is seen.\n\nKidneys: Bilateral kidneys are normal in size and symmetric in nephrogram. No\nfocal lesion is identified. There is no hydronephrosis on either side.\n\nGastrointestinal Tract: The imaged bowel loops are unremarkable. There is no\nbowel obstruction.\n\nLymph Nodes: There is no suspicious retroperitoneal or mesenteric\nlymphadenopathy\n\nVasculature: The main portal vein is patent. The hepatic arterial anatomy is\nconventional and patent. The abdominal aorta is not dilated.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion or\nsoft tissue mass.", "output": "1. Subtle persistent perfusion differences in the area of pre-existing lesion\nin segment 8, which was biopsied on ___, returning benign\npathology and likely representing inflammatory pseudotumor. No new suspicious\nhepatic lesion meeting OPTN 5 criteria.\n2. Mild hepatic steatosis." }, { "input": "Lower Thorax: The visualized lung bases and mediastinum are grossly\nunremarkable. No pleural or pericardial effusion.\n\nLiver: There is a significant in phase compared to out of phase loss of\nsignal. Punctate T2 hyperintense lesions in the liver reflects cysts or\nbiliary hamartomas, for example series 6, image 17. No suspicious liver\nlesions.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. There is\na 1.4 cm gallstone, but no gallbladder wall thickening or adjacent\ninflammatory change.\n\nPancreas: Incidental note is made of pancreas divisum. The pancreas is mildly\nfatty replaced and many millimetric CT in cystic lesions arising from the\npancreatic head and tail measuring up to 8 mm (03:19). The previously\nidentified enhancing pancreatic tail lesion has enlarged compared to ___, now 1.4 x 1.4 cm, demonstrates central T2 hyperintensity, peripheral T1\nhypointensity, and avid peripheral enhancement (06:29).\n\nSpleen: The spleen is normal in size. There is a significant in phase\ncompared to out of phase loss of signal.\n\nAdrenal Glands: The right adrenal gland normal in size and shape. Thickening\nof the left adrenal gland is unchanged since ___, but demonstrates\nout of phase compared to in phase signal loss compatible with adenomatous\nhyperplasia.\n\nKidneys: The right and left kidneys are markedly atrophied. A 0.8 x 1.1 cm\nslightly T2 hyperintense, slightly T1 hyperintense, nonenhancing lesion arises\nfrom the medial upper pole of the left kidney. Numerous new and old bilateral\nrenal cysts are seen, the largest of which measures 6.5 x 3.7 cm and arises\nfrom the upper pole of the right kidney. While most cysts demonstrate T2\nhyperintensity and T1 hypointensity, a right lower pole cysts demonstrate T1\nhyperintensity compatible with a hemorrhagic or proteinaceous cyst (10:52).\n\nGastrointestinal Tract: A gastric wall lipoma is essentially unchanged since\nat least ___ (06:23). Visualized loops of small bowel are grossly\nunremarkable. Colonic diverticulosis is noted.\n\nLymph Nodes: No visualized retroperitoneal, mesenteric, porta hepatic\nlymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion.", "output": "1. The left renal lesion of concern identified on recent CT scan favors a\nminimally complex hemorrhagic or proteinaceous cyst. Follow-up MRI could be\nconsidered in 6 months to ___ year to assess stability.\n2. A pancreatic tail lesion has minimally increased in size compared to ___\nand has characteristics compatible with a cystic neuroendocrine tumor. No\nevidence of metastasis.\n3. Suspect left adrenal adenomatous hyperplasia, similar appearance to ___.\n4. Multiple small cystic lesions of the pancreas, likely side branch IPMNs.\n5. Liver and spleen signal characteristics indicate hemosiderosis.\n6. Cholelithiasis.\n7. Diverticulosis.\n\nRECOMMENDATION(S): The left renal lesion of concern identified on recent CT\nscan favors a minimally complex hemorrhagic or proteinaceous cyst. Follow-up\nMRI could be considered in 6 months to ___ year to assess stability.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 13:15 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "2.4 x 2.1 cm lesion in liver segment ___ is T2 hyperintense and demonstrates\narterial hyperenhancement with early washout. This lesion is encapsulated\nappearing and demonstrates diffusely decreased signal on out of phase\nsequences, consistent with internal fat. It appears to arise from the surface\nof the liver rather than parenchyma, but there are no findings to suggest\nperitoneal etiology. No other concerning hepatic lesion is identified.\nMultiple subcentimeter simple hepatic cysts are scattered throughout the\nliver.\n\nThe gallbladder, intra and extrahepatic bile ducts, pancreas, spleen, and\nadrenal glands are normal. Simple renal cysts are stable. The kidneys are\notherwise unremarkable.\n\nA porta hepatis node measures 18 x 9 mm (12:50). No pathologically enlarged\nretroperitoneal or mesenteric lymph nodes. The abdominal aorta is normal\nthroughout. The right hepatic artery is replaced, arising from the superior\nmesenteric artery. The celiac axis, SMA, ___, and bilateral single renal\narteries are patent.\n\nNo free abdominal fluid. The bone marrow signal is normal throughout. The lung\nbases are clear.", "output": "2.4 x 2.1 cm encapsulated appearing peripherally located arterially-enhancing\nlesion with washout is partially exophytic from the left hepatic lobe. Given\nthe interval development since ___, findings are presumed to represent\nhepatocellular carcinoma, possibly well-differentiated given internal fat\nsignal, though imaging characteristics are also compatible with an adenoma. \nThis may be exophytic or pedunculated.\n\nNOTIFICATION: Findings were entered into the critical results dashboard for\ndirect notification of the ordering provider." }, { "input": "Liver: There are postsurgical changes from resection of hepatocellular\ncarcinoma in hepatic segment 4a. There is faint enhancement at the periphery\nof the resection bed which likely relates to expected postsurgical changes\nrather than residual disease. No new liver lesions are visualized. Multiple\nsubcentimeter hepatic cysts are unchanged from prior.\n\nBiliary: No intra extrahepatic thyroid ductal dilatation. The gallbladder\nappears normal.\n\nPancreas: No focal pancreatic lesions. No main duct dilatation. Pancreas\ndivisum is present.\n\nSpleen: The spleen is normal in contour signal characteristics. Small\nsplenule is noted.\n\nAdrenal Glands: The adrenal glands appear normal.\n\nKidneys: No suspicious renal lesions. Cortical scarring is noted in the in\nthe kidneys bilaterally. The simple appearing cortical cysts are noted in the\nleft kidney.\n\nGastrointestinal Tract: The visualized large and small bowel appears normal\nwithout evidence of masses.\n\nLymph Nodes: Prominent porta hepatis lymph nodes are again noted, series 11\nimage 39-42.\n\nVasculature: There is a replaced right hepatic artery arising from the SMA no\nabdominal aortic aneurysm. Vascular structures otherwise appear unremarkable.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Notable\ncolonic diverticulosis.", "output": "Postsurgical changes from resection of mass in hepatic segment 4a. \nEnhancement adjacent to the resection site likely inflammatory and attention\nto this area is recommended on follow-up." }, { "input": "Lower Thorax: Lung bases are included are clear. No suspicious pulmonary\nnodules or pleural effusions are seen.\n\nLiver: The liver slightly cirrhotic in appearance. Patient status post\npartial resection of segments 2 and 4A. There is no evidence for tumor\nrecurrence. No suspicious hepatic lesions are present. Several stable\nsubcentimeter biliary hamartomas are again identified.\n\nBiliary: The intra extrahepatic bile ducts are unremarkable. The gallbladder\nappears normal.\n\nPancreas: The pancreas is normal in morphology and signal intensity. The main\npancreatic duct is normal.\n\nSpleen: The spleen is normal in size. No splenic lesions are present.\n\nAdrenal Glands: The adrenal glands are normal in size.\n\nKidneys: There is no evidence for hydronephrosis. A stable ill-defined T2\nhyperintense nonenhancing lesion is again identified in the interpolar region\nof left kidney. This most likely represents a slightly complex left renal\ncyst. A stable 8 mm cyst is seen the upper pole the right kidney.\n\nGastrointestinal Tract: The GI tract is unremarkable.\n\nLymph Nodes: There is no retroperitoneal mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No suspicious bony lesions.", "output": "1. Status post partial resection of segment 4A/2. No evidence for tumor\nrecurrence. No new suspicious lesions are present. Stable biliary hamartomas\n2. Stable nonenhancing kidney lesions bilaterally most likely presenting\nrenal cysts." }, { "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver: Status post wedge resection site at segment 4A/2. Liver is normal in\nsize. Parenchyma is normal in signal and enhancement. Several small T2\nhyperintense foci without enhancement are noted consistent with cysts vs\nbiliary hamartomas. No solid mass. No evidence of hepatic steatosis on the\ndual-echo GRE images.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nis normal. No gallstone.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.\n\nSpleen: Normal in size, signal, and enhancement.\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement. No solid\nmass.\n\nGastrointestinal Tract: No evidence of obstruction. No mass.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Normal branching pattern of the\nceliac axis. Origin of the celiac artery and superior mesenteric artery are\npatent. Portal veins and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal.", "output": "Status post wedge resection site at segment 4A/2. No concerning liver lesion." }, { "input": "The examination is motion limited.\n\nLower Thorax: Lung bases are within normal limits. No pleural or pericardial\neffusion.\n\nLiver: The liver is normal appearance. No concerning liver lesions.\n\nBiliary: No intra or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal and morphology. No suspicious\npancreatic lesions or ductal dilatation. No peripancreatic stranding.\n\nSpleen: The spleen is normal in size. No focal splenic lesions.\n\nAdrenal Glands: Normal adrenals. No masses.\n\nKidneys: Bilateral enhancing renal masses are not significantly changed in\nsize when compared to the prior examination. The largest of these is within\nthe midpole of the right kidney, measuring 6.1 cm AP x 4.0 cm transverse. \nIntralesional bulk fat is compatible with angiomyolipoma, as on prior\nexaminations. Additional cysts measuring up to 1 cm noted bilaterally. No\nnew suspicious renal lesions. No hydronephrosis. Tubular perinephric fluid\nfilled structure on the right is unchanged, potentially a lymphocele.\n\nGastrointestinal Tract: Large field-of-view images of the bowel are\nunremarkable.\n\nLymph Nodes: No abnormally enlarged lymph nodes.\n\nVasculature: The abdominal aorta is not aneurysmal.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. There is a\npunctate focus of enhancement at the superior endplate of L5 (image 34, series\n1202), not significantly changed when compared to prior examinations, likely\nbenign. Compression deformity of T12 is unchanged.", "output": "1. Mildly motion limited examination.\n2. Bilateral enhancing renal lesions, not significantly changed when compared\nto the prior examination. Largest lesions are again compatible with\nangiomyolipomas; smaller ones are difficult to characterize." }, { "input": "Lower Thorax: Visualized lungs are clear. There is no pleural effusion.\n\nLiver: Normal morphology and signal intensity of the liver parenchyma. There\nis no hepatic steatosis.\n\nBiliary: The gallbladder is unremarkable. There are no gallstones. There is no\nintra or extrahepatic biliary duct dilatation.\n\nPancreas: The pancreas is normal in morphology and signal intensity. There is\nno focal pancreatic lesion. Main pancreatic duct is normal in caliber.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: Adrenal glands are unremarkable bilaterally.\n\nKidneys:\nLimited assessment of the kidneys in the absence of IV contrast and patient's\ninability to breath hold.\nRecently embolized angiomyolipoma arising from the mid-lower right kidney has\nslightly decreased in size measuring 5.6 x 4 x 4.7 cm, previously 6 x 4 x 6\ncm. There is no evidence of hemorrhage.\nAdditional bilateral renal masses are unchanged in size:\nFat containing mass arising from the upper pole of the right kidney (series 5,\nimage 10) is also likely an angiomyolipoma and measures 2 cm, previously 2 cm.\nT2 hypointense exophytic mass arising from the posterior interpolar left\nkidney measures 1.7 cm (series 6, image 18), previously 1.7 cm.\nNote is again made of bilateral renal cysts. 11 mm partially exophytic simple\ncyst arising from the anterior interpolar right kidney is stable. 6 mm simple\ncyst in the upper pole of the left kidney (series 5, image 11) has slightly\nincreased in size previously measuring 3 mm.\n\nThere is no hydronephrosis.\n\nGastrointestinal Tract: Visualized small and large bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "1. Slight interval decrease in size of the angiomyolipoma in the mid-lower\nright kidney now measuring up to 5.6 cm, previously 6 cm. Enhancement cannot\nbe assessed in the absence of IV contrast. There is no evidence of\nhemorrhage. Note that correlation is very limited due to suboptimal\nbreath-holding.\n2. Additional bilateral renal lesions are suboptimally characterized on the\ncurrent study but remain similar in size." }, { "input": "Motion mildly limits assessment.\n\nLower Thorax: No pleural or pericardial effusion.\n\nLiver: No concerning abnormality in the partially visualized liver.\n\nBiliary: The gallbladder is unremarkable. No evidence of intrahepatic or\nextrahepatic biliary dilation.\n\nPancreas: Normal parenchymal wall without ductal dilation or focal lesion\nidentified.\n\nSpleen: The normal in size without focal lesions. A tiny accessory spleen is\npresent inferiorly.\n\nAdrenal Glands: Normal in size and shape bilaterally.\n\nKidneys: Multiple nonenhancing T2 hyperintense lesions in both kidneys are\ncompatible with cysts. Numerous subcentimeter renal lesions demonstrate drop\nin signal on out of phase relative to inphase images or ___ ink artifact\nconsistent with intravoxel or bulk fat, respectively, in keeping with known\nhistory of angiomyolipomas in the setting of tuberous sclerosis. There is no\nhydronephrosis or definite new lesions.\n\nRight kidney: There are two dominant lesions in the right kidney. In the lower\npole, a fat containing lesion measures 3.9 x 5.7 x 4.6 cm (TV by AP by CC),\nstable from ___, and smaller than preembolization MRI in ___ (series 1401, image 40; series 17, image 53). In the upper pole, a fat\ncontaining enhancing lesion measures 2.0 x 1.5 x 1.9 cm (TV by AP by CC),\noverall stable from ___ (series 1401, image 51; series 17, image 34).\n\nLeft kidney: There are 3 dominant lesions in the left kidney. In the upper\npole, a fat containing enhancing lesion measures 1.2 x 1.5 x 1.5 cm (TV by AP\nby CC), stable from ___ (series 15, image 75; series 1403, image 53). In the\ninterpolar region, a fat containing enhancing lesion measures 1.3 x 1.1 x 1.1\ncm (TV by AP by CC) stable from ___ and ___ (series 17, image 45; series\n1201:41).\n\nIn the lower pole, an enhancing mass which appears lipid poor measures 1.9 x\n2.0 x 2.1 cm (TV by AP by CC), overall stable from ___ when it measured 1.9 x\n1.9 x 2.1 cm and from CT in ___ when it measured maximally 2.2 x 2.1\nx 2.0 cm (series 17, image 61; series 1403, image 57).\n\nGastrointestinal Tract: No evidence of obstruction.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Patent single renal arteries and veins bilaterally. Unremarkable\npartially visualized celiac axis and SMA.\n\nOsseous and Soft Tissue Structures: There is mild central and anterior\nvertebral body height loss involving the T12 vertebral body, stable from ___.\nNo new or concerning lesions involving the visualized soft tissues and osseous\nstructures.", "output": "1. Stable bilateral fat containing renal masses since at least ___,\ncompatible with angiomyolipomas in the setting of tuberous sclerosis.\n2. 2 cm lower pole left renal lesion is stable from the CT dated ___ and\nmost likely represents a lipid poor angiomyolipoma in this clinical setting.\n3. No new or enlarging renal masses identified." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in signal intensity and morphology. There is no\nsuspicious lesion. The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder is normal.\n\nPancreas: Normal in signal intensity without ductal dilatation. There is no\nfocal lesion.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There are numerous simple cysts bilaterally similar to the prior\nstudy. Additionally, there are multiple small fat containing renal lesions\nare similar to the prior study.\n\nRight Kidney: The dominant right lower pole renal mass measures 5.3 x 4.3 x\n3.7 cm, previously 5.2 x 4.2 x 4.1 cm when measured in similar planes (16:44,\n1503:49). There is persistent heterogeneous enhancement and areas of\nintralesional fat consistent with known angiomyolipoma. There is a new focal\narea of hypoenhancement likely representing necrosis the lower aspect this\nlesion (1503:50). The right upper pole fat containing renal mass measures 2.3\nx 1.8 x 1.7 cm, previously 2.1 x 1.9 x 1.6 cm (16:51, 1503:57).\n\nLeft Kidney: The dominant exophytic posterior left lower pole renal mass\nmeasures 2.4 x 1.7 x 1.9 cm, previously 2.5 x 1.7 x 1.9 cm when measured in\nsimilar planes (17:33, 1503:60). A smaller partially exophytic interpolar\nmass in the left kidney measures up to 1.6 x 1.2 x 1.3 cm, previously 1.6 x\n1.2 x 1.4 cm (17:60, with 1503:46).\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Unremarkable. There are single renal arteries bilaterally.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. Multiple fat containing renal lesions bilaterally consistent with\nangiomyolipomas in the setting of tuberous sclerosis.\n2. Persistent enhancement in the dominant right lower pole angiomyolipoma\nstatus post embolization with no change in overall size and a small new area\nof necrosis.\n3. Otherwise stable size of bilateral angiomyolipomas. No new or enlarging\nlesion." }, { "input": "Study is significantly degraded by respiratory motion.\n\nLower Thorax: Lower lungs are clear. There is no pericardial or pleural\neffusion.\n\nLiver: Liver is normal a in signal intensity and morphology. There are no\nsuspicious focal lesions.\n\nBiliary: There is no intrahepatic or extrahepatic biliary duct dilation. \nGallbladder appears normal.\n\nPancreas: Normal in signal intensity without pancreatic duct dilation.\n\nSpleen: Normal in intensity and morphology without focal lesions.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: significantly degraded by motion artifact limiting the evaluation for\ndetail and accurate comparison. Overall numerous simple cysts bilaterally are\nunchanged since prior. Within the limitations, the dominant lesion in the\nlower pole of the right kidney measures 5.3 x 3.3 x 2.3 cm approximately,\npreviously 5.3 x 4.3 x 3.7 cm and appears grossly unchanged. In comparison\nwith prior there is centrally less enhancement however overall the lesion\ncontinues to enhance. Multiple other fat containing lesions are again seen,\nthe largest in the left lower pole appears unchanged since prior measuring 2.3\ncm. There is no hydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: Limited views of the stomach, small bowel and large\nbowel loops are unremarkable.\n\nLymph Nodes: No lymphadenopathy\n\nVasculature: Unremarkable without aneurysms or other vascular abnormality.\n\nOsseous and Soft Tissue Structures: Chronic anterior wedge compression\nfracture of T12, unchanged since ___. No suspicious bony lesions\nnoted.", "output": "Significantly limited study due to breathing motion. Assessment of new\nlesions or accurate comparison is limited due to motion artifact. Within\nthese limitations:\n\n1. Multiple fat containing renal lesions bilaterally consistent with\nangiomyolipomas in the setting of tuberous sclerosis appear overall unchanged.\n2. The dominant lesion in the right lower pole appears unchanged in size, and\nrepresents less central enhancement likely due to necrosis however continues\nto enhance overall. Dominant lesion in the left lower pole is overall\nunchanged.\n\nRECOMMENDATION(S): Multiphasic CT is recommended for a more accurate\nassessment." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Liver is normal in signal intensity and morphology. There is no focal\nlesion. The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nGallbladder is not visualized.\n\nPancreas: Pancreas is normal in signal intensity and morphology without ductal\ndilatation. Millimetric cystic lesions, statistically side-branch IPMNs,\nrequire no further follow-up according to current departmental guidelines.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Numerous simple cysts and a few small hemorrhagic or proteinaceous\ncysts are present bilaterally. There is no hydronephrosis. Arising\nexophytically from the left lower pole, there is a 1.9 x 1.6 x 1.6 cm (TR by\nAP by CC; 7:27, 5:17) T1 hypointense, centrally T2 hyperintense lesion with a\nT2 hypointense rim and a lenticular T2 hypointense component along the\nsuperomedial aspect. The T2 hyperintense components of this lesion\ndemonstrate restricted diffusion and avid postcontrast enhancement. The T2\nhypointense components neither restrict nor enhance, likely a small amount of\nhemorrhage. This lesion does not contact the renal sinus fat or involve the\nrenal vasculature. There is a single renal artery and a single renal vein\nbilaterally.\n\nGastrointestinal Tract: Colonic diverticulosis is noted. There is a large\nduodenal diverticulum. The visualized loops of large small bowel are\notherwise unremarkable.\n\nLymph Nodes: No suspicious adenopathy\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion.\n\nPelvis: A bladder diverticulum is partially imaged (05:13). An oblong cystic\nstructure along the course of the right internal iliac vasculature may\nrepresent a small lymphocele (05:20).", "output": "1. 1.9 cm exophytic left lower pole renal lesion with imaging characteristics\nmost consistent with clear cell renal cell carcinoma. This lesion does not\ncontact the renal sinus fat or invade the left renal vasculature.\n2. Single renal arteries bilaterally, no adrenal or retroperitoneal lesion.\n3. No suspicious osseous lesions or lymph nodes." }, { "input": "Post-contrast images are limited by respiratory motion.\n\nLower Thorax: Limited assessment of the bilateral lungs appear unremarkable. \nThere is trace left pleural effusion. No pericardial effusion.\n\nLiver: The visualized liver is smooth in contour. There is no drop on out of\nphase imaging to suggest hepatic steatosis. There are no suspicious focal\nlesions.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPancreas: The visualized pancreas is normal in signal intensity without\npancreatic ductal dilatation. Multiple sub 5 mm cystic lesions are noted in\nthe pancreas, statistically likely to the side branch IPMNs, similar to prior.\n\nSpleen: The visualized spleen is normal in signal intensity and size without\nfocal lesion.\n\nAdrenal Glands: The adrenal glands appear unremarkable bilaterally.\n\nKidneys: The kidneys are symmetric in size and nephrogram. There is no\nhydronephrosis. There are bilateral T2 hyperintense renal cysts, measuring up\nto 4.1 x 3.4 cm in the left upper pole and 6.2 x 6.4 cm in the right lower\npole with layering posterior T2 hypointense T1 hyperintense component\nconsistent with blood products (3; 27). There are bilateral T1 hyperintense\nnonenhancing cysts, the largest in the left lower pole measures 2.4 x 2.5 x\n2.2 cm consistent with a proteinaceous or hemorrhagic cyst, similar to prior\n(3; 21).\n\nIn the left lower pole, there is redemonstration of the 1.7 x 1.7 x 2.0 cm\nexophytic predominantly T1 hypointense, centrally T2 hyperintense\npredominantly avidly enhancing lesion with T2 hypointense rim, similar to\nprior, and without restricted diffusion. Again there is a T2 hypointense T1\nhyperintense component along the superomedial aspect of this lesion, similar\nto prior (9; 28), likely foci of hemorrhage. Again, this lesion does not\ncontact the renal sinus fat or invade the vasculature.\n\nGastrointestinal Tract: There is a large duodenal diverticulum (3; 13). The\nvisualized small and large bowel appear normal in caliber without evidence of\nobstruction. There are scattered colonic diverticulosis without evidence of\ndiverticulitis.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy. There\nis no inguinal or pelvic sidewall lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. There is single left\nand right renal artery and single left and right renal vein.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. A subcentimeter Schmorl's node is incidentally noted in the\nsuperior endplate of L3 vertebral body (21; 68). A right superior bladder\ndiverticula is again partially imaged (2; 9). An oblong cystic structure\nalong the course of the right internal iliac vasculature again may represent a\nsmall lymphocele (2; 14), similar to prior.", "output": "1. Stable 2.0 cm left lower pole exophytic enhancing mass, again concerning\nfor clear cell renal cell carcinoma but differential also includes oncocytoma.\n2. Stable bilateral renal cysts, some of which are hemorrhagic or\nproteinaceous." }, { "input": "Lower Thorax: There is mild left basilar atelectasis. No pleural or\npericardial effusion.\n\nLiver: The imaged portion of the liver is normal in size and contour without\nevidence of focal lesions or hepatic steatosis. Scattered sub 5 mm T2\nhyperintensities likely represent biliary hamartomas or hepatic cysts.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is surgically absent.\n\nPancreas: The pancreas is mildly atrophic without evidence main pancreatic\nductal dilatation. Multiple cystic lesions are seen throughout the pancreas\nmeasuring up to 5 mm, not substantially changed in the size and number\ncompared to prior and likely representing side branch IPMNs.\n\nSpleen: The spleen is normal in size and signal intensity. Scattered sub 5 mm\nT2 hyperintensities are nonspecific but benign in appearance.\n\nAdrenal Glands: The left and right adrenal glands are normal in size and\nshape.\n\nKidneys: The kidneys are normal in size and position. There is no\nhydronephrosis. Redemonstrated are bilateral T2 hyperintense, nonenhancing\nsimple renal cysts measuring up to 6.3 cm on the right and 4.0 cm on the left,\nnot substantially changed compared to prior. Some of these cysts are noted to\nhave layering T1 hyperintense contents, likely blood products (for example\n11:46, 11:49).\n\nIn addition, there are bilateral intrinsically T1 hyperintense, nonenhancing\ncysts, the largest of which is located in the left lower pole and measures up\nto 2.5 cm, compatible with a proteinaceous/hemorrhagic cyst, similar to prior.\n\nIn the left lower pole, again seen is a 2.0 cm exophytic predominantly T1\nhypointense, centrally T2 hyperintense, avidly enhancing lesion (02:08,\n15:27). There is suggestion internal restricted diffusion. Similar to prior,\nthere is a T2 hypointense, T1 hyperintense component along the superomedial\naspect of the lesion (11:30, 02:09). There is no imaging evidence of invasion\ninto the perirenal fat or involvement of the major renal vasculature.\n\nGastrointestinal Tract: The stomach is unremarkable. Redemonstrated is a\npartially imaged large duodenal diverticulum. Visualized portions of small\nand large bowel appear normal in caliber without evidence of obstruction. \nNote is made of scattered colonic diverticula without evidence of\ndiverticulitis.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal caliber. The major abdominal\naortic branches are patent including a single right and single left renal\nartery and vein.\n\nOsseous and Soft Tissue Structures: There is no suspicious focal osseous or\nsoft tissue lesion. There are mild multilevel degenerative changes of the\nvisualized spine.", "output": "1. Stable appearance of 2.0 cm left lower pole exophytic enhancing renal mass\nwhich is indeterminate by imaging but may represent clear cell renal carcinoma\nor oncocytoma.\n2. Grossly unchanged benign bilateral renal cysts." }, { "input": "The uterus is anteverted with approximate ___ of 9.5 x 4.6 x 4.7 cm.\nThere is an anterior lower uterine segment defect consistent with prior\nC-section. There is expansion of endometrial stripe with signal of mucosa,\nlikely due to mucosal proliferation of early pregnancy (4:67).\n\nThere is extensive abnormality within the left adnexal region. There is a\ncentral 2.3 x 2.5 x 2.6 cm ovoid structure which is slightly T2 hyperintense\nwith a low T2 rim (4:64). Susceptibility artifact associated with this rim is\nnoted on diffusion-weighted imaging. There is a larger region of surrounding\nT1 hyperintense, T2 intermediate and markedly restricted diffusion material,\nwith total ___ of 6.5 x 4.4 x 3.7 cm. Edema and inflammation are seen\nwithin the surrounding fat. Overall, in the setting of known pregnancy, this\nappearance is highly suggestive of a left adnexal ectopic pregnancy with\nsurrounding hemorrhage. Prominent venous structures are noted along the\nsuperior medial margin of the hemorrhage, but no definitive findings of\ntorsion are seen.\n\nThe a right ovary is notable for a 1.7cm ovoid cyst, potentially representing\na corpus luteum cyst.\n\nThe visualized bowel is normal in appearance, including a normal appendix.\nNoncontrast appearance of the visualized solid abdominal viscera is\nunremarkable. There is no hydronephrosis. No lymphadenopathy is identified\nappear mild degenerative changes are noted of the lower lumbar spine.", "output": "Abnormality of the left adnexal region concerning for ectopic pregnancy and\nassociated hemorrhage. Findings were initially identified and discussed by\nDr. ___ with Dr ___ at ___ on ___." }, { "input": "There is cholelithiasis with the lumen of the gallbladder being almost\nentirely filled with small stones. Gallbladder wall edema is noted, new from\nthe prior exams, without significant surrounding stranding or pericholecystic\nfluid. The gallbladder itself is only minimally distended however.\n\nSmall cystic foci noted at the gallbladder fundus, seen for example on series\n2, image 9. These findings are suggestive of incidental fundal\nadenomyomatosis.\n\nAreas of transient slight arterial hyperenhancement of the liver are noted\nadjacent and above the gallbladder fossa. The liver parenchyma is otherwise\nnotable for an 8mm subcapsular lesion within segment 5. This is seen for\nexample on series 5, image 24. This is T2 hyperintense and T1 hypointense.\nThis appears to be nonenhancing on the first 2 post gadolinium sequences and\nnot identified on the more delayed sequences due to motion artifact. This\nalmost certainly is a small cyst or biliary hamartoma, each a benign entity.\n\nIntra and extrahepatic biliary tree is normal in caliber. Common bile duct\nmaximum diameter of 4 mm. No choledocholithiasis seen.\n\nThe pancreas, spleen, adrenal glands and kidneys are unremarkable in\nappearance. There is no lymphadenopathy or ascites. Vascular anatomy is\nconventional without significant atherosclerotic disease.", "output": "1. Cholelithiasis with slight arterial hyperenhancement within the liver about\nthe gallbladder fossa and interval development of gallbladder wall edema.\nFindings can be seen with acute cholecystitis, though the gallbladder is not\nparticularly distended. Clinical correlation is recommended and a HIDA scan\ncan be obtained for further assessment.\n2. Gallbladder adenomyomatosis.\n3. No choledocholithiasis or evidence of biliary dilatation." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion. Again seen is a\n2.5 cm soft tissue mass in the left lung base, unchanged since ___.\n\nLiver: Patient is status post right partial hepatectomy (segment 6). The\nremaining liver demonstrates nodular morphology, compatible with cirrhosis. \nPost ablation changes are seen in segments II/III, measuring 2.7 x 2.7 cm,\nunchanged. There is no signal drop on the opposed phase sequences to indicate\nhepatic steatosis.\n\nBiliary: Again seen are multiple central peribiliary cysts. There is no\nevidence of intrahepatic or extrahepatic biliary dilatation. Cholelithiasis\nis noted without evidence of acute cholecystitis.\n\nPancreas: The pancreas is normal and signal intensity and bulk without\nevidence of ductal dilatation or focal mass.\n\nSpleen: The spleen is enlarged, measuring up to 15.4 cm.\n\nAdrenal Glands: Again seen is a 1.6 cm adrenal adenoma in the right adrenal\ngland. The left adrenal gland appears diffusely thickened, but is unchanged.\n\nKidneys: The kidneys are normal in signal intensity, but demonstrates a mildly\natrophied left kidney, similar to the prior exam in ___. Multiple simple\ncysts are seen in bilateral renal cortices, measuring up to 1.7 cm in the left\nupper renal pole.\n\nGastrointestinal Tract: The visualized small and large bowel loops are normal\nin caliber without obstruction.\n\nLymph Nodes: There is no adenopathy in the visualized upper abdomen.\n\nVasculature: The hepatic arterial anatomy is conventional. Multiple upper\nabdominal varices are again seen.\n\nOsseous and Soft Tissue Structures: There is no evidence of concerning osseous\nlesion. There is mild levoconvex scoliosis.", "output": "1. Post ablation changes are seen in segments II/III. Cirrhotic liver\nmorphology with stigmata of portal hypertension including varices and\nsplenomegaly. No concerning liver lesion meeting OPTN 5 criteria is\nidentified.\n2. A 2.5 cm soft tissue mass in the left lung base is unchanged over multiple\nprior studies, biopsied in ___, hamartoma by pathology. See CT chest from\nsame day for additional details.\n3. Stable appearance of 1.6 cm right adrenal adenoma.\n4. Cholelithiasis without evidence of acute cholecystitis." }, { "input": "Lower Thorax: 2.1 cm lobulated T2 hyperintense lesion within the left lower\nlobe is unchanged compared to prior, a biopsy-proven hamartoma. Otherwise,\nthe lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is cirrhotic in appearance. No hepatic steatosis. 3\nseparate treatment cavities are seen within segment II and III. There is no\nnodular or masslike enhancement surrounding the treatment cavities to suggest\nresidual disease or recurrence. There are no other arterially enhancing\nlesions demonstrating washout to suggest HCC.\n\nBiliary: Mild central intrahepatic dilatation, particularly within the left\nlobe. No extrahepatic biliary dilatation.. Cholelithiasis without evidence\nof acute cholecystitis. Note is made of gallbladder fundus adenomyomatosis.\n\nPancreas: Pancreas is normal in bulk and signal intensity. No focal\npancreatic lesions. No ductal dilatation. No peripancreatic stranding.\n\nSpleen: Spleen is enlarged measuring 15.5 cm. No focal splenic lesions. \nSmall accessory spleen at the hilum.\n\nAdrenal Glands: Mild thickening of the right adrenal gland without focal\nnodules. Left adrenal gland is normal in size and shape.\n\nKidneys: Multiple cysts are seen within the kidneys bilaterally, some of which\ncontain intrinsic T1 hyperintensity, compatible with protein/hemorrhage. \nOtherwise, the kidneys enhance homogeneously and symmetrically. No enhancing\nrenal lesions. No hydronephrosis. No perinephric stranding.\n\nGastrointestinal Tract: Partially imaged stomach, small, and large bowel are\nunremarkable in appearance. No bowel obstruction.\n\nLymph Nodes: No upper mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Major abdominal branches are\npatent. Hepatic arterial anatomy is conventional.\n\nOsseous and Soft Tissue Structures: There is a moderate sized ventral hernia\nwithin the left mid anterior abdominal wall containing fat and nonobstructed\nloops of small bowel. Smaller upper midline ventral hernia containing a\nnonobstructed loop of transverse colon. Small amount of subcutaneous edema\noverlying the partially imaged lumbar spine. No suspicious osseous lesions.", "output": "1. Cirrhotic appearing liver with 3 separate ablation cavities within segments\nII and III. No surrounding nodular or masslike enhancement to suggest\nresidual disease or recurrence. No new lesions meeting OPTN criteria for HCC.\n2. Unchanged 2.1 cm lobulated T2 hyperintense lesion within the left lower\nlobe, a biopsy proven hamartoma.\n3. Other incidental findings include cholelithiasis, gallbladder fundus\nadenomyomatosis, and 2 ventral hernias containing nonobstructed loops of\nbowel." }, { "input": "Lower Thorax: Limited assessment of the bilateral lung bases demonstrate an\nincompletely imaged 2.0 cm T2 hyperintense lesion within the left lower lobe,\nsimilar to prior consistent with biopsy proven hamartoma (1001; 1). There is\nno pleural or pericardial effusion.\n\nLiver: The liver is nodular in contour consistent with known cirrhosis. There\nis no drop in signal on out of phase imaging to suggest hepatic steatosis. \nSusceptibility artifact is noted along the outer contours of the liver\nconsistent with prior resection of segment VI lesion.\n\nThree unchanged post treatment cavities are noted in segment II and III\nmeasuring up to 4.4 cm (1001; 30). There is no evidence of abnormal\nenhancement in the treatment cavity to suggest recurrence.\n\nMultiple arterially enhancing foci without correlate on T2 or delayed imaging\nare consistent with transient hepatic intensity differences (1001; 26, 39, 72,\n76). No suspicious hepatic lesions meeting OPTN 5 criteria for HCC is\nidentified.\n\nBiliary: There is stable mild left lobe intrahepatic biliary dilatation,\nsimilar to prior. There is no extrahepatic biliary dilatation. The\ngallbladder contains gallstones without evidence of gallbladder wall\nthickening or edema or adjacent fat stranding. T2 hyperintensities in the\ngallbladder wall near the fundus suggest fundal adenomyomatosis (3; 13).\n\nPancreas: The pancreas is normal in signal intensity without pancreatic ductal\ndilatation.\n\nSpleen: There is stable splenomegaly, with no focal splenic lesion. There is\ntrace perisplenic ascites. A small accessory spleen is again noted at the\nhilum.\n\nAdrenal Glands: There is 1.1 cm right adrenal adenoma with low signal on out\nof phase imaging (7; 19) stable since at least ___. The left adrenal\ngland is unremarkable.\n\nKidneys: The kidneys are symmetric in size and nephrogram. There is mild\nfullness of the left collecting system, increased compared to prior (3; 26). \nThere are bilateral T2 hyperintense nonenhancing cyst measuring up to 1.8 cm\nin the left upper pole. Multiple T1 hyperintense nonenhancing lesions are\nseen consistent with proteinaceous or hemorrhagic cysts, for example a 0.8 cm\nleft interpolar region lesion (8; 93).\n\nGastrointestinal Tract: There is a left colostomy. The visualized small and\nlarge bowel appear normal in caliber without evidence of obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy. \nRedemonstration of small porta hepatis lymph nodes.\n\nVasculature: The abdominal aorta is normal in caliber. Hepatic arterial\nanatomy is conventional. The portal veins, hepatic veins, SMV, and splenic\nvein are patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection. Please refer to the separate MR ___ study\nfrom ___ for further details.", "output": "1. Cirrhotic liver with three ablation cavities and laparoscopic partial\nresection of segment VI, with no evidence of residual tumor. No OPTN-5\nlesion.\n2. Post left colectomy without local recurrence.\n3. No abdominal metastasis or lymphadenopathy.\n4. Stable splenomegaly.\n5. Cholelithiasis." }, { "input": "The study is limited by motion artifact.\n\nLower Thorax: A well-circumscribed T2 hyperintense lesion in the lingula\nmeasuring 2.5 cm is concordant with the biopsy-proven hamartoma is better seen\non the chest CT from ___ (3:26). There is no pleural or\npericardial effusion.\n\nLiver: Again demonstrated is a diffusely nodular liver contour consistent with\nhistory of cirrhosis. Again noted is susceptibility artifact along the outer\ncontours of segment 6 consistent with prior resection.\nPosttreatment cavities of previous RFA and TACE treatments measuring up to 4.2\ncm are again demonstrated and appear largely unchanged. There is no\nsuspicious enhancement noted. These are evident in segments II and III ___:\n57, 69, 42). Subtle susceptibility artifact along the posterior margin of the\nright hepatic lobe is probably associated with postsurgical of ___ resection\nin segment VI.\n\nMultiple transiently arterially enhancing foci without concordant T2 signal\nabnormality or washout, represent transient hepatic intensity differences,\nalso seen on the most recent MR ___ example, ___: 66, 75).\n\nBiliary: Mild intrahepatic bile duct dilatation primarily involving the left\nhepatic lobe is unchanged. The gallbladder contains several stones. There is\nno gallbladder wall thickening or signs of associated inflammation. A focal\nT2 hyperintensity in the gallbladder wall suggestive of adenomyomatosis is\nunchanged (3:11).\n\nPancreas: Normal in signal intensity without ductal dilatation. There is no\nfocal lesion.\n\nSpleen: The spleen again is enlarged measuring up to 16 cm, not significantly\nchanged from the previous study. No focal lesions are noted. A 1.8 cm\naccessory spleen at the hilum is unchanged.\n\nAdrenal Glands: The previously demonstrated right adrenal nodule is not well\nseen in the current study. The left adrenal gland is unremarkable.\n\nKidneys: Multiple well-circumscribed T2 hyperintense cortical cysts are noted\nbilaterally, the largest in the left upper pole is exophytic and measures up\nto 1.9 cm. In addition, well-circumscribed T1 nonenhancing hyperintense foci,\nthe largest in the interpolar left kidney measures up to 10 mm, are compatible\nwith hemorrhagic/proteinaceous cyst. Again seen is mild fullness of the left\nrenal pelvis. Otherwise, there are no signs of hydronephrosis. There is no\nsuspicious renal lesion.\n\nGastrointestinal Tract: The patient is post left colostomy. There are no\nsigns of bowel obstruction or abnormal focal enhancement.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: There is no aortic aneurysm. The hepatic and portal veins are\npatent.\n\nOsseous and Soft Tissue Structures: Levoconvex scoliosis of the lumbar spine\nis again seen. No suspicious osseous lesion. No focal abnormality.", "output": "1. Cirrhotic liver morphology with stable post-treatment changes without\nevidence of residual or recurrent HCC.\n2. No OPTN-5 lesion.\n3. Mild splenomegaly." }, { "input": "MRI ABDOMEN:\nLung bases are clear. No pleural or pericardial effusion.\n\nThe liver is cirrhotic with nodular margins and hypointense signal on T2 WI. \nThe RF site in segment 2 is stable without early enhancing components. In\nsegment 5 there is a 13 mm lesion which is slightly hyperintense to the liver\non T2WI (5:27), slightly hypointense to the liver on the T1WI (11:90),\nexhibiting restricted diffusion (7:14), enhancing on the arterial phase with\nrapid washout and a pseudocapsule (1302:91), consistent with HCC. The lesion\nmeasured up to 7 mm on previous MRI. A 6 mm focus of arterial enhancement is\nseen in segment 3 (1301: 64), without correlation on the other sequences,\nunchanged. The portal and hepatic veins are patent. The arterial hepatic\nvascular anatomy is conventional.\n\nThe spleen is enlarged up to 16 cm. No ascites. Esophageal varices are\npresent.\nThere are stones in the gallbladder. The intra and extrahepatic biliary ducts\nare not dilated .\nThe kidneys are unremarkable except for cortical cysts.\nThere is a 11 mm right adrenal adenoma which shows loss of signal intensity on\nout of phase images in comparison with in phase images.\n9 x 16 mm lymph node in the retroperitoneum is unchanged.\n\nMRI PELVIS:\nA colostomy is present in the left lower abdominal wall. There is ___\npouch.\nThere is umbilical hernia containing small bowel. No gross finding in the\nbowel.\nNo free fluid.\nThe prostate is enlarged. Mildly trabeculated bladder wall is noted.\n\nBone marrow signal is normal. Degenerative changes in the spine.", "output": "Segment 5, 13 mm nodule with MRI characteristics of HCC OPTN 5A.\n\nHepatic cirrhosis with splenomegaly and esophageal varices but no ascites." }, { "input": "Lower Thorax: There is a stable 2.1 cm lung nodule in the lingula, that has\nbeen previously described as a hamartoma (11:26 ).There is no cardiomegaly.\n\nAscites: There is trace ascites.\n\nLiver: The liver appears cirrhotic. In segment V/VI, there is evidence of\ninterval resection with no residual suspicious focal lesion at the resection\nmargin (16:49 ). In segment II, there is an unchanged RFA cavity measuring 2.3\nx 3.7 cm with no nodularity or significant enhancement to suggest local\nrecurrence (17:12). There is an adjacent focus of 6 mm arterial enhancement\nanteriorly that is unchanged from previous and demonstrates washout ( 16:10 ).\nIn segment III there is a 5 x 8 mm lesion that demonstrates arterial hyper\nenhancement, washout and pseudocapsule, that is more conspicuous and mildly\nincreased in size from 7 mm previously (16:35 ).\n\nGallbladder and Biliary System: There are gallbladder stones without\nsurrounding inflammatory change or gallbladder distention ( 05:28 ). There is\nno significant intra or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.There is classic pancreatic ductal anatomy without dilatation.\n\nSpleen: There is splenomegaly up to 17.0 cm (09:22 ).There is no focal splenic\nlesion.\n\nKidneys and Adrenals: There are bilateral renal cysts that are unchanged and\nhave no suspicious features, with the largest on the left in the upper pole\nmeasuring 1.6 cm (05:22 ).The adrenal glands are normal bilaterally.\n\nBowel: There is an uncomplicated left-sided ostomy with no evidence of\nobstruction or complication (05:43 ). The visualized bowel loops and mesentery\nare otherwise within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: There is a large portosystemic collateral vessel seen between the\nsuperior mesenteric vein and right testicular vein ( 17:99 ). The portal and\nhepatic veins appear patent.\n\nPelvis: The prostate is enlarged. There is no suspicious pelvic or inguinal\nadenopathy. The urinary bladder is unremarkable.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "1. Status post resection of segment V/VI lesion and RFA in segment II with no\nresidual tumor detected.\n2. Two highly suspicious lesions in segment II and III that do not yet meet\nOPTN criteria for HCC.\n3. Cirrhotic liver with splenomegaly and trace ascites." }, { "input": "CHEST:\n\nLimited assessment of the lung bases again demonstrates a stable 2.1 x 1.9 cm\nlesion within the lingula previously described as a hamartoma (02:22). No\npleural effusion. Visualized heart is unremarkable without pericardial\neffusion.\n\nABDOMEN:\n\nThe liver is heterogeneous in signal intensity and nodular in contour\nconsistent with known history of cirrhosis. Within segment V/VI is a 1.2 x\n1.1 cm (previously 1.3 x 1.0 cm) T2 hyperintense nonenhancing area consistent\nwith previous resection bed without evidence of disease recurrence (1 901:87,\n___. In segment II there is an unchanged RFA cavity measuring 3.9 x 2.2\ncm with no nodularity or enhancement to suggest local disease recurrence\n(___).\n\nSlight interval increase in size of a 0.9 x 0.7 cm (previously 0.6 x 0.5 cm)\narterially enhancing lesion is seen, which appears isointense on delayed\nimaging (___) and remains without T2 correlate.\n\nThere is a new 1.1 x 0.7 cm arterially enhancing lesion which is isointense on\ndelayed imaging within segment ___ (___).\n\nWithin segment III a 1.4 x 0.7 cm (previously 1.1 x 0.6 cm) arterially\nenhancing segment III lesion which demonstrates washout and pseudo capsule and\nis consistent with a hepatocellular carcinoma, satisfying OPTN-5A critera.\nTrace ascites is again noted.\n\nNo intra or extrahepatic biliary duct dilatation. The gallbladder is within\nnormal limits without filling defects to suggest gallstones. The portal vein,\nSMV, and splenic vein are patent. The spleen is persistently enlarged\nmeasuring 16.8 cm. A 1.5 x 1.0 cm (09:27) accessory spleen is noted. An\nadditional 2.0 x 1.8 cm accessory spleen is present.\n\nThe left adrenal gland is unremarkable. Again seen is a 1.5 x 1.6 cm (___)\nrounded right adrenal nodule which drops signal on out of phase imaging\nconsistent with an adenoma.\n\nA 0.3 cm cystic lesion is seen in the pancreatic body and is statistically\nlikely to represent a side branch IPMN (9:25). The pancreas is otherwise\nnormal in signal intensity without pancreatic ductal dilatation or enhancing\nlesion. The left kidney demonstrates stable mild cortical atrophy with an\nextrarenal pelvis, unchanged in appearance since previous examination. A\nstable 0.7 x 0.6 cm (previously 0.8 x 0.6 cm) T2 heterogeneous, T1\nhyperintense, nonenhancing lesion is seen within the lower pole of the left\nkidney consistent with a hemorrhagic/ proteinaceous cyst. Multiple additional\nT2 hyperintense nonenhancing lesions are noted largest measuring 1.6 x 1.4 cm\n(09:23) which is consistent with a simple cyst. The kidneys are otherwise\nunremarkable without hydronephrosis or obstructing stones.\n\nLimited assessment of the esophagus is unremarkable without hiatal hernia. \nAgain seen is a left-sided ostomy without evidence of strangulation or\nobstruction. Visualized stomach, small bowel, and colon are otherwise within\nnormal limits. No retroperitoneal or mesenteric lymph node enlargement.\nVisualized aorta is normal in caliber without aneurysmal dilatation. The\nceliac axis and SMA are patent.\n\nPELVIS: The bladder and distal ureters are unremarkable. No pelvic free\nfluid. No pelvic or inguinal lymph node enlargement.\n\nOSSEOUS: The bone marrow signal is grossly unremarkable.", "output": "1. Interval increase of a 1.4 cm segment III mass satisfying OPTN 5A criteria\nfor HCC.\n2. New 1.1 cm lesion in segment ___ does not meet OPTN-5 criteria but is\nhighly suspicious for ___. Close attention on followup recommended.\n3. Post resection of a segment V/VI lesion and RFA in segment II with no\nresidual or recurrent tumor detected.\n4. Interval increase in 0.9 cm segment II transient hepatic intensity\ndifference. Continued attention to this area recommended.\n5. Cirrhotic liver with splenomegaly and trace ascites.\n6. Stable right adrenal adenoma.\n7. 0.3 cm cystic lesion in the pancreatic body is statistically likely a side\nbranch IPMN. No dedicated followup needed per interdepartmental guidelines.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 13:02 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "The liver is overall shrunken within nodular contour and reticular pattern of\nprogressive enhancement, consistent with underlying cirrhosis. Multiple\nperibiliary cysts are noted, as can be seen in the setting of cirrhosis. There\nis evidence of portal hypertension based on splenomegaly (caudal cranial\ndimension of 17.5 cm), portal systemic venous collaterals (including\ngastroesophageal varices), as well as trace amount of abdominal ascites. The\nportal venous system remains patent and contrast opacified.\n\nThere is a new ablation zone within the anterior aspect of segment III. This\ninvolves 5.4 x 3.0 x 4.5 cm of liver parenchyma (08:54), with retraction of\nthe overlying capsule (11:60). Adjacent perihepatic fat also demonstrates a\nhalo of low T2 signal and enhancement, in keeping with post ablation changes.\nThe ablated liver parenchyma is now decreased in T2 signal with a thin rim of\nhyperintense T2 signal. On T1 weighted imaging, the ablation zone has a\nperipheral rim of hyperintensity with central intermediate signal. There is a\nthin, smooth rind of surrounding liver parenchyma which is subtly\nhyperenhancing but no internal enhancement is noted within the ablation zone.\nThere is no residual arterial hyperenhancement or subsequent washout to\nsuggest residual or recurrent tumor.\n\nThe older ablation zone within segment II is unchanged in appearance. This\ncontinues to have approximate ___ of 3.9 x 2.3 cm with a nonenhancing\nT1 hyperintense material, consistent with coagulation necrosis. There is no\nnodular arterial hyperenhancement along the periphery to suggest residual or\nrecurrent tumor at that location.\n\nSusceptibility artifact is seen along the liver capsule at segment V/VI,\ncorrelating with the site of prior resection. No residual or recurrent tumor\nis noted at this location.\n\nThere is a nodule along the anterior aspect of segment II, away from both\nablation zones, which is arterially hyperenhancing and demonstrates subsequent\nwashout and pseudocapsule (10:34). Given ___ of 10 x 7 mm, this meets\nOPTN-5A criteria for hepatocellular carcinoma.\n\nAdditional tiny subcentimeter foci of arterial hyperenhancement have no\ncorrelate on precontrast or delayed post contrast sequences, and are thought\nto be perfusional.\n\nThere is cholelithiasis as well as focal fundal gallbladder adenomyomatosis.\nThe intra and extrahepatic bile ducts are normal in caliber.\n\nLymphadenopathy is again noted along the gastrohepatic ligament and periaortic\nand distribution (10:84). This is unchanged from prior.\n\nA 12 mm right adrenal adenoma is again demonstrated, unchanged from prior. \nThe left adrenal gland is normal in appearance.\n\nThere are bilateral simple appearing renal cysts, each T2 hyperintense, T1\nhypointense and nonenhancing. No concerning renal lesions appreciated.\n\nPancreatic parenchyma maintain normal bulk, intrinsic hyperintense T1 signal\nand enhancement pattern. There is a single 3 mm cystic structure within the\nanterior aspect of the pancreatic body (03:25). This is unchanged from prior\nexamination and warrants continued attention on further followup examinations.\n\nNote is made of a 2 cm lingular hamartoma, previously-characterized and\nunchanged from prior examination (02:21). There is a left-sided colostomy,\nwithout associated inflammation or obstruction. Visualized bowel loops are\notherwise unremarkable.\n\nThe visualized bones are notable for a mild levoscoliosis of the lumbar spine.\nNo significant associate degenerative changes are noted.\n\nMild gynecomastia is again noted.", "output": "1. 1.0 cm segment II lesion which now meets OPTN-5A criteria for\nhepatocellular carcinoma.\n2. Cirrhosis with sequela of portal hypertension.\n3. Segment II and III RF ablation zones and segment V/VI resection bed\nwithout evidence of residual or recurrent tumor.\n4. Stable 3 mm pancreatic cystic lesion, presumably side branch IPMN. \nContinued attention to this on future follow-up examinations is warranted.\n5. Unchanged 12 mm right adrenal adenoma.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on ___\nat 07:54 into the Department of Radiology critical communications system for\ndirect communication to the referring provider." }, { "input": "The lung bases are grossly clear. There is trace perihepatic ascites.\n\nLiver: The liver is nodular in appearance compatible with history of\ncirrhosis. There is a 3.9 x 2.8 cm ablation zone in segment II and a 4.7 x\n2.6 cm ablation zone in segment III. Both ablation zones have intrinsic\nincreased T1 signal but demonstrate no suspicious postcontrast enhancement.\n\n10 mm arterially enhancing nodule which demonstrates washout and a pseudo\ncapsule just anterior to the segment II ablation zone (series 1401, image 24).\n\nThere is no significant intra or extrahepatic biliary ductal dilatation.\n\nGallbladder: Adenomyomatosis at the gallbladder fundus. There are small\ngallstones in the gallbladder without gallbladder wall thickening or edema.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nductal dilatation. There is classic pancreatic ductal anatomy. \nWell-circumscribed T2 hyperintense lesions in the pancreatic head measuring 3\nmm (series 5, image 27), pancreatic body measuring 5 mm (series 5, image 22)\nand 2 mm (series 5, image 21).\n\nSpleen: The spleen is normal in signal but enlarged measuring up to 15.9 cm in\nlength.\n\nKidneys and Adrenals: There is stable thickening of the right adrenal gland. \nThe left kidney is asymmetrically smaller in size. There is no hydronephrosis\nor perinephric abnormality. Sub cm well-circumscribed lesions in the\nbilateral kidneys which demonstrate increased T2 signal compatible with simple\ncysts. There is a partially exophytic 1.9 cm cyst arising from the superior\npole of the left kidney. There is a sub cm hemorrhagic cyst in the upper pole\nand interpolar region of the left kidney.\n\nBowel: There is a left lower quadrant colostomy with ___ pouch.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: Stenosis at the origin of the left renal artery. The remaining\nvasculature is patent.\n\nPELVIS: There is no free fluid in the pelvis. There is no concerning\nlymphadenopathy. The prostate is enlarged.\n\nBones: The osseous structures are unremarkable.", "output": "1. Stable post radiofrequency ablation changes in segment II and III with no\nevidence of recurrent/ residual disease within the ablation zones.\n2. Stable 10 mm arterially enhancing lesion with washout and pseudo capsule\nin segment II just anterior to the ablation zone, compatible with an OPTN-5A\nlesion.\n3. Hepatic cirrhosis with splenomegaly suggestive of portal hypertension. \nTrace perihepatic ascites.\n4. Subcentimeter pancreatic IPMNs, as described above.\n5. Cholelithiasis with adenomyomatosis at the gallbladder fundus.\n6. Left renal artery stenosis.\n\nNOTIFICATION: perfusion\nRAS" }, { "input": "Lower Thorax: A 21 x 18 mm T2 hyperintense lesion containing intravoxel fat in\nthe lingula is again noted. This finding was previously described as a\nhamartoma on the CT scan dated ___ and is unchanged compared to the\nprevious exam. The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is nodular in contour. There are diffuse peripheral\nreticular T2 markings with progressive enhancement in keeping with the known\nhistory of cirrhosis. There is a small amount of perihepatic ascites.\n\nIn segment 2, there is a 2.4 x 3.6 x 3.3 cm ablation zone which demonstrates\nhigh T1 signal and no suspicious enhancement. This finding is unchanged\ncompared to the previous exam. In segment 3, a similar-appearing ablation\nzone measures 2.5 x 4.0 x 3.7 cm and is unchanged. There is no enhancement to\nsuggest recurrent or residual disease.\n\nAn arterially enhancing mass just anterior to the segment 2 ablation zone\n(series 12, image 42) stable in size. There is no true arterial phase on the\nexam to assess for washout kinetics. No new arterially enhancing lesions or\nlesions demonstrating washout kinetics.\n\nBiliary: No intra- or extra-hepatic duct dilatation. There are periportal\ncystic changes compatible with peribiliary cysts. The common bile duct is\nwithin normal limits. Adenomyomatosis is noted in the fundus of the\ngallbladder. There are small gallbladder calculi measuring up to 3 mm. No\nevidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: Splenomegaly measuring up to 16.4 cm is again noted. An incidental\nnote is made of a 17 x 18 mm accessory spleen. No focal lesions are\nidentified.\n\nAdrenal Glands: Thickening of the medial limb of the right adrenal gland is\nunchanged compared to the previous exam. The left adrenal gland is\nunremarkable.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no concerning solid or cystic\nlesions. Multiple non-enhancing subcentimeter cortical cysts are unchanged\ncompared to the previous exam. Several of these cysts demonstrate high T1\nsignal in keeping with hemorrhagic/proteinaceous cysts. The largest cyst\narises from the interpolar region and measures 17 mm. No hydronephrosis or\nhydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. There\nis a para-stromal hernia. A left-sided colostomy is noted.\n\nLymph Nodes: A prominent interaortocaval lymph node measuring up to 9 mm in\nshort axis diameter is unchanged compared to the previous exam. No\nsignificant mesenteric, retroperitoneal or porta hepatis lymphadenopathy by\nsize criteria.\n\nVasculature: Mild atherosclerosis is noted in the abdominal aorta. Left renal\nartery stenosis is unchanged.\n\nOsseous and Soft Tissue Structures: Multilevel degenerative change is noted\nthroughout the lumbar spine. The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. Stable post radiofrequency ablation change in segments 2 and 3 with no\nevidence of recurrent/residual disease.\n2. Anterior to the segment 2 ablation zone, there is an 8 mm arterially\nenhancing mass with washout kinetics. This finding is stable in size and\nmorphology compared to the previous exam. Although this finding does meet\nOPTN-5A criteria, the lesion remains suspicious for ___ and close surveillance\nis recommended.\n3. Subcentimeter pancreatic IPMN's, as described above." }, { "input": "Lower Thorax: Unchanged 1.9 cm T2 hyperintense lesion along the left cardiac\nborder, previously characterized as a hamartoma.\n\nLiver: The liver is nodular and dysmorphic, compatible with the known\nunderlying cirrhosis. There is reticular enhancement and increased T2 signal\ncompatible with fibrosis. There are a few millimetric foci of arterial\nenhancement noted scattered throughout the hepatic parenchyma, largest\nmeasuring 1.7 cm is in segment ___ (1001:73). Several other nodular areas of\nhyper enhancement are seen including nodules measuring 1.7 cm in segment ___\n(1001:34).\n\nThere are no lesions meeting OPTN criteria noted within the liver.\n\nThere previous radiofrequency ablation zones noted in segments 2 and 3, with\nno suspicious residual enhancement identified.\n\nThere is focal fat with an enhancing rim near the RFA bed, unchanged from\npriors, compatible with post RFA change.\n\nBiliary: There is subtle gallbladder fundal adenomyomatosis. As before, there\nare a few peribiliary cysts. Intrahepatic and extrahepatic bile ducts are\nnormal in caliber\n\nPancreas: The visualized pancreas is within normal limits, with no suspicious\nlesions were main pancreatic ductal dilation.\n\nSpleen: Spleen is enlarged measuring 16.0 cm. 2 accessory spleens are noted\nmeasuring 1.0 and 1.8 cm.\n\nAdrenal Glands: The adrenal glands are slightly bulky, however no suspicious\nadrenal gland lesions are identified.\n\nKidneys: There are bilateral simple appearing renal cysts, largest at the\nupper pole of the left kidney measuring 2.0 cm. No suspicious renal lesions\nor hydronephrosis identified.\n\nThere is stenosis at the left renal artery, with decreased size of the left\nkidney comptible with chronic stenosis. This is unchanged since ___.\n\nGastrointestinal Tract: Incompletely visualized left lower quadrant colostomy\nis seen. Otherwise the visualized small and large bowel loops are within\nnormal limits.\n\nLymph Nodes: Re- demonstration of slightly prominent porta hepatis an\ngastrohepatic ligament lymph nodes, likely reactive.\n\nVasculature: There is extensive collateralization between the right renal vein\nand the superior mesenteric vein, incompletely imaged but best seen on the\ncoronal haste sequences.\n\nThere is abrupt angulation causing mild stenosis at the celiac trunk and SMA. \nThe hepatic arterial anatomy is conventional. The portal vein, splenic vein,\nand superior mesenteric vein are patent.\n\nOsseous and Soft Tissue Structures: Visualized bony structures are within\nnormal limits. Millimetric foci of arterial enhancement are noted in the\nright anterior lower chest wall subcutaneous fat (1003:46, 55) measuring up to\n4 mm and are unchanged since ___.", "output": "1. Nodular and dysmorphic liver compatible with the known underlying\ncirrhosis. Multiple foci of arterial hyperenhancement as detailed above, none\nof which meets OPTN criteria.\n2. Radiofrequency ablation zones from the previously treated segments 2 and 3\nlesions are re- demonstrated, with no evidence of recurrent or residual\ndisease.\n3. 2 arterially enhancing millimetric nodules seen in the anterior right chest\nwall subcutaneous fat (1003:46, 55), nonspecific and unchanged since ___. Recommend close evaluation on follow-up.\n4. Stable 1.9 cm T2 hyperintense lesion along the left cardiac border,\npreviously characterized as a hamartoma.\n5. Incidental findings as detailed above." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size. There is no\npericardial effusion. Along the left cardiac border, there is a 19 mm T2\nhyperintense lesion, which has been previously characterized as a hamartoma. \nIt is only partially imaged on this exam.\n\nLiver: The liver is nodular, in keeping with the history of cirrhosis. There\nis no hepatic steatosis.\n\nThere are postsurgical changes along the right lobe of the liver. These\nchanges are stable in appearance from the prior exam. There is no evidence of\na residual hematoma or fluid collection. In the periphery of the right lobe\nof the liver near the postsurgical changes, there is reticular enhancement\nthat persists on the delayed phases, and is compatible with fibrosis. \nAdditionally, there are several foci of arterial hyperenhancement that have no\ncorrelate on the other sequences, and likely represent transient hepatic\nintensity differences. The largest measures approximately 10 mm (10, 74).\n\nPost RFA changes are noted in the left lobe of the liver. The ablation zones\nare not significantly changed from the prior exam. There continues to be\ncoagulation necrosis in both zones. There is no abnormal enhancement around\nthe zones to suggest residual or recurrent disease. Anterior to the ablation\nzone in segment 3, there is a focus of fat which likely represents fat\nnecrosis (10, 60). There is no abnormal enhancement within this fat\ncontaining focus.\n\nThere is a 28 x 24 mm wedge-shaped focus of arterial hyperenhancement that\npersists on the delayed phases peripheral to the ablation zone in segment 2\n(10, 40). In comparison the prior exam, it is slightly more conspicuous,\nthough not significantly changed in size. There is no evidence of washout or\na pseudocapsule. Given the location, this most likely represents a small\nfocus of cholangitis related to the prior treatment or other nonspecific\ninflammatory changes.\n\nNo lesions meet OPTN-5 criteria for HCC.\n\nThe hepatic arterial anatomy is conventional. The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. Tiny\nperibiliary cysts are noted, and in keeping with the history of cirrhosis. \nThere is unchanged fundal adenomyomatosis and small gallstones are identified;\notherwise the gallbladder is normal.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no solid mass or duct dilation.\n\nSpleen: The spleen is enlarged, measuring 16.2 cm. There are no focal\nlesions. Small accessory spleens are noted in the splenic hilum.\n\nAdrenal Glands: There is a 12 mm nodule in the right adrenal gland, which in\nretrospect is unchanged from the prior exam. It drops in signal on the out of\nphase images, and is most compatible with an adenoma. The left adrenal gland\nis slightly thickened, though no discrete nodule is identified.\n\nKidneys: The right kidney is normal in size. The cortex of the left kidney is\nslightly atrophic. This is unchanged from prior exam. There are multiple\ncysts bilaterally. Several in the left kidney are hemorrhagic or\nproteinaceous. None have worrisome features. The largest measures 18 mm. \nThere is an extrarenal pelvis on the left. There is no hydronephrosis or\nperinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is a left lower quadrant colostomy. Very trace\nperihepatic ascites is noted.\n\nLymph Nodes: There are a few prominent periportal and celiac access lymph\nnodes. None meet size criteria for pathologic enlargement. These are likely\nreactive. There is one unchanged 9 mm right retroperitoneal lymph node, which\nis nonspecific. There is no mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is moderate atherosclerotic plaque. Mild to moderate\nnarrowing is noted at the takeoffs of the celiac artery and SMA, likely due to\natherosclerotic plaque. Small esophageal varices are noted.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nModerate multilevel degenerative changes are noted throughout the spine. \nThere is a small amount of symmetric bilateral gynecomastia. In the right\nanterior abdomen subcutaneous tissues, there are two unchanged subcentimeter\nfoci of arterial enhancement, which are of uncertain etiology. They likely\nrepresent tiny lymph nodes. No new soft tissue nodules are identified.", "output": "1. Post treatment changes in the liver, as described above. No evidence of\nresidual or recurrent disease. No lesions meet OPTN-5 criteria for HCC.\n2. Wedge shaped region of arterial hyperenhancement in segment 2 which likely\nrepresents a small focus of cholangitis or other nonspecific inflammatory\nchange. Continued attention on follow-up exams is recommended.\n3. Cirrhotic liver with evidence of portal hypertension, including\nsplenomegaly, varices, and trace perihepatic ascites.\n4. Enhancing subcentimeter nodules in the right subcutaneous that are\nnonspecific and unchanged. Continued attention on followup exams is\nrecommended.\n5. Right adrenal adenoma.\n6. Cholelithiasis." }, { "input": "Lower Thorax: 19 mm T2 hyperintense lesion seen along the left heart border is\nonly visualized on coronal SSFSE images, unchanged, previously characterized\nas hamartoma on chest CT. The imaged lung bases are clear.\n\nLiver: The liver is nodular with geographic redistribution compatible with\ncirrhosis. Postsurgical changes are noted in the right hepatic lobe. Area of\nnon masslike reticular subcapsular enhancement in the right hepatic lobe\npersists on delayed images, likely representing fibrosis adjacent to the\npostsurgical change (1104:70). 3.8 x 2.4 cm RF ablation zone in hepatic\nsegment II/III is unchanged compared to prior examination, with areas of\ninternal coagulation necrosis. Adjacent to the RF ablation zone in hepatic\nsegment II, there are 3 subcapsular arterially enhancing foci, more apparent\non the prior examinations measuring 11 mm, 11 mm and 8 mm (1101:26, 30) which\nare subtly T2 hyperintense, demonstrate washout on delayed phase with\nsuggestion of a pseudo capsule (1102:26). Another subtle 11 mm lesion in\nhepatic segment II is seen more medially (11 02:34) demonstrates subtle\nheterogeneous arterial enhancement with washout, pseudo capsule and T2\nhyperintensity. A 12 mm enhancing lesion in hepatic segment VI, adjacent to\nthe gallbladder is once again demonstrated, however does not persist on\ndelayed sequences and likely represents a transient hepatic intensity\ndifference. A few other scattered, smaller areas are seen throughout the\nright hepatic lobe. Portal vein is patent. There is trace perihepatic\nascites.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Tiny parrot\nileus cysts are once again noted. Small gallstone is noted in the region of\nthe gallbladder neck. Mild gallbladder wall thickening is likely secondary to\nbackground cirrhosis. Fundal adenomyomatosis is unchanged.\n\nPancreas: Pancreas is normal in signal intensity without focal lesion or duct\ndilatation.\n\nSpleen: Spleen is enlarged measuring up to 15 cm in longest axis. There is no\nfocal splenic lesion. Small accessory spleen noted.\n\nAdrenal Glands: A 13 mm right adrenal nodule drop signal on out of phase\nimaging compatible with adenoma. There is persistent slight thickening of the\nleft adrenal gland without frank nodularity.\n\nKidneys: There are scattered bilateral renal cysts measuring up to 19 mm in\nthe left upper pole kidney and 8 mm in the right upper pole kidney. \nExtrarenal pelvis is noted on the left. Kidneys are otherwise unremarkable\nwithout focal suspicious lesion or hydronephrosis.\n\nGastrointestinal Tract: Stomach is unremarkable. Imaged small and large\nbowel loops are normal caliber without evidence of obstruction.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Visualized portion of the abdominal aorta is normal caliber. \nCeliac axis, SMA and bilateral renal arteries are grossly patent. There is\nconventional hepatic arterial anatomy.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is normal. A left\nlower quadrant ostomy is partially visualized with peristomal herniation of\nnonincarcerated small bowel. There are stable enhancing subcutaneous soft\ntissue lesions in the right upper quadrant anterior abdominal wall measuring 4\nmm and 9 mm (1101:34, 41), unchanged.", "output": "1. Four arterially enhancing lesions with washout in hepatic segment II. \nThree of these lesions measure 11 mm and now meet OPTN Class 5a criteria,\ncompatible with ___. While the fourth lesion does not meet size criteria,\nthis remains highly suspicious for ___ as well.\n2. Stable left lobe RF ablation changes as well as postsurgical changes in the\nright hepatic lobe.\n3. Cirrhotic liver with sequela of portal hypertension including splenomegaly.\n4. Stable enhancing subcutaneous nodules in the right anterior abdominal wall,\nnonspecific.\n5. Right adrenal adenoma.\n6. Cholelithiasis.\n7. Left lower quadrant ostomy with parastomal herniation of small bowel." }, { "input": "Lower Thorax: A 1.9 cm hyperintense lesion on T2 weighted images along the\nleft heart border is again seen, unchanged and was previously characterized as\na hamartoma. The lung bases are otherwise clear. There is no pleural or\npericardial effusion.\n\nLiver: The liver demonstrates nodular contour in keeping with cirrhosis. \nPostsurgical changes are again seen in the right hepatic lobe. A 3.9 x 2.7 cm\nRF ablation zone in hepatic segment ___ is unchanged compared to previous. A\nsecond ablation zone is seen in hepatic segment 2, also unchanged compared to\nprevious.\n\nThe patient is status post chemo embolization for three arterially enhancing\nlesions in segment 2 of the liver. These lesions are no longer visualized and\nthere is no definite arterial hyperenhancement. New serpiginous lesions that\nare hypo enhancing on all phases are seen in segment ___ and may represent\ndilated bile ducts or embolized hepatic artery.\n\nBiliary: There is increased subsegmental biliary ductal dilatation seen in the\nleft lobe. There is no extrahepatic biliary ductal dilatation. Small\ngallstones are again seen within the gallbladder without gallbladder wall\nthickening or abnormal enhancement. Fundal gallbladder adenomyomatosis is\nunchanged.\n\nPancreas: The pancreas demonstrates normal signal intensity without focal\nlesions or ductal dilatation.\n\nSpleen: The spleen is enlarged, measuring 15.4 cm. A small accessory spleen\nis again noted.\n\nAdrenal Glands: A 1.4 cm right adrenal nodule is again seen, in keeping with\nadenoma. There is stable mild thickening of the left adrenal gland without\nfrank nodularity.\n\nKidneys: Bilateral cysts are again seen in the kidneys which are unchanged\ncompared to previous. Small hemorrhagic cysts are seen on the left. There\nare no suspicious lesions or hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. A left lower quadrant\nostomy is partially visualized with peristomal bowel herniation common non\nchanged compared to previous. There are no signs of obstruction. The\nvisualized large and small bowel loops demonstrate normal caliber, wall\nthickness and enhancement.\n\nLymph Nodes: A 1.1 cm aortocaval lymph node is stable in size. There is no\nmesenteric lymphadenopathy.\n\nVasculature: The portal vein is patent. Hepatic artery anatomy is\nconventional. The abdominal aorta demonstrate normal caliber.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. \nThere are stable enhancing subcutaneous soft tissue lesions in the right upper\nquadrant anterior abdominal wall.", "output": "1. The patient is status post chemoembolization for arterially enhancing\nlesions in segment 2 of the liver. These lesions are no longer visualized and\nthere are no new suspicious lesions.\n\n2. Interval development of mild subsegmental biliary ductal dilatation in the\nleft lobe of the liver, of uncertain significance. Additional serpiginous\nhypoenhancing lesions within segment ___ represent dilated bile ducts or\nembolized hepatic artery.\n\n3. Stable left lobe RF ablation changes and post surgical changes in the\nright hepatic lobe." }, { "input": "Lower Thorax: A round solid nodule within the lingula measures 1.8 x 1.7 cm,\nstable since at least ___, consistent with a hamartoma. Otherwise,\nthe lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is cirrhotic in appearance. There is no evidence of hepatic\nsteatosis. The patient is status post RFA and TACE of segment II and III\nliver lesions. There is coagulation necrosis within the treatment beds, but\nno evidence of residual or recurrent disease. A 1.8 x 1.4 cm lesion within\nsegment VIII demonstrates peripheral arterial hyperenhancement, but no washout\non delayed images. This lesion is stable compared to ___. \nMultiple additional ill-defined foci of arterial hyperenhancement do not\ndemonstrate correlates on the delayed images, likely representing transient\nhepatic intensity differences. No evidence of portal vein thrombosis.\n\nBiliary: There is mild intrahepatic biliary dilatation within the left lobe of\nthe liver, stable, and likely related to prior TACE. There is no extrahepatic\nbiliary dilatation. Cholelithiasis without gallbladder wall thickening.\n\nPancreas: The pancreas is normal in size and signal intensity. No focal\nlesions. No ductal dilatation.\n\nSpleen: The spleen is enlarged measuring 16.0 cm. No focal lesions. Multiple\nsplenules are seen at the hilum.\n\nAdrenal Glands: The 1.6 cm right adrenal nodule is stable compared to prior,\nconsistent with an adenoma. There is thickening of the left adrenal gland\nwithout any discrete nodularity, stable.\n\nKidneys: Multiple T2 hyperintensities within the kidneys bilaterally,\nmeasuring up to and 1.9 cm at the left upper pole are consistent with simple\ncysts. Otherwise, the kidneys enhance symmetrically. No enhancing renal\nlesions. No perinephric abnormalities.\n\nGastrointestinal Tract: The stomach is within normal limits. A left lower\nquadrant colostomy is visualized. Otherwise, the small large bowel are within\nnormal limits.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is bowel in caliber.\n\nOsseous and Soft Tissue Structures: There is a 1.4 x 1.2 cm enhancing nodule\nwithin the subcutaneous tissues of the right lower anterior chest wall (series\n12, image 93). This has slowly increased over time, however had a slightly\ntubular appearance on prior examinations. Minimal levoconvex scoliosis of the\nlumbar spine. No suspicious osseous lesions.", "output": "1. Status post RFA and TACE of segment II and III lesions. No evidence of\nresidual or recurrent disease within the treatment beds.\n2. 1.8 cm arterial hyperenhancing lesion within the periphery of liver segment\nVIII without washout, stable compared to prior, but warrants attention on\nfollow-up examinations.\n3. Stable mild intrahepatic biliary dilatation within the left lobe of the\nliver, likely related to prior TACE.\n4. 1.4 cm enhancing nodule within the subcutaneous tissues of the right lower\nanterior chest wall, which has increased in size compared to prior\nexaminations. This lesion had a slightly tubular appearance on prior\nexaminations, possibly representing a varix. This can be evaluated on\nfollow-up examinations or further characterized with ultrasound.\n5. Other incidental findings include a left pulmonary hamartoma, a right\nadrenal adenoma, and cholelithiasis, all unchanged from prior." }, { "input": "Lower Thorax: The known left pulmonary hamartoma is again noted measuring 2.1\ncm. New nodule at the right lung base measuring 0.9 cm. A few small\npericardial lymph nodes are also present, unchanged.\n\nLiver: Partial right hepatectomy changes again noted. The liver\nredemonstrates cirrhotic morphology with 2 ablation cavities. The cavity in\nsegment 2 measures 3.5 x 2.5 cm, previously 3.6 x 2.6 cm. The cavity in\nsegment 3 measures 3.5 x 2.9 cm, previously 3.6 x 3.1 cm. A few regions of\narterially hyper enhancement without correlate on additional sequences are\nnonspecific, possibly perfusional. No findings of recurrence or new HCC\nvisualized.\n\nBiliary: Biliary prominence adjacent to the ablation site is stable. No\nextrahepatic biliary ductal dilatation. Cholelithiasis is again noted.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: Mild splenomegaly is redemonstrated.\n\nAdrenal Glands: The left adrenal gland is unremarkable. Nodularity of the\nright adrenal gland is stable.\n\nKidneys: Diminutive bilateral renal cysts are stable. Mild atrophy of the\nleft kidney. The kidneys are otherwise unremarkable.\n\nGastrointestinal Tract: A left colostomy is again noted. No intestinal\nobstruction or ascites in the upper abdomen. Small focus of fat necrosis in\nthe omentum is again seen.\n\nLymph Nodes: No enlarged abdominal lymph nodes are demonstrated.\n\nVasculature: Nonocclusive thrombus in a medial branch of the left portal vein\nis again seen. The remaining hepatic vasculature is patent.\n\nOsseous and Soft Tissue Structures: 1.5 cm enhancing nodule in the\nsubcutaneous right upper quadrant anterior abdominal wall is larger than 0.9\ncm previously.", "output": "Cirrhotic liver morphology without findings of new HCC or recurrence.\n\nRedemonstration of a left pulmonary hamartoma. New 0.9 cm right lower lung\nnodule which could be assessed with CT chest.\n\nInterval growth of subcutaneous nodule in the right upper quadrant.\n\nRECOMMENDATION(S): CT chest." }, { "input": "Lower Thorax: Partially imaged left lingular pulmonary nodule measuring up to\n2.3 cm, most consistent with a hamartoma, as seen on dedicated chest CT.\n\nLiver: The liver is shrunken and nodular appearance, consistent with\nbackground cirrhosis. There is trace perihepatic ascites. Postsurgical\nchanges from right partial hepatectomy are again seen. Segment II and III\nablation cavities have mildly decreased in size compared to prior. No nodular\nenhancement along the ablation cavity is to suggest recurrent disease.\n\nThere is a 0.9 x 0.9 cm arterial hyperenhancing lesion in segment V without\ndefinite washout or pseudocapsule (series 10, image 32).\nThere are additional areas of arterial hyperenhancement in the periphery of\nthe liver without associated washout, likely transient hepatic intensity\ndifferences.\n\nBiliary: There is cholelithiasis. There is no intra or extrahepatic or\nextrahepatic biliary duct dilation. Mild intrahepatic biliary duct dilation\nadjacent to the ablation zone is stable.\n\nPancreas: The pancreas is normal in signal intensity. No focal pancreatic\nlesion is seen. There is no pancreatic duct dilation. There is no evidence\nof pancreas divisum.\n\nSpleen: The spleen is enlarged measuring 15.9 cm.\n\nAdrenal Glands: There is unchanged thickening of the left adrenal gland\nwithout discrete nodularity. There is a stable 1.3 cm right adrenal adenoma.\n\nKidneys: Multiple T2 hyperintense lesions within the bilateral kidneys are\nconsistent with simple cysts. These measure up to 1.7 cm in the left upper\npole. There is an extrarenal pelvis in the left kidney. No hydronephrosis.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are limited, but unremarkable. Note is made of a left lower\nquadrant ostomy.\n\nLymph Nodes: Prominent retroperitoneal lymph nodes measuring up to 1.0 cm\n(series 10, image 54), are unchanged.\n\nVasculature: Hepatic arterial anatomy is conventional. There is no abdominal\naortic aneurysm. Thrombus in a peripheral left portal branch in the region of\nthe ablation zones is unchanged. Remainder of the portal veins are patent. \nHepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. \nRecently biopsied right upper quadrant soft tissue nodule has decreased in\nsize now measuring 0.8 cm.", "output": "1. Postsurgical changes from prior partial hepatectomy and left hepatic TACE. \nNo lesions meeting OPTN criteria.\n2. 0.9 cm arterial enhancing lesion in the right lobe of the liver without\nwashout or pseudocapsule, attention on follow-up imaging.\n3. Stable changes post TACE with mild intrahepatic biliary duct dilation and\nthrombus in a peripheral left portal vein branch.\n4. Decrease in size of right upper quadrant soft tissue nodule." }, { "input": "Lower Thorax: T2 hyperintense lingular nodule measuring up to 19 mm is\nunchanged from prior exams, better assessed on prior dedicated chest\nexaminations, compatible with a pulmonary hamartoma. Otherwise, the lung\nbases are clear. No pleural or pericardial effusion. No hiatus hernia.\n\nLiver: The liver is shrunken and nodular, compatible with cirrhosis. Changes\nrelated to prior partial right hepatectomy are again noted. The 3.3 x 2.5 cm\nablation zone in segment II, and the 3.3 x 2.5 cm ablation zone in segment\nIII, are unchanged. No nodular enhancement to suggest local recurrence. \nIntrinsically T1 hyperintense material is seen within the ablation zones,\nunchanged.\n\nA 9 mm focus of arterial hyperenhancement in segment V is unchanged (see\nseries 13 and 14, image 26 for both). Just anterior and inferior to this also\nin segment V is a 7-8 mm more ill-defined focus of arterial hyper enhancement\n(for example see series 13 and 14, image 29). Additional foci of non masslike\narterial hyper enhancement in the periphery of the liver are similar in\nappearance to prior exam and may relate to transient hepatic intensity\ndifferences. None of these foci or areas of arterial hyperenhancement have a\ndiscernible T2 correlate, washout or pseudo capsule.\n\nBiliary: Gallstones layer dependently in the gallbladder lumen. The\ngallbladder is otherwise unremarkable. There is no intra or extrahepatic\nbiliary ductal dilation.\n\nPancreas: The pancreas is within normal limits.\n\nSpleen: There is unchanged moderate splenomegaly.\n\nAdrenal Glands: There is thickening of the left adrenal gland, unchanged. \nRight adrenal adenoma is unchanged.\n\nKidneys: The kidneys enhance normally by. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are within normal limits. \nImaged small and large bowel loops are unremarkable. Left lower quadrant\nostomy site is partially visualized.\n\nLymph Nodes: Scattered retroperitoneal and mesenteric lymph nodes are not\npathologically enlarged by CT size criteria. There is trace perihepatic\nascites.\n\nVasculature: The abdominal aorta is normal in caliber mildly tortuous. Major\nproximal tributaries are grossly patent. The majority of the portal vein is\npatent, however again seen is poor opacification of a peripheral left portal\nvein branch, consistent with previously demonstrated distal thrombus. The\nsplenic vein and SMV are patent.\n\nOsseous and Soft Tissue Structures: No concerning foci of abnormal is marrow\nsignal are seen.", "output": "1. No lesions meeting OPTN criteria for ___. Segment V 9 mm focus of arterial\nhyperenhancement, in addition scattered areas of arterial hyperenhancement\nseen elsewhere which may represent transient hepatic intensity differences,\nnot significantly unchanged. Attention on follow-up studies.\n2. Cirrhotic hepatic morphology and changes related to prior partial right\nhepatectomy.\n3. Trace perihepatic ascites. Unchanged moderate splenomegaly. Sequelae of\nprior thrombus in a peripheral left portal vein branch, as on prior; remainder\nof the portal vein is patent.\n4. Unchanged right adrenal adenoma and left adrenal thickening.\n5. Left lower quadrant ostomy is partially visualized.\n6. Unchanged 19 mm T2 hyperintense lingular lesion, better evaluated on\ndedicated chest imaging." }, { "input": "Lower Thorax: 2.4 cm round lesion in the left lower lung is unchanged and was\npreviously characterized as pulmonary hamartoma.\n\nLiver: Patient is post partial right hepatectomy. Areas of non enhancement in\nsegment 2 and 3 are consistent with ablation zones, unchanged. Liver contour\nis nodular, consistent with cirrhosis.\n\n OPTN CRITERIA (any lesion greater than 1cm, up to 5 lesions)\nMaximum lesion diameter (late arterial or portal venous phase): 1.5cm\nLocation: Segment 2 (1001:30)\nArterial enhancement: yes\nWashout:yes\nLate capsule or pseudocapsule enhancement on delayed phase: yes\nGrowth (maximal diameter increase >50% in <=6 months): No. This lesion was\nless conspicuous on ___, likely due to technical reasons.\n\nClassification: Class 5A: size 1-2cm, arterially enhancing, washout AND\npseudocapsule\n\n0.8 cm arterially enhancing nodule in segment 5 (1001:63) without definite\nrapid washout is unchanged compared to ___. Multiple arterially\nenhancing foci throughout the liver becomes isoenhancing on later phases,\nconsistent with transient hepatic intensity differences, similar to before.\n\nBiliary: Gallbladder contains gallstones. Intra and extrahepatic bile ducts\nare normal size.\n\nPancreas: Pancreas demonstrates homogeneous enhancement throughout. \nPancreatic duct is normal caliber.\n\nSpleen: Enlarged spleen measures 17 cm.\n\nAdrenal Glands: 1.4 cm right adrenal adenoma is unchanged. Mildly thickened\nappearance of the left adrenal gland is stable.\n\nKidneys: Bilateral nephrograms are symmetric. Multiple renal cysts measuring\n1.8 cm or less are identified in bilateral kidneys. There is no\nhydronephrosis.\n\nGastrointestinal Tract: Left lower quadrant colostomy is present. Stomach is\nunremarkable. Small and large bowel loops are normal caliber.\n\nLymph Nodes: There is no lymphadenopathy. Prominent subcentimeter pericardial\nlymph node is unchanged.\n\nVasculature: There is no abdominal aortic aneurysm. Mildly attenuated\nappearance of left portal vein segment 3 branch is similar to before.\n\nOsseous and Soft Tissue Structures: No concerning bone or soft tissue lesion\nis identified.", "output": "1. 1.5 cm segment 2 lesion is consistent with OPTN 5A.\n2. Multiple sites of arterial enhancement are stable and consistent with\ntransient intensity differences.\n3. Liver cirrhosis with splenomegaly.\n4. Unchanged right adrenal adenoma." }, { "input": "Lower Thorax: Limited exam of bilateral lung fields demonstrates a 2.1 X 2.3\ncm circular T2 hyperintense mass, which is stable from prior and was\npreviously characterized as a pulmonary hamartoma (series 3, image 24). \nOtherwise, no pleural effusion. No pericardial effusion.\n\nLiver: Hepatic margin is nodular in contour, consistent with known cirrhosis.\nPatient is status post hepatic segment VI resection with stable postsurgical\nchange seen as susceptibility artifacts at the right and inferior hepatic\nmargins. There are T1 hyperintense, T2 hypointensities with rim-enhancing\nfeatures around segment II, III corresponding to prior radiofrequency ablation\n(series 4, image 12 and 17, respectively). Otherwise, there is weakly T1\nhypointensity around segment VI, corresponding to post TACE treatment changes\n(series 4, image 23).\n\nNotably, the 2 prior Organ Procurement and Transplantation Network (OPTN)\nclass 5 lesions seen in segment II and ___ on MR ___ are no longer\nvisualized. There are no new lesions that fulfill the OPTN class 5 criteria.\n\nBiliary: The gallbladder is normal in shape, with multiple gallstones without\npericholecystic fluid or wall thickening to suggest acute cholecystitis. \nBiliary ducts are not dilated.\n\nPancreas: The pancreas is normal in contour and demonstrates homogeneous T1\nhyperintensity throughout. No main pancreatic duct dilatation.\n\nSpleen: The spleen demonstrates homogeneous expected enhancement. Accessory\nspleen noted. Stable splenomegaly appreciated.\n\nAdrenal Glands: Interval enlargement of right adrenal adenoma, now measuring 2\ncm in the largest dimension. The left adrenal gland appears mildly thickened,\nwhich is stable from prior.\n\nKidneys: Right kidney normal in shape. Left kidney appears atrophic. Multiple\nT2 hyperintense circular foci are again appreciated. The largest measures 1.9\nx 1.5 mm, most likely resembling stable simple renal cysts. There is no\nhydronephrosis.\n\nGastrointestinal Tract: The visualized stomach and small bowel are normal in\ncaliber and shape. Left lower quadrant colostomy site noted. There is no\nobstruction.\n\nLymph Nodes: No mesenteric or retroperitoneal adenopathy appreciated.\n\nVasculature: The abdominal aorta is normal in caliber and shape. Splenic vein\nvarices noted. There is also a bed of varices in the R hemiabdomen draining to\nthe IVC.\n\nOsseous and Soft Tissue Structures: No concerning bony or soft tissue\nabnormalities identified.", "output": "1. The 2 prior OPTN class 5 lesions in segment II and ___ are no longer\nvisualized. No new lesions fulfilling OPTN criteria.\n2. Stable post RFA, TACE changes as noted above.\n3. Stable splenomegaly .\n4. 2.0cm right adrenal adenoma.\n5. Stable bilateral simple renal cysts." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion. The T2\nhyperintense mass previously characterized as a pulmonary hamartoma is only\npartially visualized on this study.\n\nLiver: The liver is shrunken and nodular consistent with cirrhotic morphology.\nThe patient is status post right hepatectomy with stable postsurgical changes.\nThere is evidence of prior ablation in hepatic segments II and III. There are\nmultiple foci of arterial enhancement without correlate on other sequences,\npossibly transient hepatic intensity differences (for example 1101; 37, 41,\n50, 63, 74). Branches of the left portal vein are again noted to be\nattenuated. The right portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nMultiple peribiliary cysts are noted (4; 16). The gallbladder contains\ngallstones.\n\nPancreas: Normal in signal intensity without ductal dilatation. There is no\nfocal lesion.\n\nSpleen: Spleen is enlarged measuring 16.6 cm. There is no concerning focal\nlesion.\n\nAdrenal Glands: There is nodular thickening of the left adrenal gland. A 1.6\ncm nodule seen in the right adrenal gland which contains fat, consistent with\nan adrenal adenoma (7; 17).\n\nKidneys: The left kidney is mildly atrophic. There is no hydronephrosis.\nMultiple simple cysts are seen in bilateral kidneys measuring up to 3 cm in\nthe left upper pole. Hemorrhagic cysts are seen in the right kidney.\n\nGastrointestinal Tract: A left lower quadrant colostomy is noted with a\nparastomal hernia. No obstruction.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Hepatic anatomy is conventional. Multiple upper abdominal\nvarices are noted.\n\nOsseous and Soft Tissue Structures: There is levoconvex lumbar scoliosis. No\nsuspicious osseous lesion. No focal abnormality.", "output": "1. Cirrhotic liver without hepatic lesions meeting OPTN criteria. Stable\nsequelae of portal hypertension including splenomegaly and varices.\n2. Cholelithiasis.\n3. Unchanged right adrenal adenoma." }, { "input": "There is a pulmonary nodule in the left lung base (07:14), unchanged from\nprior CT's. There is no pleural or pericardial effusion.\n\nThere is diffuse marked dropoff of signal of the hepatic parenchyma on T1 out\nof phase images in comparison to in-phase images, consistent with severe\nsteatosis. Multiple hepatic lesions are seen, with target-like appearance,\nhigh signal intensity on T2WI, steatotic sparing, restricted diffusion and\n___ relative to the background parenchyma. The lesions measure up\nto 4 cm and are concerning for metastases.\n\nThe portal and hepatic veins are patent. There is conventional arterial\nhepatic anatomy.\n\nThe gallbladder is normal. The intra and extrahepatic biliary ducts are normal\nin caliber.\n\nThere is moderate pancreatic steatosis. The main pancreatic duct is normal in\ncaliber. There is cystic lesion in the tail of the pancreas measuring 14 x 9\nmm, consistent with a side branch IPMN (02:32).\n\nAnterior to the pancreas a 14 mm gastroepiploic lymph node (07:27, 12:45,\n3:34).\n\nThe patient is post Nissen fundoplication. Along the proximal lesser\ncurvature of the stomach, adjacent to the fundoplication site, is an area of\ngastric wall thickening (07:21), with restricted diffusion (03:31) and\nrelative ___ to the gastric mucosa, the spanning approximately 5.2\nx 1.8 cm (12:36). There is adjacent fat stranding between the stomach and\nliver with an enlarged gastrohepatic lymph node measuring 1.6 x 1.8 cm\n(07:23). The constellation of findings are concerning for a neoplasm.\n\nThere are multiple cortical peripheral tiny cysts in both kidneys, consistent\nwith glomerulocystic disease.\n\nThe adrenals are normal.\n\nAn enlarged left paraaortic lymph node measures 1.4 cm (07:38, 12:59).\n\nThe spleen is normal in size.\n\nThe bone marrow signal is normal.\n\nThere is no free fluid in the abdomen.", "output": "1. Ill-defined 5.8 x 1.2 cm hypoenhancing lesion along the proximal aspect of\nthe lesser curvature of the stomach, adjacent to the fundoplication site, with\nenlarged gastrohepatic, gastroepiploic, and left paraaortic lymph nodes,\nadjacent fat stranding, and numerous liver lesions, concerning for metastatic\ngastric neoplasm. These findings would be atypical for CLL conversion into\nlymphoma. Endoscopy is recommended for further evaluation. If no biopsy\ntarget is seen on endoscopy, a targeted liver biopsy could be performed under\nultrasound guidance.\n2. Severe hepatic steatosis.\n3. Glomerulocystic renal disease.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on ___\nat 20:44 into the Department of Radiology critical communications system for\ndirect communication to the referring provider." }, { "input": "Lower Thorax: 7 mm right lower lobe pulmonary nodule appears unchanged (4:4). \nNo pleural effusion is present.\n\nLiver: Several scattered sub cm simple cysts or biliary hamartomas are\ndemonstrated in the left lobe of the liver. Remainder of the liver is normal\nin signal without concerning lesion.\n\nBiliary: Mild intra and extrahepatic biliary dilatation with the common bile\nduct measuring up to 7 mm appears unchanged, and likely related to prior\ncholecystectomy.\n\nPancreas: Within the pancreatic head, there is a well-circumscribed lobulated\nlesion which is homogeneously hyperintense on T2 weighted imaging which\nmeasures 15 x 10 mm, previously 12 x 8 mm in ___. No nodularity or internal\nseptations are clearly noted within this lesion. Main pancreatic duct is\nnormal in caliber. No additional pancreatic lesions are seen. The background\nsignal of the pancreas appears normal.\n\nSpleen: Normal in size and without focal mass.\n\nAdrenal Glands: Normal.\n\nKidneys: Punctate simple cysts are noted in both kidneys. Otherwise, the\nkidneys appear normal without hydronephrosis.\n\nGastrointestinal Tract: Stomach, and loops of small bowel large bowel appear\nunremarkable.\n\nLymph Nodes: No pathologically enlarged mesenteric or retroperitoneal nodes\nare present.\n\nVasculature: Abdominal is normal caliber.\n\nOsseous and Soft Tissue Structures: No concerning bone marrow signal\nabnormalities are present.", "output": "1. Continued gradual interval growth in the cystic lesion within the\npancreatic head now measuring 15 x 10 mm. Again this likely reflects a side\nbranch IPMN, and recommend follow-up MRI in ___ year.\n\n2. Unchanged 7 mm right lower lobe pulmonary nodule.\n\nRECOMMENDATION(S): ___ year follow-up MRI." }, { "input": "Lower Thorax: There is a 7 mm nodule in the right lower lobe(series 5:3),\nunchanged dating back to CT abdomen and pelvis ___.\n\nLiver: There are several simple cysts or biliary hamartomas measuring up to 6\nacross maximal diameter(series 5:3), unchanged from ___. there is no\nabnormal hepatic parenchymal signal on noncontrast imaging.\n\nBiliary: Again noted is mild central biliary ductal dilation, unchanged from\n___, likely from a post-cholecystectomy state.\n\nPancreas: In the pancreatic head there is a well circumscribed septated cystic\nlesion measuring 10 x 6 mm in transverse ___ 5:31), previously\n15 x 10 mm on ___ likely from interval endoscopic ultrasound and FNA. \nThere is T2 hypointense components within this lesion likely representing\nhemorrhage. No additional pancreatic lesions are seen. The main pancreatic\nduct is normal in caliber.\n\nSpleen: The spleen is normal in size without focal lesion.\n\nAdrenal Glands: Normal\n\nKidneys: There are punctate simple cysts noted in both kidneys measuring up to\n5 mm across maximal diameter in the right kidney(series 5:33).\n\nGastrointestinal Tract: The stomach, partially visualized small and large\nbowel loops are normal.\n\nLymph Nodes: There is no pathologically enlarged mesenteric or retroperitoneal\nlymph node.\n\nVasculature: The abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion.", "output": "1. Interval decrease in size of a cystic lesion in the pancreatic head which\nnow measures 10 x 6 mm, previously 15 x 10 mm on MRI abdomen ___\nlikely following interval endoscopic ultrasound and aspiration in ___. \nNo new pancreatic lesions.\n2. 7 mm right lower lobe lung nodule is stable dating back to CT abdomen and\npelvis ___. Given this long term stability, this nodule is likely\nbenign." }, { "input": "A fluid-filled appendix is present in the right lower quadrant (series 5,\nimage 31) measuring up to 6 mm in diameter, upper limits of normal to mildly\ndilated. The base of the appendix appears normal in caliber without\nsignificant luminal fluid. The mid and distal portions contain fluid. No\nsignificant stranding is seen in the right lower quadrant. The appendix has\nrestricted diffusion, raising the concern for inflammatory changes. No\nabscess or significant free fluid. Cecal tip is preserved, but\nunderdistended. The findings raise concern for mild or early appendicitis. \nNo significant adenopathy in the right lower quadrant. Small bowel loops are\nnormal in caliber throughout.\n\nPartially included liver and spleen have normal signal intensity. The\npancreas appears unremarkable. No biliary ductal dilatation. The common duct\nis normal in caliber. The gallbladder is unremarkable. The adrenal glands\nare normal. No hydronephrosis or hydroureter. The gonadal veins appear\npatent. No free fluid is seen within the abdomen or pelvis. Gravid uterus\nwith anterior placenta. Probable contraction of the anterior uterus. This\nstudy is not designed to evaluate fetal structures. The cervix is closed. \nThe ovaries are normal bilaterally. No significant free fluid. No\nsignificant pelvic adenopathy.\n\nOverlying soft tissues are preserved. Bone marrow signal is within normal\nlimits.", "output": "1. Fluid-filled appendix in the right lower quadrant measuring up to 6 mm,\nparticularly involving the mid and distal appendix, suggestive of mild or\nearly appendicitis. No complications of abscess or significant adjacent\ninflammatory changes.\n2. Gravid uterus, anterior placenta, and closed cervix.\n\nFindings were originally communicated by Dr. ___ (after reviewing with\nDr. ___ with Dr. ___ physician, at 6:51 a.m. Subsequently, the\nimages were rereviewed and were rediscussed with surgery resident, Dr. ___\n___, at 9:25 a.m. The patient's surgical attending, Dr. ___, has been\nnotified of findings by Dr. ___." }, { "input": "Lower thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: There are few subcentimeter scattered T2 hyperintense nonenhancing\nhepatic cysts or biliary hamartomas. No imaging features suggestive of\ncirrhosis. No signal drop on out of phase imaging to suggest hepatic\nsteatosis. No ascites.\n\nBiliary: Minimal intrahepatic biliary duct dilatation. The common bile duct\nis dilated measuring up to 1.1 cm and smoothly tapers to the level of the\nampulla without obstructing stone or obstructing mass. Gallbladder is\nunremarkable.\n\nPancreas: Few subcentimeter pancreatic cystic lesions, largest measuring 0.2\ncm, likely side branch intraductal papillary mucinous neoplasm (IPMN).\nPancreas is homogeneous in signal intensity without suspicious mass. No\npancreatic duct dilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: There are few subcentimeter T2 hyperintense nonenhancing simple renal\ncysts. Bilateral kidneys are otherwise homogeneous in signal intensity\nwithout suspicious mass. No hydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction. Within the left upper quadrant there\nis a 5.5 x 5.4 cm single loculated cystic retroperitoneal lesion without\nseptations or nodular enhancement, unchanged since ___. No definite\nconnection to the adjacent bowel loops or pancreatic tail.\n\nPelvis: Bladder is well distended and thin-walled. Distal ureters are\nunremarkable. Fibroid uterus is noted. No pelvic free fluid. No large\nadnexal mass.\n\nLymph Nodes: Renal, pelvic sidewall, retroperitoneal, mesenteric lymph nodes\nare nonenlarged.\n\nVasculature: Mild atherosclerotic disease noted. No abdominal aortic\naneurysm. Celiac and SMA stent are noted causing artifact, limiting\nevaluation of the vessels at this level. Vasculature is patent distally. \nBilateral renal veins, and ___ are patent. Hepatic veins, main portal vein,\nSMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable", "output": "1. 5.5 cm cystic retroperitoneal lesion without septations or nodular\nenhancement, unchanged since ___. Findings favor a lymphangioma, with\nmucinous cystadenoma a rarer common consideration.\n2. Dilated intra- and extrahepatic biliary ducts with findings suggestive of\nsphincter of Oddi dysfunction. No choledocholithiasis or obstructing mass\nseen.\n3. Pancreatic cystic lesions, largest measuring 0.2 cm, likely side branch\nintraductal papillary mucinous neoplasm (IPMN). Consider follow up MRCP in ___\nyear to assess for expected stability.\n\nRECOMMENDATION(S): Follow up MRCP in ___ year to assess for expected stability\nof pancreatic cystic lesions." }, { "input": "Lower Thorax: Moderate bilateral pleural effusions are unchanged.\n\nLiver: The liver is smooth in contour. There is loss in signal on inphase\nrelative to out of phase imaging consistent with iron deposition. A\nheterogeneous T2 hyperintense lesion in segment II previously characterized as\na hemangioma is unchanged compared to recent prior imaging, decreased in size\nsince ___. No new or concerning hepatic lesions.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. The\ngallbladder contains layering gallstones. There is a Phrygian cap morphology\nat the fundus.\n\nPancreas: The pancreas is heterogeneous in signal intensity. Peripancreatic\nfluid collections are variably changed in size. A dominant fluid collection\nabutting the left hepatic lobe has slightly decreased in size and measures 5.0\nx 3.5 cm, previously 5.8 x 3.5 cm (series 6, image 18). A heterogeneous fluid\ncollection in/abutting the lateral pancreatic tail measures 4.7 x 2.9 cm,\npreviously 5.1 x 3.4 cm (series 6, image 22). A fluid collection arising from\nthe pancreatic body extending up to the expected location of the main\npancreatic duct measures 3.5 x 1.5 cm, previously 2.8 x 0.8 cm (series 6,\nimage 27). A fluid collection inferior to the pancreatic body/medial tail\nmeasures 3.9 x 2.1 cm, previously 1.9 x 0.9 cm (series 6, image 29). A\ndrainage catheter at least abuts the inferior margin of this collection. Small\nfluid collections posterior to the pancreatic head and mesenteric vasculature\nhave decreased in size, previously together spanning up to 6.2 x 2.0 cm, now\nappearing as 2 separate fluid collections measuring 2.6 x 1.8 cm and 1.5 x 1.1\ncm (series 6, image 29). A fluid collection surrounding a loop of jejunum is\ndecreased in size and measures 5.5 x 4.8 cm, previously 7.3 x 4.8 cm (series\n6, image 43). No main pancreatic duct dilation. The majority of the\npancreatic duct is not clearly identifiable.\n\nSpleen: The spleen is normal in size. No focal lesions identified.\n\nAdrenal Glands: The adrenal glands are normal in size and shape. No nodules.\n\nKidneys: The kidneys are atrophic. There are multiple bilateral simple\nappearing cysts. No hydronephrosis.\n\nGastrointestinal Tract: There is a small hiatal hernia. There is marked\nsusceptibility artifact in the proximal second portion of the duodenum\ncorresponding to metallic foreign body seen on prior CT. Small bowel loops\nare normal in caliber. The colon is unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is mild diffuse soft tissue edema. \nThere are innumerable T2 hyperintense lesions scattered throughout the\nvertebral bodies.", "output": "1. Peripancreatic fluid collections arising from/abutting the pancreatic body\nand medial tail and abutting the drainage catheter have increased in size.\n2. Other peripancreatic fluid collections have decreased in size.\n3. Innumerable T2 hyperintense vertebral body lesions appear similar to the\nlesions identified on cervical spine MRI performed ___ years prior. \nDifferential considerations continue to include amyloidosis and brown tumors\nin the setting of chronic renal insufficiency.\n4. Cholelithiasis.\n5. Small hiatal hernia." }, { "input": "Lower Thorax: There is mild bibasilar atelectasis. Multiple lung nodules are\nre-demonstrated and grossly unchanged from recent CT. Largest measuring 1.4\ncm in the right lower lobe. Heart is mildly enlarged.\n\nLiver: The liver demonstrates a nodular morphology compatible with background\ncirrhosis. There is a T2 hyperintense infiltrative mass with marked\nrestricted diffusion involving the entire left lobe of the liver. Numerable\ntiny satellite lesions with similar signal characteristics are noted in\nsegment VIII/V and in segment VII/VI but to a lesser extent. Lesion\ndemonstrates heterogeneous enhancement with hypoenhancement with regard to\nbackground liver parenchyma on more delayed phase imaging. There is small\nvolume ascites.\n\nThere are multiple additional T2 hyperintense lesions scattered throughout the\nliver with the largest measuring 4.0 x 3.3 cm at the hepatic dome, consistent\nwith cysts.\n\nBiliary: The gallbladder is unremarkable without evidence of stones. There is\nno intra or extrahepatic biliary duct dilation. Note is made that the central\nintrahepatic bile ducts are displaced to the right by the large infiltrative\nmass.\n\nPancreas: The pancreas is normal in morphology and signal intensity although\nthere is edema interdigitating between the pancreatic parenchyma most\npronounced in the head and pancreaticoduodenal groove. No focal pancreatic\nlesion is seen.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size. There are numerous T2\nhyperintense cysts in the kidneys some which contain septations. Notable\ncysts include a 8.6 x 7.9 cm cyst with thin septation but no internal\nenhancement in the right upper pole as well as a septated 4.2 x 4.4 cm cyst in\nthe left mid pole with thickened non enhancing septations and layering\nhemorrhage. Previously seen septated cyst in the left upper pole on prior\nrenal MRIs has near completely involuted (series 4, image 12).\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. The right and middle hepatic veins are patent but\nattenuated. The left hepatic vein is not visualized. The main and right\nportal veins are patent. The left portal vein is patent but attenuated\nparticularly in its distal branches.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. \nThere is no superficial soft tissue abnormality.", "output": "1. Infiltrative mass involving the entire left lobe of the liver with\ninnumerable small satellite nodules seen in the right lobe of the liver in\nprimarily segment VIII and segment V, findings are highly concerning for\ncirrhotometic hepatocellular carcinoma.\n2. Left hepatic vein is thrombosed. Right and middle hepatic veins are\npatent but attenuated. Left portal vein is also attenuated.\n3. Focal edema surrounding/interdigitating between the pancreatic head and\npancreaticoduodenal groove, concerning for acute pancreatitis, recommend\ncorrelation with lipase.\n4. Bilateral complex renal cysts with the most suspicious 4.4 cm hemorrhagic\ncyst in the left mid pole with thickened septations, for which short-term\nsix-month follow-up is recommended.\n\nRECOMMENDATION(S):\n1. Correlation with lipase.\n2. Six-month follow-up evaluate complex renal cysts." }, { "input": "Note, the exam is limited by respiratory motion.\n\nLower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base of the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is no hepatic steatosis. Innumerable tiny T2\nhyperintense lesions are noted throughout the liver, and are compatible with\ncysts or biliary hamartomas. There are no arterially enhancing liver lesions.\nNote, the splenic artery and common hepatic artery arises separately from the\naorta (14, 21). The portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is collapsed, which somewhat limits evaluation. There appears to\nbe several small stones (9, 27). There is no MRI evidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 10.1 cm. There no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are multiple simple cysts in\nthe bilateral kidneys. The largest is in the left and measures 79 mm. \nCorresponding to the hyperdense lesion seen on CT, there is a 12 mm rounded\nlesion in the interpolar left kidney which is low signal on the T2 weighted\nimages (9, 23), hyperintense on the precontrast T1 weighted images (12, 39),\nand is nonenhancing. It is compatible with a hemorrhagic cyst. There is no\nhydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. There is diverticulosis\nwithout evidence of diverticulitis. The imaged portions of the large bowel\nare otherwise normal.\n\nLymph Nodes: There are multiple enlarged retroperitoneal lymph nodes, similar\nto the prior exam. There is a conglomerate of lymph nodes in the right\nretroperitoneum which measures 40 x 26 x 30 mm (17, 40 and 2, 26). This\nconglomerate compresses the IVC, though the IVC appears patent. Prominent\nperiportal lymph nodes are also unchanged. There is no definite evidence of\nmesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is mild atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nIn T11 vertebral body, there is an 11 mm T2 hyperintense lesion, which likely\nrepresents a hemangioma. In the left transverse process of L3, there is a\nsimilar lesion, which corresponds to a hemangioma, as seen on the prior CT. \nThe soft tissues are unremarkable.", "output": "1. Retroperitoneal lymphadenopathy, most marked on the right. There is\ncompression of the IVC, though it remains patent. The differential diagnosis\nincludes lymphoma/lymphoproliferative disorder or metastatic disease.\n2. Hemorrhagic or proteinaceous renal cyst on the left. No worrisome renal\nlesions." }, { "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: The liver is unremarkable without suspicious focal lesion. The\ngallbladder is surgically absent. There is no intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: The pancreas is atrophic. In the pancreatic tail, there are multiple\nclustered cystic structures which taken as a conglomerate measure 2.0 x 1.9\ncm, previously 2.5 x 1.6 cm, not significantly changed and are stable since at\nleast ___. There is non-visualization of a segment of the main pancreatic\nduct just downstream to the cysts which likely reflects stricturing from prior\npancreatitis and is unchanged since ___. The visualized main\npancreatic duct is normal in caliber in the remaining body and head. Chronic\npancreatitis-related changes are again noted in the tail with tethering of the\nposterior gastric wall at the location of prior pseudocyst. There is no new\nfluid collection or acute inflammation.\n\nSpleen: The spleen is enlarged and measures 15.4 cmThere is no focal splenic\nlesion. There is chronic thrombosis of the splenic vein with multiple\nperisplenic and anterior abdominal collaterals.\n\nKidneys and Adrenals: The kidneys are normal bilaterally. 6mm parapelvic cyst\nis noted in the right kidney. The left adrenal gland appears thickened\nwithout focal mass. The right adrenal gland is normal.\n\nBowel: The visualized bowel loops and mesentery are within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "1. Unchanged appearance of a cluster of cystic structures in the pancreatic\ntail which likely reflects side-branch IPMNs and/or ductal ectasia secondary\nto prior pancreatitis. These have been stable since at least ___. Follow-up\nis recommended in ___ years to ensure continued stability. No new fluid\ncollection or acute inflammation.\n\n2. Stable narrowing of the pancreatic duct consistent with sequelae of prior\npancreatitis.\n\n3. Splenomegaly. Chronic thrombosis of the splenic vein." }, { "input": "Lower Thorax: There is no pleural pericardial effusion.\n\nLiver: No hepatic lesion is seen.\n\nBiliary: The patient is status post cholecystectomy. There is no intra or\nextrahepatic biliary duct dilation.\n\nPancreas: T2 hypointense linear scar tissue is again noted within the\npancreatic body extending to the gastric wall. Similar appearance of the\ncystic lesions in the pancreatic tail, showing communication with the main\npancreatic duct, measuring up to 1.0 cm, that likely represent sequela of\nprior pancreatitis. The main pancreatic duct is normal in caliber. Pancreas\ndivisum is again noted.\n\nSpleen: The spleen is mildly enlarged, measuring 13.2 cm craniocaudally. \nMultiple venous collaterals from chronic splenic vein thrombosis is\nredemonstrated.\n\nAdrenal Glands: Similar appearance of the left adrenal thickening. The right\nadrenal gland is normal in size and shape.\n\nKidneys: The kidneys are normal in size with no hydronephrosis. There is an\nunchanged 1.0 cm T2 hyperintense lesion in the lower pole of the right kidney\nsuggestive of cyst. Subcentimeter cysts are also noted in the lower pole of\nthe left kidney.\n\nGastrointestinal Tract: Visualized portion of the GI tract is unremarkable.\n\nLymph Nodes: There is no upper abdominal or retroperitoneal lymphadenopathy.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is seen.", "output": "1 . Stable mildly dilated side branch ducts in the pancreatic tail\nsuggesting sequela of prior pancreatitis.\n2. Chronic splenic vein thrombosis is redemonstrated with multiple venous\ncollaterals.\n3. Stable splenomegaly." }, { "input": "The study is degraded by motion artifact.\n\nLower Thorax: No pleural or pericardial effusion. No airspace opacification.\n\nLiver: No focal suspicious hepatic lesions.\n\nBiliary: The patient is status post cholecystectomy. No intra or extrahepatic\nbile duct dilatation.\n\nPancreas: The pancreas appears atrophic. Pancreas divisum. There is areas of\nnonvisualization of the pancreatic duct in the pancreatic body which may\nsuggest narrowing/stricture secondary to prior pancreatitis. The pancreatic\nduct is not dilated.\n\nThere is a cluster of T2 hyperintense cystic lesions in relation to the tail\nof the pancreas measuring 15 mm in combined diameter, which appears similar\ncompared to prior MRCP done ___ and ___. This\ncluster of cystic lesions appear to communicate with the main pancreatic duct\nand represent side branch IPMNs and/or ductal ectasias secondary to prior\npancreatitis.\n\nChronic pancreatitis related changes are again noted in the pancreatic\nbody/tail with tethering of the posterior gastric wall at the location of the\nprior pseudocyst (series 3, image 26).\n\nSpleen: Splenomegaly without focal splenic lesions.\n\nAdrenal Glands: No focal renal lesions.\n\nKidneys: No hydronephrosis. Bilateral small simple appearing renal cortical\ncysts.\n\nGastrointestinal Tract: No evidence of bowel obstruction.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: Chronic thrombosis of the splenic vein with gastroepiploic\ncollateralization\n\nOsseous and Soft Tissue Structures: No suspicious bony lesions.", "output": "1. No significant interval change compared to prior imaging.\n\n2. The cluster of cystic lesions in the pancreatic tail may represent side\nbranch IPMNs or ductal ectasia secondary to prior pancreatitis related duct\nstricture as described above. These findings are unchanged compared to prior\nMRCP studies done ___ and ___.\n\n3. Prior pancreatitis changes in relation to the body and tail of the pancreas\nas well as mild narrowing of the pancreatic duct in the pancreatic body.\n\n4. Splenomegaly. Chronic obliteration of the splenic vein with\ncollateralization" }, { "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: The liver is normal in signal intensity without evidence of focal mass.\nPeriportal edema is noted, and could be due to biliary obstruction.\n\nGallbladder and Biliary System: The gallbladder is distended with sludge and\ngallstones again noted, similar to prior ultrasound. No overt wall edema.\nThere is mild to moderate central intrahepatic ductal dilation and the\nextrahepatic ductal dilation with the common bile duct measuring 10 mm. A\nfilling defect within the distal common bile duct in the region of the ampulla\nis compatible with choledocholithiasis as noted on prior ultrasound (6:33;\n4:20).\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.There is classic pancreatic ductal anatomy without dilatation.\n\nSpleen: The spleen is minimally enlarged at 13.9 cm in the craniocaudal\ndimension (4:33).There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal\nlesion.The adrenal glands are normal bilaterally.\n\nBowel: The visualized bowel loops and mesentery are grossly within normal\nlimits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent. There is\nconventional hepatic arterial anatomy. There is focal narrowing at the origin\nof the celiac trunk, a commonly seen finding sometimes related to an\nimpression upon the celiac origin by the median arcuate ligament. However, in\nsome patients this effect may be symptomatic as well.", "output": "1. Mild-moderate intrahepatic and extrahepatic biliary ductal dilation with\ncholedocholithiasis noted in the distal common bile duct.\n2. Periportal edema could be due to the obstructive stone/cholestasis. No\nfocal hepatic lesions.\n3. Borderline enlarged spleen." }, { "input": "Lower Thorax: The lung bases are clear. The visualized heart and pericardium\nare unremarkable.\n\nLiver: There is drop in signal on in phase images, consistent with iron\ndeposition.This is also confirmed by low signal on the DWI sequences. There\nis no hepatic steatosis. The morphology of the liver is stable with\nenlargement of the left lobe.\n\nThe patient is status post TACE and RF ablation of a lesion in the caudate\nlobe. A rim of T1 hyperintensity around this lesion is consistent with\ncoagulative necrosis. There are no areas of arterial enhancement within this\nlesion. This lesion now measures 4.1 x 3.9 cm.\n\nA lesion in segment 5 is again noted, which is hypointense on portal venous\nand delayed phases and remains concerning for ___. Arterial enhancement is\nsubtle and only seen well on the subtraction images. This is believed to be\ndue to early timing of the arterial sequence. This lesion measures 7 mm, not\nsignificantly changed compared to the prior study (series 1002, image 53).\n\nThere is also a lesion in segment 6 demonstrating arterial enhancement with\nwashout. This is in the region of the previously described cyst, which is no\nlonger visualized. This lesion does not have a pseudocapsule. This lesion\nmeasures 11 mm.\n\nAnother lesion is also noted in segment 7, also with restricted diffusion and\nhypointensity on portal venous phase. Arterial enhancement is subtle and only\nwell seen on the subtraction images, but this is again believed to be due to\nearly timing of the arterial phase. This lesion is difficult to measure but\nmeasures approximately 8 mm (series 1002, image 44).\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe patient is status post cholecystectomy.\n\nPancreas: The pancreas is normal in bulk and signal characteristics without\nfocal lesions or main pancreatic ductal dilation.\n\nSpleen: The spleen is normal in size without focal lesions.\n\nAdrenal Glands: The adrenal glands are normal in size and signal\ncharacteristics without focal lesions.\n\nKidneys: The kidneys are normal in size and corticomedullary differentiation\nwithout focal lesions or hydronephrosis.\n\nGastrointestinal Tract: The stomach and visualized loops of small and large\nbowel are unremarkable without any evidence of wall thickening or obstruction.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. Note is made of a\nreplaced common hepatic artery arising from the SMA. The portal and hepatic\nveins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions are present.", "output": "1. Status post treatment of the caudate lobe lesion with expected post\nprocedure appearance. No arterial enhancement or other concerning features.\n2. Similar appearance of sub centimeter lesion in segment 5, which remains\nsuspicious for ___.\n3. Two additional lesions highly suspicious for ___, neither of which meets\nOPTN criteria.\n4. Mild iron deposition in the liver." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural or\npericardial effusion.\n\nLiver: Mild signal loss on in phase imaging versus out of phase imaging is\ncompatible with iron deposition, unchanged. There is new hypoenhancement in\nthe distribution of the posterior right portal vein, which is now thrombosed\non post contrast images (16:64), and demonstrates internal early arterial\nenhancement with washout compatible with tumor thrombus. The previously\ntreated lesion in the caudate lobe again exhibits intrinsic T1 hyperintense\nsignal peripherally, compatible with coagulation necrosis. There is no\nresidual arterial enhancement, and the lesion now measures 4.0 x 3.6 cm,\npreviously 4.1 x 3.9 cm (08:45). The previously described arterially\nenhancing lesion in segment 5 is again noted (10:54), currently 9 mm,\npreviously 7 mm. This demonstrates washout characteristics on portal venous\nand delayed phase imaging, with pseudo capsule. In the distribution of the\nposterior branch of the right portal vein, there has been enlargement of\narterially enhancing segment ___ lesions which are now confluent. Although\nthe lesion is ill-defined, it spans approximately 18 mm in maximal axial\ndimension and demonstrates washout on portal venous and delayed phase imaging\n(10:74). Although difficult to accurately assess in a single plane, when\nportal venous thrombus in the posterior branch of the right portal vein is\nincluded with the mass, the maximal axial measurement is approximately 21 mm\n(14:66). The inferior-most nodular component in segment 7 has also increased\nin demonstrates washout on portal venous phase imaging.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilation.\n\nPancreas: Pancreas is unremarkable. No focal lesions or pancreatic ductal\ndilation is identified.\n\nSpleen: Spleen is normal in size and signal intensity, with no focal lesions.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are normal in size in cortical medullary differentiation,\nwith no focal lesion, hydronephrosis, or perinephric abnormality.\n\nGastrointestinal Tract: The stomach and visualized loops of abdominal small\nand large bowel are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The posterior right portal venous occlusion is new since the\nprior study. The right common hepatic artery arises from the SMA. The\nhepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions are identified.", "output": "1. New tumor thrombus involving the posterior branch of the right portal vein,\nwith interval enlargement of lesions in segment ___, which are now confluent. \nOverall conglomerate lesion measures over 2 cm.\n2. Segment 5 lesion is now 9 mm and remains highly suspicious for ___,\nalthough below size threshold for OPTN criteria.\n3. Previously treated caudate lobe lesion is slightly smaller, with intrinsic\nperipheral T1 hyperintensity compatible with coagulation necrosis. No\nresidual enhancement.\n\n OPTN CRITERIA\nMaximum lesion diameter: 2.1cm\nLocation: Segment ___.\nArterial enhancement: yes\nWashout:yes\nLate capsule or pseudocapsule enhancement on delayed phase: no\nGrowth (maximal diameter increase >50% in <=6 months): yes\n\nClassification: Class 5B: size 2-5cm, arterially enhancing AND washout OR\npseudocapsule OR growth OR bipsy proven\n\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:39 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "The patient has undergone resection for segment ___ HCC. Treated lesion\nwithin the caudate lobe was not resected at the time of surgery.\n\nLower Thorax: Right-sided pleural effusion. Left pleural space and lung base\nare clear.\n\nLiver: Postsurgical changes are seen involving the posterior aspect of the\nright lobe from recent resection. Large area of coagulation necrosis within\nthe caudate lobe measuring 4.1 x 3.7 cm in keeping with site of previously\ntreated HCC is unchanged in appearance with no evidence of residual or\nrecurrent disease. No new hepatic mass lesions. However, there is new\nextensive tumor thrombus seen within the distal branches of the right anterior\nportal vein and distal branches of the left portal vein, with the main portal\nvein, splenic vein and superior mesenteric vein remaining patent.\n\nBiliary: No intra or extrahepatic ductal dilatation. Status post\ncholecystectomy.\n\nPancreas: Pancreas is normal in appearance with normal T1 signal\nhyperintensity, with no focal mass, main duct dilatation or peripancreatic\nabnormality.\n\nSpleen: The spleen is normal in size and appearance.\n\nAdrenal Glands: Adrenal glands are normal in appearance.\n\nKidneys: The kidneys enhance symmetrically with no focal mass, perinephric\nabnormality or dilatation of the collecting system.\n\nGastrointestinal Tract: The visualized gastrointestinal tract is within\nnormal limits.\n\nLymph Nodes: Multiple small retroperitoneal and upper abdominal lymph nodes\nare identified, not significantly changed from the prior study.\n\nVasculature: No aneurysmal dilatation of the abdominal aorta.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions.", "output": "1. Status post resection of hepatic lesion within the posterior aspect of the\nright lobe.\n\n2. New extensive tumor thrombus is seen within distal branches of the portal\nvasculature, with no thrombosis seen within the main portal vein, splenic\nvein, or superior mesenteric vein.\n\n3. Large area of coagulation necrosis within the caudate lobe is unchanged in\nsize and appearance, reflecting previously treated HCC. No evidence of\ndisease recurrence or new lesions meeting OPTN criteria for HCC.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:58 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Included views of the lung bases are clear. There is no pericardial or\npleural effusion. The heart size is normal.\n\nThe liver contour is smooth. The hepatic parenchyma demonstrates normal\nsignal intensity on T1 and T2 weighted sequences. No discrete hepatic mass is\ndetected, although further evaluation is limited by use of non contrast\ntechnique. There is no focus of restricted diffusion.\n\nThere is no intra or extrahepatic bile duct dilation. The gallbladder is\nnormal. No ductal stones are detected.\n\nThe pancreas demonstrates normal signal intensity and bulk. There is no\npancreatic duct dilation.\n\nThe spleen size is normal. No concerning splenic mass is seen.\n\nThe adrenal glands are normal.\n\nThe kidneys are normal in size. No discrete renal mass is seen. There is no\ncollecting system obstruction.\n\nThe stomach and intra-abdominal loops of small and large bowel are within\nnormal limits. There is mild colonic diverticulosis (series 5, image 30, 29).\n\nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, and SMA are normal in caliber.\n\nThere is moderate levoscoliosis centered about the thoracolumbar junction\n(series 3, image 23). A 17 mm hemangioma arises from the L1 vertebral body,\ndenoted by high internal signal intensity on T2 weighted sequences (series 3,\nimage 24).", "output": "1. Exam limited by lack of IV contrast (see technique section).\n2. No concerning hepatic mass. No MR evidence for cirrhosis or steatosis.\n3. No intra or extrahepatic bile duct dilation.\n4. Mild colonic diverticulosis.\n5. Moderate levoscoliosis centered about the thoracolumbar junction." }, { "input": "The lung bases are grossly clear. There is no pleural or pericardial effusion.\nSusceptibility artifacts from prior sternotomy are seen (05:27).\n\nThere is mild atrophy of the right hepatic lobe and hypertrophy of the left\nlobe, as well as nodular border of the liver, consistent with known cirrhosis.\nThere is no evidence of hepatic steatosis. Several T2 hyperintense\nnonenhancing sub cm lesions are consistent with cysts or biliary hamartomas\n(6: 8, 28). In segment V there is subcapsular 7 mm lesion within low signal on\nT2 WI (06:26), central focus of intrinsically high signal on T1 WI (07:49),\nrestricted diffusion (03:13) and no hyper enhancement or washout (09:47). This\nlesion is not specific, but is not suspicious for malignancy. No arterial\nhyper enhancing or washing out lesions are seen in the liver. There is\nconventional arterial hepatic anatomy. The portal and hepatic veins are\npatent.\n\nThe patient is status postcholecystectomy. The intrahepatic biliary ducts are\nnormal in caliber.\nIn the pancreatic head there is a poorly defined area of T1 hyperintensity\n(07:57), without restricted diffusion and without abnormal enhancement,\ncorresponding to sequela of prior acute pancreatitis. The main pancreatic duct\nin the body and tail is mildly dilated and irregular with some dilated side\nbranches, consistent with chronic pancreatitis. The pancreatic duct in the\nhead of the pancreas is not visualized. The proximal and mid CBD is prominent,\nwith smooth tapering in the pancreatic head and nonvisualization of the distal\nCBD. These are sequela of prior pancreatitis with fibrosis in the pancreatic\nhead.\n\nThe spleen size is borderline measuring 13 cm in craniocaudal dimension. Small\nperisplenic and perigastric varices are seen.\nSubcentimeter cortical renal cysts are seen bilaterally. The adrenals are\nnormal.\n\nThere is no free fluid in the abdomen.\nThere is no concerning retroperitoneal or mesenteric lymphadenopathy.\nThe bone marrow signal is normal.", "output": "1. Cirrhotic liver with signs of portal hypertension.\n2. 7 mm nonspecific lesion in segment V is not suspicious for malignancy.\n3. Sequela of acute pancreatitis, with poorly defined fibrosed pancreatic head\nand mild dilatation of the pancreatic duct and the CBD. The abnormality in the\npancreatic head was previously larger, biopsied and proven to be benign." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The surface contour of the liver is nodular, compatible with cirrhosis.\nAgain seen in segment V is a peripheral/subcapsular 8 mm irregularly-shaped\nnonenhancing focus which demonstrates a small area of intrinsic T1\nhyperintense signal (series 9, image 69), unchanged in appearance in\ncomparison to prior exam, non-specific. No concerning focal liver lesions are\nidentified. The portal vein is patent.\n\nBiliary: The gallbladder is surgically absent. There is no intra- or\nextrahepatic biliary ductal dilation.\n\nPancreas: The pancreas demonstrates normal homogeneous signal intensity. \nThere is no main pancreatic ductal dilation.\n\nSpleen: There is no splenomegaly or focal splenic lesion.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration.\n\nKidneys: A circumscribed 6 mm T2 hyperintense lesion arising partially\nexophytically from the right interpolar renal cortex is compatible with a\nbenign renal cyst. Otherwise, The kidneys display normal symmetric\nenhancement and signal intensity characteristics. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. Partially\nimaged non-dilated small bowel loops are normal in course and caliber without\nevidence of wall thickening, mural or mucosal hyperenhancement, or\nobstruction. The partially imaged colon is unremarkable.\n\nLymph Nodes: There is no evidence of retroperitoneal or mesenteric\nlymphadenopathy.\n\nVasculature: Paraesophageal varices are noted. The splenic artery is\nreplaced to the proximal SMA. The abdominal aorta is normal in caliber without\nevidence of aneurysm or dilation. Major proximal tributaries are patent.\n\nOsseous and Soft Tissue Structures: Multiple median sternotomy wires are\nnoted. No suspicious foci of abnormal marrow signal are seen.", "output": "1. No concerning focal liver lesions identified.\n2. 8 mm non-enhancing, nonspecific subcapsular focus in segment V is unchanged\nsince ___.\n3. Cirrhotic hepatic morphology. Patent portal vein. No ascites seen. \nParaesophageal varices." }, { "input": "Lower Thorax: The bases of the lungs are grossly clear. There is no pleural\nor pericardial effusion.\n\nLiver: The liver has a somewhat nodular contour, in keeping with given history\nof cirrhosis. The previously described subcapsular hepatic segment V 9 mm\nirregularly shaped nonenhancing focus is unchanged in appearance (8:75,\n1102:78), with a punctate focus of intrinsic T1 signal hyperintensity. No\nconcerning focal liver lesions are identified.\n\nBiliary: The gallbladder is surgically absent. There is no intra or\nextrahepatic biliary ductal dilation.\n\nPancreas: The pancreas is normal in intrinsic signal intensity and morphology,\nwith no evidence of focal lesion or pancreatic ductal dilation. There is no\nperipancreatic abnormality.\n\nSpleen: The spleen is normal in size, with no evidence of focal lesion.\n\nAdrenal Glands: Bilaterally normal.\n\nKidneys: The kidneys are somewhat lobulated in appearance, but present\nsymmetric nephrograms. A tiny cortical cyst is again noted in the interpolar\nright kidney. There is no evidence of hydronephrosis or concerning renal\nlesion bilaterally. No perinephric abnormality is detected.\n\nGastrointestinal Tract: The imaged gastrointestinal tract is within normal\nlimits.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The portal vein is patent. Small upper abdominal and lower\nparaesophageal varices are again noted (12:55, 12:31). Incidental note is\nmade of a replaced splenic artery arising from the superior mesenteric artery.\nThere is conventional anatomic configuration of the hepatic arterial supply.\n\nOsseous and Soft Tissue Structures: Multilevel degenerative changes are noted\nin the lumbar spine, including grade 1 anterolisthesis of L4 on 5 and grade 1\nretrolisthesis of L2 on L3. No osseous lesion worrisome for malignancy or\ninfection is identified. Susceptibility artifact related to median sternotomy\nwires and right upper quadrant abdominal surgical scar is again noted.", "output": "1. No concerning hepatic lesions are identified.\n2. Subcentimeter peripheral segment V nonenhancing lesion is unchanged,\nnonspecific.\n3. Hepatic cirrhosis with small upper abdominal and lower paraesophageal\nvarices. No evidence of ascites." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base of the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. There is no hepatic\nsteatosis. No worrisome liver lesions are identified. The portal veins are\npatent. Note, the entire liver is not included in the field of view.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal. No stones are identified.\n\nPancreas: Within the pancreas, there are multiple cysts. The largest is in\nthe tail, and measures 33 x 30 x 23 mm (3, 7 and 14, 45). The cysts appear\nsimple without abnormal enhancement or nodularity. The duct is normal. The\ncysts are in keeping with the known history of ___ disease.\n\nSpleen: The spleen is normal in size measuring 11.9 cm. There are no focal\nlesions.\n\nAdrenal Glands: The right adrenal gland is normal. The left adrenal gland is\nmildly thickened, though no obvious discrete nodule is identified. It is\nsimilar in appearance to prior exams, including the MIBG scan from ___\nat which time it demonstrated no uptake.\n\nRight kidney: The patient is status post a partial nephrectomy, with\nresection of a renal cell carcinoma from the lower pole. There are\npostsurgical changes along the parenchyma, without abnormal enhancement to\nsuggest local recurrence. Extending inferiorly from the resection site is a\n14 x 16 x 14 mm round well-circumscribed T2 hypointense lesion which is\nhyperintense on the T1 weighted images, and nonenhancing. This is most\ncompatible with a hematoma versus a hemorrhagic cyst.\n\nIn the mid to upper pole of the right kidney, there is a 7 mm lesion (1102,\n15), which has no obvious correlate on the T2 weighted images. It is\nhypointense on the T1 weighted images, and appears to be mildly hypoenhancing.\nThis lesion appears new, as it was not definitely present in ___ or\n___. Note, these prior exams are limited by motion.\n\nMultiple other simple cysts are noted in the right kidney, and appear grossly\nunchanged.\n\nThere is no hydronephrosis or perinephric abnormality.\n\nLeft kidney: There are four complex cystic lesions in the left kidney. Three\nare highly suspicious for renal cell carcinoma. One is equivocal, though\nneeds continued follow-up. These include:\n\nIn the mid left kidney, there is a 12 mm lesion (3, 18), which is partially\nexophytic and heterogeneously enhancing (1102, 40). The enhancement is linear\nand nodular. There is no evidence of hemorrhage within this lesion. It is\nunchanged in size from the prior exam from ___ and from the earliest\nexam on ___. This is concerning for a small clear cell renal cell\ncarcinoma.\n\nIn the mid left kidney, there is an 11 mm lesion (3, 24), which is also\nheterogeneously enhancing. The enhancement is linear and nodular (1102, 23). \nThere is no hemorrhage within the lesion. In comparison to the prior exam\nfrom ___, it is slightly increased in size. It previously measured 9\nmm. In comparison to the earliest available exam from ___, it\nappears new. This is suspicious for a renal cell carcinoma.\n\nIn the upper pole, there is a 7 mm lesion (3, 27), that appears to have\nseveral septations (1102, 16), though it is partially hyperintense on the T1\nweighted images (9, 16). It is slightly enhancing. This is unchanged in size\nfrom the prior exam from ___ and from the earliest exam on ___. Given the enhancement, this is also concerning for RCC.\n\nIn the central left mid kidney, there is a 13 mm lesion (1102, 36), which has\nno obvious correlate on the T2 weighted images. It may be slightly\nhyperintense on the T1 weighted images (9, 37), suggesting there is internal\nhemorrhage. There does appear to be at least one septation. It has equivocal\nenhancement. It is unchanged in size from the prior exam from ___\nand from the earliest exam on ___. This may represent a slightly\ncomplex hemorrhagic cyst, though renal cell carcinoma is difficult to exclude,\nas its enhancement characteristics are difficult to measure.\n\nIn the very upper pole of the left kidney, there is a 4 mm hemorrhagic cyst\n(1102, 32 and 9, 31). Other simple cysts are also noted, and unchanged.\n\nThere is no hydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or atherosclerotic plaque. There is a single renal artery\nbilaterally. The renal vein anatomy is conventional. There is no evidence of\na thrombus.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe soft tissues are unremarkable.", "output": "1. Post right partial nephrectomy with a small hematoma at the resection bed.\nNo local recurrence.\n2. Three enhancing lesions within the left kidney are highly suspicious for\nclear cell renal cell carcinoma. A fourth lesion demonstrates equivocal\nenhancement, suspicious for neoplasm.\n3. One enhancing lesion within the right kidney is highly suspicious for\nclear cell renal cell carcinoma.\n3. Numerous pancreatic cysts, which is in keeping with ___\ndisease." }, { "input": "Lower Thorax: There is a small right pleural effusion. There is an area of\nround atelectasis at the right lung base. The heart is mildly enlarged.\n\nLiver: Post surgical changes at the poster right hepatic lobe. There is a\nround lesion which measures 3.9 x 3.3 cm at the posterior aspect of the liver\nwhich shows loss of signal on the out of phase dual echo GRE images indicating\nintra-voxel fat as well as arterial phase mild hyper-enhancement with delayed\nphase washout and pseudocapsule. This satisfies OPTN-5B criteria for ___.\n\nNo evidence of hepatic steatosis on the dual-echo GRE images.\n\nBiliary: Pneumobilia is present. Intrahepatic and extrahepatic bile ducts are\nnot dilated. Gallbladder is absent.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated.\n\nSpleen: Normal in size, signal, and enhancement.\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement. No solid\nmass. Left upper pole T2 hyperintense focus without enhancement consistent\nwith a simple cyst.\n\nGastrointestinal Tract: No evidence of obstruction. No mass.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Main and left portal veins are\npatent. Hepatic veins are patent. Known right anterior portal vein thrombus\nextends to the hepatic mass, but has been gradually expanding since the ___\nstudy and currently demonstrates mild enhancement. Non-breath-hold technique\nlimits evaluation somewhat but this is concerning for tumor thrombus.\n\nOsseous and Soft Tissue Structures: There is a small lipoma of the right\nserratus anterior. Normal bone marrow signal.", "output": "1. 3.9 x 3.3 cm right posterior hepatic mass satisfying OPTN-5B criteria for\nHCC.\n2. Adjacent right anterior portal vein thrombosis has expanded with mild\ninternal enhancement, highly suspicious for tumor thrombus.\n3. Persistent small right pleural effusion with right lower lobe rounded\natelectasis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 11:20 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: There is re-demonstration of small bilateral pleural effusions\nand round atelectasis at the right lung base.\n\nLiver: The liver is nodular, in keeping with cirrhosis. Postsurgical changes\nare seen in the right hepatic lobe. There is a 4.2 x 3.8 nonenhancing region\nwithin the right lobe that corresponds to the HCC seen on prior MRI from\n___. There is no evidence of abnormal enhancement within the treatment\nzone to suggest residual or recurrent disease. No new suspicious lesions are\nidentified.\n\nBiliary: The patient is status post Roux-en-Y hepaticojejunostomy. There is\nin pneumobilia. Mild intrahepatic biliary ductal dilatation is seen within\nthe left hepatic lobe, not significantly changed compared to previous.\n\nPancreas: The pancreas is mildly atrophied with normal signal intensity. \nThere is no pancreatic ductal dilatation, focal masses, or peripancreatic\nabnormalities.\n\nSpleen: Spleen is mildly enlarged, measuring 14.3 cm. There are no focal\nlesions.\n\nAdrenal Glands: Bilateral adrenals are within normal limits.\n\nKidneys: Several cortical cysts are seen in the left kidney, including a\nseptated cyst measuring 3.9 x 2.9 cm in the superior pole of the left kidney. \nThere is no abnormal enhancing mass, hydronephrosis, or perinephric\nabnormality.\n\nGastrointestinal Tract: The stomach and visualized large and small bowel\nwithin the upper abdomen appear unremarkable.\n\nLymph Nodes: Several small periportal and retroperitoneal lymph nodes are\nseen, not individually size significant. There is no mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. There are accessory\nright renal arteries. There is a replaced right hepatic artery arising from\nthe SMA. The portal vein is patent.\n\nOsseous and Soft Tissue Structures: Postsurgical changes are seen in the\nanterior abdominal wall. There are no suspicious osseous or soft tissue\nlesions.", "output": "Status post chemoembolization of a right hepatic lobe HCC. There is no\nevidence of recurrent or residual disease." }, { "input": "Lower Thorax: There are small bilateral pleural effusions with associated\natelectasis, worse on the right.\n\nLiver: The liver is cirrhotic in morphology. Postsurgical changes are again\nseen in the right hepatic lobe. Post ablation zone in segment VII is overall\nunchanged in size, there is internal high intensity suggesting fat as well as\ncoagulation necrosis. There is no suspicious nodular enhancement. There are\nno new arterial enhancing lesions. There is no ascites\n\nBiliary: The gallbladder is absent. There is pneumobilia, as expected.\n\nPancreas: There is mild fatty atrophy of the pancreas. There is no suspicious\npancreatic lesion. There is no pancreatic duct dilation.\n\nSpleen: Spleen is enlarged measuring 13.3 cm.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There is a 3.0 x 2.8 cm simple cyst in the upper pole of the left\nkidney.\n\nGastrointestinal Tract: Post procedural changes are noted from Roux-en-Y\nhepaticojejunostomy. Views of the small and large bowel are unremarkable.\n\nLymph Nodes: There are scattered retroperitoneal lymph nodes, but none that\nare pathologically enlarged.\n\nVasculature: There is no abdominal aortic aneurysm. There is an replaced\nright hepatic artery arising from the SMA. The main, right posterior, and\nleft portal veins are patent. There is absence of the anterior right portal\nvein, as seen previously.\n\nOsseous and Soft Tissue Structures: Note is made of mild gynecomastia. There\nis diastasis of the rectus abdominus muscle. There are no suspicious bony\nlesions. Lipoma measuring 2.8 x 1.8 cm in the right lateral abdominal wall.", "output": "1. Post procedural changes from chemoembolization of segment VII\nhepatocellular carcinoma. No evidence of residual or recurrent disease.\n2. Cirrhotic liver with mild splenomegaly." }, { "input": "Lower Thorax: Please refer to CT chest performed the same date for evaluation\nof intrathoracic structures. There are small bilateral pleural effusions and\nrounded atelectasis in the right lower lobe.\n\nLiver: There is no hepatic steatosis. The 4.0 x 3.6 cm lesion treated by TACE\nin segment VII demonstrates intrinsic T1 hyperintensity with loss of signal on\nthe out of phase images, compatible with Lipiodol uptake. Ill-defined\narterial enhancement along the posteroinferior aspect of the treatment zone\n(series 1701, images 38-43) which normalizes on the more delayed phases is\nunchanged appearance compared to MRI of the liver from ___, and is\nmost compatible with perfusion alteration. Again seen is expansion and\nthrombosis of the anterior branch of the right portal vein, which courses\ntoward the segment VII lesion. Apparent low-level enhancement within the\nthrombus on the subtraction images (series 50, images 50-56) is presumably\nartifactual secondary to misregistration and remains unchanged from prior.\n\nBiliary: There is pneumobilia, as expected status post hepaticojejunostomy. \nThere is mild intrahepatic biliary ductal dilatation in segments VI and VII,\nunchanged (series 3, images ___. The gallbladder surgically absent.\n\nPancreas: The pancreas is diffusely atrophic. No main pancreatic ductal\ndilatation.\n\nSpleen: Spleen is mildly enlarged measuring 13.7 cm and normal in signal\nintensity.\n\nAdrenal Glands: The adrenal glands are unremarkable, bilaterally.\n\nKidneys: The kidneys are mildly atrophic bilaterally with areas of cortical\nscarring. Note is made of small bilateral extrarenal pelves. There is no\nhydronephrosis. There is a dominant 3.3 cm simple cyst in the upper pole of\nthe left kidney, as well as a few other cortical cysts in the left kidney. \nThere is no suspicious renal lesion.\n\nGastrointestinal Tract: The patient is status post Roux-en-Y\nhepaticojejunostomy. Visualized loops of small and bowel are nondilated.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. There is a replaced right\nhepatic artery arising from the SMA. The main portal vein is patent.\n\nOsseous and Soft Tissue Structures: No evidence of osseous malignancy or\ninfection. There is a small intramuscular lipoma of the right lateral chest\nwall (series 5, image 28). There is diastasis of the rectus abdominus with\nventral protrusion of bowel loops. There are incisional changes of the\nanterior abdominal wall.", "output": "1. Cirrhotic liver morphology. Post-TACE changes of a segment VII lesion and\nadjacent expanded and thrombosed anterior branch of the right portal vein,\nunchanged compared to prior MRI of the liver from ___. No definite\nfindings of residual recurrent tumor. No new hepatic lesion.\n2. Mild splenomegaly, likely sequelae of portal hypertension." }, { "input": "Lower Thorax: Small left pleural effusion and trace right pleural effusion\nwith associated atelectasis predominately on the right.\n\nLiver: Liver cirrhotic. Chemoembolization zone is seen within the right\nhepatic lobe. Again noted is non enhancement of the right anterior portal\nvein, presumably in part related to prior treatment. No concerning residual\nenhancement. No additional focal hepatic lesion is noted. Additional\nfibrotic changes are seen inferior to the region of ablation. Artifact from\npneumobilia is noted.\n\nBiliary: The patient is status post hepaticojejunostomy. There is no intra or\nextrahepatic biliary ductal dilation. Punctate filling defects in the lower\nremnant common duct appears to represent small biliary stones (series 3, image\n23).\n\nPancreas: There appears to be pancreas divisum with a small Santoricele at the\nminor papilla (series 5, image 29).\n\nSpleen: Mildly enlarged, 13.4 cm.\n\nAdrenal Glands: Unremarkable without discrete nodularity.\n\nKidneys: 3 cm left upper pole renal cyst. No hydronephrosis or hydroureter. \nNo concerning focal renal lesion.\n\nGastrointestinal Tract: Grossly unremarkable. There is a broad diastasis of\nthe upper ventral abdominal wall.\n\nLymph Nodes: No significant lymphadenopathy.\n\nVasculature: Incidental note made of 3 right renal arteries. Mild\natherosclerotic changes of the aorta.\n\nLimited images of the bladder demonstrates significant trabeculations,\npresumed to be secondary to chronic outflow obstruction. The prostate also\nappears mildly enlarged.\n\nOsseous and Soft Tissue Structures: There appear to be chronic changes related\nto fusion at the lower lumbar spine.", "output": "1. Status post right hepatic lobe TACE. No evidence of residual or new\ndisease.\n2. Status post hepatojejunostomy; punctate biliary stones in the remnant\nintrapancreatic aspect of the lower common duct.\n3. Notably trabeculated bladder, consistent with chronic outflow obstruction." }, { "input": "Lower Thorax: The partially imaged lung bases are unremarkable.\n\nLiver: The liver is normal in signal, enhancement, and contour. No\nconcerning lesions.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. Patient\nstatus-post cholecystectomy.\n\nPancreas: The pancreas is normal in signal intensity. No focal lesions.\n\nSpleen: The spleen is normal in size, signal intensity, and enhancement. No\nfocal lesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape. No nodules.\n\nKidneys: The kidneys are normal and symmetric in size and shape. There are\nmultiple small simple cysts. No concerning lesions. No hydronephrosis.\n\nGastrointestinal Tract: Small hiatal hernia. There is a small periampullary\nduodenal diverticulum. There is colonic diverticulosis. The stomach and\npartially imaged loops of large and small bowel are otherwise unremarkable.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: Small, fat containing umbilical or\nparaumbilical hernia with a hernia neck measuring 11 mm. Indeterminate T2\nhyperintense changes in the right anterior abdominal wall measuring 1.1 x 0.6\ncm immediately inferolateral to the umbilicus (series 4, image 58) is\nincompletely characterized and may represent fat herniating into the anterior\nabdominal wall or involuting hematoma/seroma. There is subcutaneus edema\ninvolving the anterior abdominal wall. No large drainable collection. Mild\nrectus diastasis measuring 20 mm.\nPostsurgical changes involving the anterior abdominal wall as well as\nbilateral partially imaged breast reconstructions.\n\nNo suspicious osseous lesions. Multiple sacral Tarlov cysts.", "output": "1. There is subcutaneous edema involving the anterior abdominal wall. No\nlarge drainable collection.\n2. Small, fat containing umbilical or paraumbilical hernia not containing\nbowel. No bowel obstruction\n3. There is a small area of T2 signal hyperintensity in the right anterior\nabdominal wall immediately inferolateral to the umbilicus which is\nincompletely characterized on this examination. This may represent fat\nherniating into the umbilical wall or involuting seroma/hematoma. Dedicated\nultrasound imaging may be performed to differentiate between these 2\netiologies.\n4. Mild rectus diastasis." }, { "input": "Lower Thorax: Lung bases clear.\n\nLiver: There is diffuse moderate hepatic steatosis. There are nodular\ncontours within the liver but no notable redistribution. No focal concerning\nlesions are identified. The main portal vein is patent. No evidence of\nascites.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. There has\nbeen prior cholecystectomy.\n\nPancreas: Pancreas divisum. There is diffuse fatty replacement of the\npancreas. Small cystic lesion within the distal pancreatic body measuring up\nto 2 mm as well as in the pancreatic head measuring up to 8 mm, likely a small\nside branch IPMN. This is overall stable in appearance compared to prior MRI.\n\nSpleen: Normal signal and morphology. No focal lesions.\n\nAdrenal Glands: Bilateral adrenal glands are within normal limits.\n\nKidneys: Bilateral simple renal cysts. There is cortical thinning and\nparenchymal scarring involving the right mid kidney. No evidence of\nhydronephrosis.\n\nGastrointestinal Tract: The imaged alimentary tract is within normal limits.\n\nLymph Nodes: No intra-abdominal or retroperitoneal lymphadenopathy.\n\nVasculature: Conventional visceral arterial anatomy. There is an ulcerated\nplaque anteriorly in the infrarenal abdominal aorta, near the origin of the\n___ (10:87). There is a retroaortic left renal vein.\n\nOsseous and Soft Tissue Structures: No worrisome osseous findings.", "output": "1. No focal hepatic lesions meeting OPTN criteria for HCC.\n2. Diffuse moderate hepatic steatosis.\n3. No interval change in small cystic lesions within the pancreas, compatible\nwith small side branch IPMNs. Continued imaging follow-up recommended in ___\nyears given stability since ___.\n\nRECOMMENDATION(S): MRCP in ___ years recommended for pancreatic cysts given\nstability since ___" }, { "input": "Please note that this study is degraded by patient motion artifact,\nparticularly the arterial phase postcontrast sequence.\n\nLower Thorax: The lung bases are grossly clear. No pleural or pericardial\neffusion.\n\nLiver: The liver is normal in size with smooth contour. Qualitatively, there\nis mild hepatic steatosis. Patient motion artifact on the arterial phase of\nthis study limits assessment for hepatocellular carcinoma. Allowing for this\nlimitation, no concerning liver lesions are identified.\n\nBiliary: The gallbladder surgically absent. No intra or extrahepatic biliary\nductal dilatation.\n\nPancreas: Incidental note is made of pancreas divisum. The pancreas is normal\nin signal intensity and bulk. A 4 mm cystic lesion in the uncinate process is\nunchanged, and statistically most likely represent side branch IPMN. No\nevidence of main duct dilatation.\n\nSpleen: The spleen is normal in size and homogeneous in signal intensity.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Kidneys are normal in size and demonstrate symmetric enhancement\nafter the administration of contrast. Several bilateral cortical cysts are\npresent. No enhancing renal lesions or evidence of hydronephrosis.\n\nGastrointestinal Tract: The stomach is within normal limits. Prominent area\nof linear soft tissue in the lumen of the second portion the duodenum is\nunchanged from at least ___ (1002:112), and intervening EGD performed was\nunremarkable. Therefore, this area may represent a prominent papilla or fold.\nOtherwise imaged loops of large and small bowel are normal in course and\ncaliber. The appendix is well seen and normal appearing.\n\nLymph Nodes: Multiple prominent lymph nodes in the porta hepatis appear\nstable. No pathologically enlarged mesenteric lymph nodes.\n\nVasculature: Abdominal aorta is normal in caliber. Atherosclerotic disease is\nnoted throughout the aorta. The portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No concerning osseous lesions are\nidentified.", "output": "Please note that this study is degraded by patient motion artifact,\nparticularly the arterial phase postcontrast sequence.\n\n1. No concerning hepatic lesions, within limitations of this study.\n2. Mild hepatic steatosis.\n3. Stable 4 mm pancreatic cystic lesion, which statistically most likely\nrepresents a side branch IPMN. Per department protocol, recommend follow-up\nimaging in ___ years." }, { "input": "The patient is status post Whipple procedure and left lateral segmentectomy.\n\nThe liver demonstrates significant heterogeneous signal drop on opposed phase\nimaging in keeping with severe heterogeneous fat deposition. There are\ngeographic, and patchy / nodular areas of fatty sparing demonstrated with\ncorresponding T2 hyperintensity, periportal edema, and increased arterial\nenhancement seen in these regions. No corresponding biliary dilatation or\nportal vein thrombosis is demonstrated.\n\nFor example there is a large wedge-shaped region bordering segments 4A and 8\nof the liver (series 1201, and image 59 and series 8, image 10). Similar\nappearing regions are demonstrated in segment 7 of the liver (series 8, image\n9) passes and segment 5(series 1201, image 91).\n\nThere is of focus enhancement in the dome of the right lobe measuring 1.0 cm\n(series 1201, image 24). There is no T2 correlate, and no washout is\ndemonstrated. There is a 2 mm biliary hematoma again noted in segment 4A/B\nof the liver.\n\nThe patient has had a prior cholecystectomy. There is wall thickening /\nenhancement involving the common bile duct (series 1202, image 76). The\nhepatic arteries and portal vein are patent. The IVC and hepatic veins are\npatent.\n\nThe spleen is normal size. There is no pancreatic mass. There is mild\nprominence of the pancreatic duct which measures 6 mm. No intra or\nextrahepatic dilatation is present.\n\nThe adrenal glands are unremarkable. Parapelvic cysts are noted in the left\nkidney measuring up to 14 mm in the lower pole. There is no adenopathy. 7 mm\nshort axis portacaval lymph node is noted. There is no ascites. There is no\nosseous lesion present.", "output": "1. Marked heterogeneous hepatic steatosis.\n2. Areas of fatty sparing have T2 hyperintensity, periportal edema, and\nincreased arterial enhancement suggesting active inflammation. Correlation\nwith labs is recommended. Biopsy could be performed with US guidance if\nneeded.\n3. 1 cm focus of enhancement in the dome of the right lobe favored to be\nperfusional. No definite metastasis are identified." }, { "input": "The liver shows severe dropout of signal on out of phase imaging, consistent\nwith fatty deposition. Again noted are regions of geographic sparing.\nPreviously described high T2 signal and periportal edema is no longer\nappreciated but there is still mottled hyperenhancement on arterial phase\nimages. The pattern is more nodular, but this is likely due to differences in\nbolus timing. There is no discrete lesion within the liver including the\npreviously described focus in the dome. There is an unchanged prominent\nintrahepatic bile duct without a visible obstructing lesion (2:17).\n\nThe patient has had a prior Whipple and a left lateral segmentectomy. Note is\nmade of a replaced right hepatic artery. There is a 13 mm small bowel\ndiverticulum arising near the ligament of Treitz that is seen on prior CT and\nPET-CT (7:33). The residual pancreas still shows a prominent duct. The spleen\nand adrenals are normal. There are several peripelvic cysts on the left. There\nis no free fluid. There is no worrisome osseous lesion.", "output": "1. Persistent heterogeneous hepatic steatosis. Appearance suggestive of\nactive inflammation have decreased from ___ though in part may be\nrelated to differences in contrast timing.\n2. No focal liver lesion suggestive of metastasis.\n3. Replaced right hepatic artery." }, { "input": "The bases of the lungs are clear. There is no pericardial effusion.\n\nThe patient is status post Whipple and cholecystectomy as well as partial\nhepatectomy.\n\nNew since prior examination are several foci of T1 hypo intense T2\nhyperintense foci within the right hepatic lobe. Within segment VII, there\nare two lesions measuring 1.1 x 0.9 cm (6:6) and approximately 1.1 x 1.1cm \n(6:8) which demonstrates restricted diffusion (7:18). Posteriorly and\ninferiorly, a smaller vague T2 hyperintensity is seen additionally with a\ndiffusion abnormality (6:7). Within segment VIII of the liver, a 0.6 cm\nlesion is noted (6:11) which appears to demonstrate similar characteristics.\nThere are multiple peripheral wedge shaped diffusion abnormalities throughout\nthe right hepatic lobe, predominantly segment V and VI (7:25).\n\nThe remainder of the pancreas is normal in signal intensity with no focal\nlesion identified. There is mild dilation of the main pancreatic duct up to 4\nmm (6:21), minimally increased since prior examination. The spleen, bilateral\nadrenal glands and kidneys are unremarkable appear no focal lesions are\nidentified. There is no hydronephrosis.\n\nVisualized loops of bowel demonstrate no evidence of obstruction. There is no\nabdominal free fluid. There is no retroperitoneal or mesenteric adenopathy\nidentified. The abdominal aorta is normal in caliber without aneurysmal\ndilatation.\n\nA well defined T2 hyperintensity within the T12 vertebral body is most\ncompatible with a hemangioma. No suspicious lesions are identified.", "output": "1. At least three T2-hyperintense restricting right hepatic lobe lesions; in\nthe absence of infectious symptoms, however, these diffusion abnormalities are\nsuspicious for metastatic disease. If infectious symptoms are present,\nhepatic microabscesses may be considered. Lack of intravenous contrast to\nadverse sensation in the patient's throat after injection of intravenous\ncontrast, however, limits assessment.\n\n2. Several peripheral wedge shaped diffusion abnormalities are identified,\nwhich in the correct clinical setting may reflect an inflammatory process,\npotentially related to cholangitis." }, { "input": "LUNG BASES: The visualized lung bases are clear with no pleural effusion. The\nheart is normal in caliber with no pericardial effusion.\n\nABDOMEN: The patient is status post Whipple procedure and left segmentectomy\nwith gastrojejunostomy and choledochojejunostomy.\n\nIn segment VIII, at the area of the previously noted T2 hyperintense lesion,\nthere is residual high signal on diffusion-weighted images, though this is\nsmaller (7:5), and this lesion is no longer visualized on the T2-WI. This\nlikely reflects near resolution of a prior microabscess. The liver\ndemonstrates regional areas of arterial hyperenhancement scattered in segments\nVII (1301:23), VIII (1301:39), V (1301:64-67), and segment VI (1301:92, 108),\nwith corresponding high signal on diffusion-weighted images. 4 mm T2\nhyperintense focus in segment IVB (05:24) is likely a cyst or biliary\nhamartoma, unchanged, and no new T2 hyperintense foci are seen concerning for\nabscess. A replaced right hepatic artery off the SMA is again seen. \nPneumobilia is redemonstrated in segment IV of the liver.\n\nThe residual pancreas is normal in signal intensity with mild ductal\ndilatation near the anastomosis, measuring up to 6 mm (05:25), unchanged. The\nspleen is normal in signal intensity and size. The kidneys enhance\nsymmetrically with no evidence of hydronephrosis. Parapelvic cyst is noted in\nthe interpolar region of the left kidney (05:26). Abdominal loops of bowel are\nnormal in caliber. Retrocrural and mesenteric lymph nodes are prominent,\npossibly reactive. No ascites.\n\nPELVIS: Urinary bladder, prostate, and seminal vesicles are unremarkable. The\nrectum and sigmoid are normal in caliber. No pelvic lymphadenopathy or free\nfluid.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. The\nceliac axis, SMA, ___, and renal arteries are patent.\n\nRounded T2 hyperintense focus in the T12 vertebral body is compatible with a\nhemangioma.", "output": "Limited examination due to only a single phase of contrast as a result of the\npatient vomiting after contrast administration, despite being pre-medicated\nwith prednisone.\n\n1. Compared to the prior MRI, the previously noted area of hyperintensity on\nT2-WI in segment VIII appears improved with only residual high signal on\ndiffusion-weighted sequences, likely reflecting resolving microabscess. No\nnew abscess identified.\n2. Multiple peripheral, wedge-shaped areas of arterial hyperenhancement\naccompanied by high signal on diffusion-weighted sequences, compatible with\nnon-specific hepatic inflammation. Cholangitis is a possibility given the\npresence of a choledochojejunostomy though the bile ducts are not dilated." }, { "input": "The lung bases are grossly clear. There is no pleural or pericardial effusion.\n\nThe patient is status post Whipple procedure and left hepatectomy. The intra\nhepatic biliary ducts are normal in caliber, indicating patency of the\nhepaticojejunostomy. The main pancreatic duct in the remnant of the pancreas\nis dilated up to 5 mm and there is some atrophy of the pancreatic parenchyma.\nThis appearance is stable compared to prior examinations.\n\nCompared to prior examination in ___, there has been additional\nimprovement in hepatic signal abnormalities. There has been near-complete\nresolution of most of T2 hyperintensities and diffusion abnormalities in\nsegments V, VII and VIII. In segment VI there is a wedge-shaped region of T2\nhyperintensity (05:20), with associated restricted diffusion (7:9) and\nlow-level arterial hyper enhancement (1301:58), consistent with inflammation.\nIn segments V, VII and VIII there are peripheral and rounded ill-defined\nregions of arterial hyper enhancement (1301: 7, 15, 31, 74), with mildly\nrestricted diffusion (7:2, 6, 12), without signal abnormality on T2 WI, which\nare consistent with improved inflammation. In addition, rounded foci of\narterial hyper enhancement (1301:29, 36, 46) without diffusion or T2\nabnormalities are unlikely to be metastases and are more consistent with\nperfusion abnormalities. There are no washing out lesions in the liver.\nUnchanged 4 mm cyst or biliary hamartoma is unchanged (05:21).\nThere variant arterial hepatic anatomy with replaced right hepatic artery from\nthe SMA (1301:74). The portal and hepatic veins are patent.\n\nThe spleen is normal in size.\nThe kidneys and adrenals are normal.\n\nIn the pelvis, the urinary bladder, prostate and seminal vesicles are\nunremarkable.\n\nThere is no free fluid in the abdomen and pelvis.\nThere is no concerning retroperitoneal, mesenteric or pelvic lymphadenopathy.\nThe bone marrow signal is normal.", "output": "Improvement of signal abnormalities throughout the liver, which are consistent\nwith ongoing cholangitis. There are still areas of inflammation, especially a\nwedge-shaped area in segment VI. There are rounded foci of arterial hyper\nenhancement without restricted diffusion, which are consistent with perfusion\nabnormalities and are unlikely to be metastases. Please correlate with tumor\nmarkers." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: Patient is status post Whipple procedure and left hepatectomy. There\nare patchy areas of mild steatosis. There is a stable small cyst (07:17) and\nthe liver is otherwise unremarkable. There is no abnormal enhancement or\nrestricted diffusion suggest cholangitis. The portal and hepatic veins are\npatent.\n\nBiliary: There is no biliary ductal dilatation. The gallbladder is normal.\n\nPancreas: Patient is status post Whipple procedure. There is mild prominence\nof the main pancreatic duct similar to the prior study.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Bilateral kidneys are unremarkable. No hydronephrosis.\n\nGastrointestinal Tract: No bowel dilatation or ascites in the upper abdomen.\n\nLymph Nodes: No lymphadenopathy in the upper abdomen.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion.", "output": "1. Stable pancreatic ductal dilatation. No findings of recurrent disease.\n2. Mild hepatic steatosis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Patient is status post left hepatectomy and hepaticojejunostomy. The\nright lobe of the liver is normal in signal intensity and morphology without\nfocal lesion. There is no significant hepatic steatosis.\n\nBiliary: The patient is status post cholecystectomy and hepaticojejunostomy\nwithout evidence of anastomotic complication. There is minimal irregular\nintrahepatic biliary ductal dilatation, predominantly within segment ___ and\nsegment VIII. There is no peribiliary enhancement or restricted diffusion.\n\nPancreas: Patient is status post Whipple procedure. There is slight narrowing\nat the pancreaticojejunostomy anastomosis (05:13), with mild dilatation of the\nmain pancreatic duct. There is mild loss of the normal T1 hyperintense signal\nwith the pancreas. There is no focal lesion.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Kidneys are normal in size and morphology without focal lesion or\nhydronephrosis.\n\nGastrointestinal Tract: The visualized loops of large small bowel are\nunremarkable.\n\nLymph Nodes: There is no suspicious lymphadenopathy.\n\nVasculature: There is a replaced right hepatic artery arising from the SMA.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nSmall hemangiomas are noted within T12 and L1. Susceptibility artifact along\nthe anterior abdomen related to prior Whipple and left hepatectomy is noted.", "output": "1. Minimal irregular intrahepatic biliary ductal dilatation, most likely\nrepresenting chronic secondary sclerosing cholangitis following Whipple\nprocedure. There is no evidence for acute cholangitis.\n2. Status post left hepatectomy and Whipple procedure with minimal narrowing\nat the pancreaticojejunostomy anastomosis with mild upstream pancreatic ductal\ndilatation." }, { "input": "Lower Thorax: Lung bases are clear without pericardial or pleural effusions.\n\nLiver: Throughout the liver, there are several T2 hyperintense lesions which\nexhibit peripheral contrast pooling on delayed phases, compatible with\nhemangiomas. These measure approximately 1.4 x 1.0 cm in the left hepatic\nlobe (1301:68), 2.6 x 1.9 cm of the confluence of the hepatic veins (1303:25),\nand 3.0 x 2.8 cm in segment VII (1303:27). There is a smaller segment V\nhemangioma measureing approximately 1 cm (1302:88). There is no hepatic\nsteatosis.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is unremarkable.\n\nPancreas: An 8 x 6 mm T2 hyperintense, nonenhancing focus in the pancreatic\nbody exhibits communication with the main pancreatic duct, compatible with a\nside branch IPMN (4:21).\n\nSpleen: The spleen is normal in size without focal lesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: Several bilateral parapelvic cysts are present in addition,\nmillimetric for intense, nonenhancing foci in both kidneys are compatible with\nsimple cysts.\n\nGastrointestinal Tract: Imaged small and large bowel loops are normal\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is tortuous but normal caliber.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion detected.\n\nIncidental note is made of a 5 cm left para-adnexal cystic structure, grossly\nunchanged since ___, and appreciated on scout views.", "output": "1. Multiple hepatic lesions are compatible with hemangiomas which were\npresent in ___. No suspicious hepatic lesion meeting OPTN 5 criteria\nfor HCC.\n\n2. 8 x 6 mm side-branch IPMN at the pancreatic body, for which ___ year MRCP\nfollow-up is recommended.\n\nRECOMMENDATION(S): MRCP in ___ year." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The imaging plane leads to exclusion of some of the posterior and\nsuperior liver from the T2 weighted images, otherwise the liver is normal in\nsignal intensity and morphology. No significant signal dropout on out of phase\nimages to indicate steatosis. There is no suspicious lesion. The portal and\nhepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder is normal.\n\nPancreas: Normal in signal intensity without ductal dilatation. There is no\nfocal lesion.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: 6.1 x 5.0 cm multilobulated cystic lesion in the right lower renal\npole has increased from 4.7 x 4.1 cm in ___. The walls are smooth,\nhowever there 3 enhancing septa measuring up to 3 mm.\nSeveral sub 5 mm simple cortical cysts are noted in the left kidney. No solid\nmass. There is no hydronephrosis.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal in caliber and patent. There is an accessory right renal artery. \nThere is a replaced right hepatic artery off the SMA.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. 6.1 cm multilobulated cystic lesions in the right lower renal pole with\nthin walls and 3 enhancing septations measuring up to 3 mm has slightly\nincreased in size since ___, consistent with a Bosniak ___ lesion. Follow-up\nin 6 to 12 months is recommended to assess for morphologic changes.\n2. No MRI correlate for the hypoechoic structure seen on the ultrasound from ___\n\nRECOMMENDATION(S): MRI in ___ month follow-up for cystic right renal lesion" }, { "input": "Lower Thorax: Lower lung bases, pleural spaces and lower mediastinal\nstructures are grossly normal.\n\nLiver: Visualized liver demonstrates normal signal intensity with no focal\nmass.\n\nBiliary: No intra or extrahepatic ductal dilatation. Gallbladder is\nunremarkable.\n\nPancreas: Pancreas demonstrates normal signal intensity with no ductal\ndilatation, or peripancreatic abnormality.\n\nSpleen: Spleen is normal in size and appearance.\n\nAdrenal Glands: Adrenal glands bilaterally are within normal limits.\n\nKidneys: Asymmetric prominence of the right renal collecting system with a\nsmall filling defect within a right lower pole calyx (series 3, image 25),\nwhich is incompletely characterized on this noncontrast MRI, however is\nfavored to represent debris. Findings are likely secondary to gravid uterus. \nNo perinephric abnormality. No dilatation of the left renal collecting\nsystem.\n\nGastrointestinal Tract: Arising from the base of the cecum is the appendix,\nwhich demonstrates circumferential wall thickening, measuring up to 1 cm in\ndiameter. Small amount of fluid/ sludge is seen within the appendiceal lumen.\nThe appendix demonstrates restricted diffusion (series 7, image 22, series\n700, image 34). Trace inflammatory fat stranding surrounds the appendix. No\nfluid collections/abscesses are identified. Overall findings are in keeping\nwith acute appendicitis.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: No aneurysmal dilatation of the abdominal aorta.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions are\ndemonstrated.\n\nSingle intrauterine pregnancy is noted with an anterior fundal placenta. The\ncervix measures 4.5 cm in length.", "output": "1. Acute appendicitis. No adjacent fluid collection.\n2. Mild right renal caliectasis, likely secondary to gravid uterus." }, { "input": "LOWER THORAX: Clear visualized lungs. No pleural effusion.\n\nLIVER: Normal signal. No discernible mass.\n\nBILIARY: No ductal dilation. Normal gallbladder.\n\nPANCREAS: Normal signal. No ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENAL GLANDS: No nodules.\n\nKIDNEYS: No hydronephrosis or hydroureter. No discrete mass.\n\nGASTROINTESTINAL TRACT: Unremarkable stomach, small and large intestine. \nAppendectomy. No free fluid or fluid collection.\n\nPELVIS: Unremarkable rectum and bladder. Gravid uterus with ___ and\ncephalic presentation. No placenta previa. Examination is not optimized for\nfetal evaluation. Unremarkable ovaries.\n\nLYMPH NODES: No adenopathy.\n\nVASCULATURE: Normal signal void in major vasculature. Tortuous right gonadal\nvein.\n\nOSSEOUS AND SOFT TISSUE STRUCTURES: Slight increase in signal on T2-weighted\nimages in the left greater than right sacroiliac joint without diffusion\nrestriction. Subtle left iliac subchondral cystic changes. No adjacent fat\nstranding. It appears subtly increased since the previous examination, most in\nkeeping with physiologic strain from pregnancy. Normal bone marrow signal\notherwise. No soft tissue mass.", "output": "Status post appendectomy. No fluid collection. No pathology to explain\npatient's symptoms." }, { "input": "Again seen is the T2 hypointense right adrenal lesion measuring 2.0 (AP) x 1.5\n(TR) x 1.8 (CC) cm demonstrating extensive loss of signal on out-of-phase\nimages compared to the in-phase images, consistent with an adrenal adenoma. \nThe left adrenal gland is normal. The liver is normal in signal intensity. \nThe patient is status post cholecystectomy, without intra- or extra-hepatic\nbile duct dilation. The kidneys, spleen and pancreas are normal. The imaged\nabdominal bowel loops are unremarkable. The abdominal aorta is normal in\ncaliber. An oval T2 hyperintense lesion in the left iliocostalis muscle in\nthe lower lumbar region is unchanged and consistent with an intramuscular\nlipoma (3, 17).", "output": "No change in right adrenal adenoma.\n\nNo change in the left iliocostalis intramuscular lipoma." }, { "input": "The liver is diffusely nodular in contour with diffuse band-like fibrosis.\nMultiple previously-seen arterial enhancing foci are much less conspicuous on\ncurrent examination throughout the liver, but grossly stable in size. While\nthere is subtle enhancement in some of these areas, the enhancement is not\nmass-like and there is no associated washout. No solid or new lesions are\nidentified. There is no visualized intrahepatic or extrahepatic biliary ductal\ndilatation. Portal vein patent. Stranding around the celiac axis, is\nnon-specific, and may be somewhat accounted for by varices and is likely\nunchanged. Prominent periportal lymph nodes, unchanged. The gallbladder\ncontains a stone.\n\nThe spleen is enlarged, measuring 14.9 cm, a stable finding. There is a\nmoderate amount of ascites throughout the abdomen, increased. There is a large\nright pleural effusion, incompletely visualized, but increased from prior MRI\nand from outside hospital chest radiograph. There is associated atelectasis of\nthe right lung.", "output": "1. Fibrotic and cirrhotic liver with portal hypertension.\n2. Foci of arterial enhancement are even less conspicuous than on prior\nexamination, remain without washout and are compatible with perfusion\nanomalies. No suspicious hepatic lesions are identified.\n3. Worsening large right pleural effusion with associated atelectasis.\nModerate ascites has also increased in the interim." }, { "input": "3 plane localizer images and coronal T2 weighted images were obtained without\nthe use of IV contrast. The patient was unable to continue the examination\ndue to pain and no subsequent images were obtained.\n\nLimited images show 3.7 x 2.6 x 4.2 cm heterogeneously T2 hyperintense right\nsubcapsular hepatic lesion (2:36, 1:15), not further characterized as only T2\ncoronal and localizer images were obtained. This is concerning for an implant\nrather than involution of the prior fluid collection. Limited views of the\nliver, spleen, adrenals, kidneys, and pancreas are grossly unremarkable. \nThere is no intrahepatic or extrahepatic biliary ductal dilatation and the\ngallbladder is unremarkable. Visualized loops of bowel are not dilated.\n\nThe large cystic and solid ovarian mass is partially seen. The\nretroperitoneal adenopathy is also noted.", "output": "1. Only coronal T2 weighted images and the localizes for obtain, therefore the\nexam is incomplete. Patient could not continue the exam due to pain. \nAlthough not definitive, the lesion of concern in the liver is favored to\nrepresent a perihepatic implant rather than HCC.\n2. Heterogeneous mixed solid and cystic pelvic mass, a malignant epithelial\novarian tumor until proven otherwise with retroperitoneal adenopathy and\nascites, as on recent CT.\n\nRECOMMENDATION(S): Although not definitive, the right hepatic lesion could\nrepresent a perihepatic implant. MRI under conscious sedation or anesthesia\nor tissue sampling." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is is hyperintense on the T2 weighted images with diffuse\nsevere hepatic steatosis. Since the prior exam in ___, the caudate lobe has\nincreased in size and there is increased pre portal space, suggesting with\ncirrhosis. On the precontrast T1 weighted images, there are multiple tiny\nnodules, which are hyperintense, and demonstrate no arterial enhancement. \nThese are consistent with regenerative nodules. No discrete arterially\nenhancing lesion is identified. The hepatic arterial anatomy is conventional.\nThe portal veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is contracted, which limits evaluation. No definite stones are\nidentified. T1 hyperintense and T2 intermediate material within the bladder\nlikely represents concentrated bile, as no sludge was identified on the recent\nultrasound.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is mildly enlarged, measuring 13.2 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: In the right kidney, there is a 4 mm simple cyst. The kidneys are\notherwise normal without worrisome lesions, hydronephrosis, or perinephric\nabnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque. There are several small\nperiesophageal and perigastric varices.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThere is abnormal edema and enhancement in the paraspinal musculature\nimmediately adjacent to the the left transverse processes in the upper lumbar\nspine. There is abnormal edema and abnormal enhancement within the left L1,\nL2, and possibly L3 transverse processes that likely reflects nondisplaced\nfractures This is likely posttraumatic, given the history of a fall. No\ndefinite abnormal signal is identified within the bones to suggest a fracture.\nThe soft tissues are otherwise unremarkable.", "output": "1. Cirrhotic appearing liver with innumerable regenerative nodules. No\nlesion meeting OPTN-5 criteria for HCC.\n2. Evidence of portal hypertension with mild splenomegaly and varices. No\nascites.\n3. Abnormal enhancement along the left paraspinal muscles, which is most\nlikely traumatic, given the history of a recent fall. Likely nondisplaced\nfractures of the L1, L2, and possibly L3 transverse processes." }, { "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: There is no hepatic steatosis. The liver morphology is within normal\nlimits. Avidly T2 hyperintense lesions scattered throughout the liver are\nconsistent with simple hepatic cysts.\n\nBiliary: Cholecystectomy clips are noted in the gallbladder fossa. There is a\n3.6 x 1.4 cm collection with a thin wall in the gallbladder fossa, which may\nrepresent a small postoperative seroma or remnant gallbladder. There is low\ninsertion of the right posterior duct. The cystic duct stump arises from the\nright posterior duct.\n\nThere is no intra or extrahepatic biliary ductal dilatation. The CBD stent is\nappropriately positioned.\n\nPancreas: Tiny T2 hyperintense lesions, measuring up to 3 mm, arising from the\nuncinate process and body of the pancreas (series 5, image 27) likely\nrepresent tiny side-branch IPMNs.\n\nSpleen: The spleen is mildly enlarged measuring 13.5 cm.\n\nAdrenal Glands: The adrenal glands unremarkable, bilaterally.\n\nKidneys: No hydronephrosis or suspicious renal lesion, bilaterally.\n\nGastrointestinal Tract: The stomach, small and large bowel are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is severe stenosis at the origin of the celiac artery\nlikely from impression of the median arcuate ligament. Hepatic arterial\nanatomy is conventional.\n\nOsseous and Soft Tissue Structures: There is no osseous malignancy or\ninfection.", "output": "1. Persistent fluid collection in the gallbladder fossa with a thin enhancing\nwall may be postoperative seroma or remnant gallbladder. There is no clear\ncommunication between the cystic duct stump and the collection.\n2. No intra or extrahepatic biliary ductal dilatation. Appropriately placed\nCBD stent.\n3. Normal liver morphology without evidence of hepatic steatosis or chronic\nliver disease.\n4. The spleen measures at the upper limits of normal or mildly enlarged,\nmeasuring 13.5 cm.\n5. Probable side branch IPMNs in the uncinate process and body of the\npancreas. ___ year follow-up MRI is recommended." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in signal intensity and morphology. A 10.1 x 9.3\ncm T2 hyperintense, nonenahncing cyst is seen in the right hepatic lobe,\nsimilar to prior (3; 12). There are multiple smaller T2 hyperintense lesions\nseen throughout the liver, consistent with simple cysts or biliary hamartomas.\nThere is no suspicious lesion. The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is normal.\n\nPancreas: Normal in signal intensity without ductal dilatation. There is no\nfocal lesion.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion. \nTiny T2 hyperintense cortical lesions in the right kidney are consistent with\nsimple cysts.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: There is a common trunk of the celiac artery and SMA. \nOtherwise, unremarkable.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "Unchanged 10.1 cm benign-appearing right hepatic lobe cyst." }, { "input": "Lower thorax: There is minimal atelectasis in the imaged bases. No pleural\npericardial effusion is seen.\n\nLiver: The liver is normal in contour. There is dropout signal on out of\nphase imaging, consistent with steatosis, with a calculated fat fraction of\n14%. No focal lesions are identified.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is unremarkable.\n\nPancreas: Unremarkable.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: There is a subcentimeter exophytic cyst at the left upper renal pole.\nThe kidneys are otherwise unremarkable. No hydronephrosis.\n\nGastrointestinal Tract: There is a small hiatus hernia. Redemonstration of\npartial gastrectomy changes, without evidence of residual or recurrent\ndisease. The remaining stomach is unremarkable. Small and large bowel loops\nare normal in caliber. Ascites.\n\nPelvis: The urinary bladder, prostate and seminal vesicles are unremarkable. \nNo pelvic free fluid.\n\nLymph Nodes: A 9 mm left para-aortic cystic structure is unchanged (4:35)\ngoing back to ___. There are no enlarged abdominal, pelvic or inguinal lymph\nnodes.\n\nVasculature: The abdominal aorta is normal in caliber. The portal and hepatic\nveins are patent. Conventional hepatic arterial anatomy demonstrated.\n\nOsseous and Soft Tissue Structures: There are multilevel degenerative changes\nin the", "output": "1. No evidence of recurrent or metastatic disease in the abdomen or pelvis.\n2. Patchy hepatic steatosis with greater involvement of the right lobe,\npossible etiology for abnormal liver function tests. No intra or extrahepatic\nbiliary ductal dilation noted. No suspicious focal liver lesions identified.\n\nRECOMMENDATION(S): Radiological evidence of fatty liver does not exclude\ncirrhosis or significant liver fibrosis which could be further evaluated by\n___. This can be requested via the ___ (FibroScan), or the\nRadiology Department with MR ___, in conjunction with a GI/Hepatology\nconsultation\" *\n\n* Chalasani et al. The diagnosis and management of nonalcoholic fatty liver\ndisease: Practice guidance from the ___ Association for the Study of\nLiver Diseases. Hepatology ___ 67(1):328-357" }, { "input": "The lung bases are grossly clear. There is no ascites.\n\nLiver: The liver is normal in signal intensity and without a focal mass. Tiny\nT2 hyperintensity in the liver is likely a biliary hamartoma (4:17). There is\nno significant intra or extrahepatic biliary ductal dilatation.\n\nGallbladder: The gallbladder is normal. There is no evidence of\ncholedocholithiasis or stricture.\n\nPancreas: The pancreatic duct has divisum morphology. There are multiple\nT2-bright sub centimeter cystic lesions in the head of the pancreas compatible\nwith side branch IPMNs (4:27). The pancreas is normal in signal intensity\nwithout evidence of focal mass or ductal dilatation.\n\nSpleen: The spleen is normal in appearance.\n\nKidneys and Adrenals: The adrenals are normal. There are several simple cysts\nin the kidneys measuring up to 5.8 x 5.0 cm.\n\nBowel: There is a fundal gastric diverticulum. Sigmoid diverticulosis is\nnoted.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is widely patent.\n\nBones: The osseous structures are unremarkable.", "output": "1. No MR findings to explain ___ abdominal pain.\n2. Multiple tiny cystic lesions in the head of the pancreas. These are likely\nside branch IPMNs. Followup MRCP without contrast is recommended in ___ year.\n3. Pancreas divisum.\n\nNOTIFICATION: Findings were submitted to the critical results dashboard." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. In the right lobe, there is\nan unchanged 3 mm cyst or biliary hamartoma. No worrisome liver lesions are\nidentified on this noncontrast exam.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal without evidence of stones.\n\nPancreas: There is dual drainage with a dominant dorsal duct. The ducts\nappear slightly larger on today's exam, though there is no pathologic dilation\nor evidence of a stricture.\nSeveral cystic lesions and dilated side branches in the head of the pancreas,\nare most consistent with side branch IPMNs. The largest measures 8 mm (5, 1).\nIn comparison the prior exam, these are unchanged. The pancreatic parenchyma\nis normal in signal and bulk.\n\nSpleen: The spleen is normal in size, measuring 7.9 cm. No focal lesions are\nidentified.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There is a dominant 59 mm simple\ncyst in the upper pole of the right kidney. Other smaller cysts are noted\nbilaterally. There is no hydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: There is a moderate-sized hiatal hernia. The stomach\nand small bowel are otherwise normal in course and caliber. There are\nscattered colonic diverticula. The imaged portions of the large bowel are\notherwise normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. Evaluation the vasculature is limited on this non-contrast exam.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMinimal multilevel degenerative changes are noted throughout the spine. The\nsoft tissues are unremarkable.", "output": "1. No change in the sub-centimeter pancreatic cystic lesions, as described\nabove. If the patient is symptom free, per departmental protocol, a\nnon-contrast MRCP is recommended in ___ years.\n2. Dual drainage of the pancreatic ducts with a dominant dorsal duct. The\nducts appear slightly larger on today's exam, though there is no pathologic\ndilation.\n3. Moderate sized hiatal hernia.\n4. Diverticulosis.\n\nRECOMMENDATION(S): MRCP in ___ years." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver demonstrates normal contours and signal characteristics without\nmorphological signs of liver cirrhosis. Stable 7 mm T2 hyperintense lesion\nwithin segment V (series 3, image 15), compatible with cysts/biliary\nhamartomas. No worrisome hepatic mass lesions on this noncontrast study.\n\nBiliary: Gallbladder is present without gallstones. No gallbladder wall\nthickening or pericholecystic fluid. There is no intrahepatic or extra\nbiliary duct dilatation. The common bile duct tapers normally towards the\nampulla without obstructing filling defects.\n\nPancreas: Normal morphology and signal characteristics of the pancreatic\nparenchyma. There are few ectatic side branches at the uncinate process\n(series 8, image 37) and at the pancreatic tail (series 8, image 34), that\nappears stable in size when compared to prior. There are also multiple T2\nhyperintense cystic lesions scattered throughout the pancreas (series 3, image\n21, series 2, image 15), stable from prior, most likely representing\nside-branch IPMNs. Main pancreatic duct is not dilated. No peripancreatic\ninflammatory changes or fluid collections.\n\nSpleen: Spleen is normal in size and signal characteristics.\n\nAdrenal Glands: The adrenal glands are normal bilaterally without focal\nnodules.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There is a stable 5.8 x 5.8 cm simple cyst\narising from the upper pole of the right kidney. No suspicious renal masses\nor hydronephrosis.\n\nGastrointestinal Tract: Moderate hiatal hernia. The remainder stomach and\nvisualized small bowel in the upper abdomen are within normal limits. There\nare scattered colonic diverticulosis. No free fluid in the upper abdomen.\n\nLymph Nodes: No suspicious mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta is normal in caliber.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue mass\nlesions.", "output": "No change in few ectatic pancreatic side branches, likely related to sequelae\nof prior pancreatitis. There are also unchanged scattered subcentimeter\ncystic lesions within the pancreas, most likely side-branch IPMNs. Per\ndepartmental protocol, this can be followed up with MRCP in ___ years.\n\nRECOMMENDATION(S): MRCP in ___ years." }, { "input": "Lower Thorax: The visualized lung bases are clear.\n\nLiver: The liver is normal in signal intensity and morphology. There are no\nsuspicious hepatic lesions within the limitation of a un-enhanced study. There\nis an unchanged 6 mm cyst in the right hepatic lobe. There is no ascites.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreatic parenchyma is normal in signal and morphology.\nScattered T2 bright cystic lesions are seen in the pancreatic parenchyma,\nstable from prior and favored to represent IPMNs. The largest of these is\nlocated in the pancreatic head measuring up to 10 mm, unchanged (10:66). The\nmain pancreatic duct is normal in caliber. There is incomplete pancreas\ndivisum with a dominant dorsal duct.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion.\nThere is a stable 6.0 x 5.3 cm simple cyst arising from the right upper pole. \nAdditional scattered renal cysts are seen bilaterally.\n\nGastrointestinal Tract: There is a moderately sized hiatal hernia. Partially\nvisualized loops of large and small bowel are non-dilated. Incidental note is\nmade of colonic diverticulosis.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Unchanged cystic lesions within the pancreatic parenchyma measure up to 10\nmm in largest diameter, favored to represent IPMNs. Follow-up MRCP without\ncontrast in ___ years is recommended as outlined below.\n2. Moderately sized hiatal hernia.\n\nRECOMMENDATION(S): For management of pancreatic cyst(s) between 6-15 mm in\npatients between 65- ___ years at presentation, recommend non-contrast MRCP\nfollow-up every other year up to a total of ___ years.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nThe hepatic parenchyma demonstrates normal signal intensity on T1 and T2\nweighted sequences. No concerning hepatic mass is detected. There is no intra\nor extrahepatic bile duct dilation. Numerous gallstones are present (series\n3, image 22). The gallbladder is otherwise normal. No ductal stones are\ndetected.\n\nThere is moderate fat stranding anterior to the pancreatic body and tail\nabutting the transverse mesocolon, demonstrating slightly increased signal\nintensity on T2 weighted sequences (series 3, image 17), heterogeneous signal\nintensity on T1 weighted precontrast images (series 8, image 34), and\nprogressive enhancement, in keeping with known history of pancreatitis. No\nfocal fluid collections are present. The main pancreatic duct is normal in\ncaliber. A 6 mm cystic lesion arising from the pancreatic head demonstrates\nhigh internal signal intensity on T2-weighted sequences, either a tiny side\nbranch IPMN versus a small intrapancreatic pseudocyst or dilated side branch\n(series 3, image 28, series 2, image 24).\n\nThe spleen, adrenal glands, right kidney, stomach, and intra-abdominal loops\nof small and large bowel remain normal. Arising from the interpolar aspect of\nthe left kidney is a well-circumscribed cyst, denoted by high internal signal\nintensity on T2 weighted sequences, low signal intensity on T1 weighted\nprecontrast images, without appreciable internal contrast enhancement,\nmeasuring 3.7 x 3.3 cm (series 3, image 27).\n\nThe abdominal aorta, celiac trunk, SMA, SMV, splenic vein, and portal veins\nare patent. There is no pseudoaneurysm.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "1. Evolving subacute pancreatitis without necrosis or fluid collections.\nAdjacent vessels remain patent and normal in caliber.\n2. Subcentimeter pancreatic head cystic lesion is either a tiny side branch\nIPMN versus a small intrapancreatic pseudocyst or dilated side branch, and can\nbe followed with an MRCP in ___ year per departmental guidelines.\n3. Cholelithiasis. No intra or extrahepatic bile duct dilation. No ductal\nstones currently present." }, { "input": "Multiple cystic lesions are re- demonstrated throughout the pancreas. The\nlargest of these, located in the pancreatic head, measures approximately 2.1 x\n0.9 x 1.5 cm, which is slightly decreased from the previous examination at\nwhich time it had measured 2.6 x 1.2 x 1.7 cm. This contains multiple pseudo\nseptations. Some a conglomerate of cysts along the medial aspect of the\npancreatic head measures 1.8 x 0.9 by 1.2 cm, and previously measured 1.7 x\n1.0 by 0.9 cm. The cyst in in the pancreatic tail that measures 1.2 x 1.3 by\n0.9 cm, previously measured 1.2 x 1.3 x 0.9 cm. Smaller cysts scattered\nthroughout the remainder of the pancreas appear grossly unchanged. The main\npancreatic duct is nondilated. The gallbladder and bile ducts appear within\nnormal limits. The hepatic parenchymal signal intensity appears within normal\nlimits. Spleen is nonenlarged. Bilateral adrenal glands appear unremarkable.\nBilateral renal cortical cysts are noted. There is no hydronephrosis.\nAbdominal aorta and IVC are normal in caliber. Abdominal loops of bowel appear\nwithin normal limits. A focus of high signal intensity in the L1 vertebral,\nmost consistent with a hemangioma, is unchanged.", "output": "1. No significant interval change in multiple cystic lesions of the pancreas\nconsistent with side-branch IPMN. Normal caliber main pancreatic duct.\nContinued followup with repeat MRI in ___ year is recommended.\n2. Stable renal cysts, which may reflect glomerulocystic disease." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver appears homogeneous in signal intensity. There is no focal\nliver lesion within the limits of this noncontrast scan.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\n\nPancreas: There are numerous small cystic lesions throughout the pancreas\nlikely representing small side branch IPMNs. The largest cystic lesion in the\npancreatic tail measures 12 mm in largest diameter, not significantly changed\nfrom prior exam. The conglomerate group of cystic lesions in the pancreatic\nneck currently measures 26 x 14 mm, previously measuring 17 x 10 mm (series 4,\nimage 35).\n\nSpleen: Spleen appears homogeneous in signal intensity and is not enlarged.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size. There is no hydronephrosis. There\nis a 2.3 cm cyst in the mid left kidney. There are numerous small cysts in\nboth kidneys measuring less than 1 cm.\n\nGastrointestinal Tract: Visualized portions the gastrointestinal tract appear\nwithin normal limits.\n\nLymph Nodes: No pathologic lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. The\nvisualized subcutaneous soft tissues are unremarkable. There is a probable\nbenign vertebral hemangioma in an upper lumbar vertebral body.", "output": "Numerous cystic lesions throughout the pancreas compatible with multiple side\nbranch IPMNs. Some of these have mildly increased in size. The largest single\ncystic lesion in the pancreatic tail is stable measuring 12 mm. A follow-up\nMRI in 6 months is recommended given the increase in size of some of these\ncystic lesions.\n\nRECOMMENDATION(S): Follow-up MRI in 6 months is recommended." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: The liver is normal in size and signal intensity. There are no\nsuspicious lesions identified.\n\nBiliary: The gallbladder is unremarkable. There is no intra extrahepatic\nbiliary duct dilation.\n\nPancreas: Again seen, are multiple small cystic lesions throughout the\npancreas, likely representing side branch IPMNs. The largest conglomerate of\ncystic lesions are located in the pancreatic head measuring 2.6 x 1.7 cm,\ngrossly unchanged compared to prior (series 5, image 33). A smaller\nconglomerate of cysts in the uncinate process measure 1.6 x 0.9 cm, also\nunchanged (series 5, image 38. There is no main pancreatic duct dilation. No\nnew lesions are identified.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right adrenal gland is unremarkable. Thickening of the\nleft adrenal gland is unchanged compared to prior.\n\nKidneys: There are multiple cortical cysts in the kidneys with the largest\nmeasuring 2.2 x 2.3 cm in the left mid pole, consistent with glomerulocystic\nrenal disease. No suspicious renal lesion is seen. There is no\nhydronephrosis.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: Flow voids are grossly preserved.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. \nThere is no soft tissue abnormality.", "output": "Six month stability of multiple pancreatic cystic lesions, including the\nlargest in the pancreatic head.\n\nRECOMMENDATION(S): The patient can resume ___ year follow-up MRCP." }, { "input": "Liver: The liver is normal in size and smooth in contour. There is no\nevidence of hepatic steatosis. No focal hepatic lesion is detected within the\nlimits of this noncontrast examination.\n\nBiliary: The gallbladder is within normal limits. There is no intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are symmetric in size. There are multiple simple\nperipelvic cysts in the lower pole of the left kidney and a few tiny scattered\ncortical cysts in both kidneys. There is no worrisome renal lesion, within\nthe limits of this noncontrast examination.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nThe abdominal wall is within normal limits.", "output": "Multiple simple peripelvic cysts in the lower pole the left kidney, and a few\ntiny scattered cortical cysts in both kidneys. No worrisome renal lesion,\nwithin the limits of this noncontrast examination." }, { "input": "The lung bases are grossly clear. There is no ascites.\n\nLiver: The liver is normal in signal intensity without evidence of focal mass\non T2 weighted images. There is no significant intra or extrahepatic biliary\nductal dilatation.\n\nGallbladder: Patient is post cholecystectomy and hepaticojejunostomy.\n\nPancreas: Patient status post resection of the pancreatic head and uncinate\nprocess in prior Whipple procedure. The remaining pancreatic body and tail are\nnormal in signal. The pancreatic duct is normal. There are no suspicious\npancreatic lesions.\n\nSpleen: The spleen is normal in appearance.\n\nKidneys and Adrenals: The adrenal glands and kidneys are normal bilaterally.\n\nBowel: Note is made of a small hiatal hernia. Postsurgical changes related to\nprior Whipple procedure.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is widely patent.\n\nBones: 8 mm mildly T2 hyperintense lesion in the lower thoracic spine\ncompatible with a hemangioma (series 4, image 32).", "output": "Postsurgical changes related to prior Whipple procedure. There is no evidence\nof recurrent pancreatic cystic lesion." }, { "input": "Lower Thorax: Limited assessment of the lung bases shows no pleural effusion.\n\nLiver: Liver contour is nodular, consistent with cirrhosis. There is slightly\nheterogeneous signal intensity throughout the liver, but no significant drop\nin signal on opposed phase imaging to suggest hepatic steatosis. There are no\nsuspicious hepatic lesions meeting OPTN criteria for hepatocellular carcinoma\n(___).\n\nBiliary: Gallbladder is surgically absent. A small cystic structure in the\nregion of the gallbladder fossa likely represents a cystic duct stump (03:12).\nThere is no biliary dilation.\n\nPancreas: There is normal intrinsic T1 hyperintense signal throughout the\npancreas. No focal parenchymal lesions or ductal dilation.\n\nSpleen: Spleen is mildly enlarged measuring up to 13.4 cm. No focal lesions.\n\nAdrenal Glands: Normal in size and shape.\n\nKidneys: Kidneys are normal in size and shape. No solid parenchymal lesions\nare identified. There are bilateral simple renal cysts. There is no\nhydronephrosis.\n\nGastrointestinal Tract: Stomach is unremarkable. There is no bowel\nobstruction or ascites.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are not enlarged by\nsize criteria.\n\nVasculature: Abdominal aorta is not aneurysmal. Celiac artery, superior\nmesenteric artery, and bilateral renal arteries are patent. Hepatic arterial\nanatomy is conventional. The portal venous system is patent.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are\nidentified. Soft tissues are unremarkable.", "output": "1. No suspicious hepatic lesions meeting OPTN criteria for HCC.\n2. Cirrhotic liver morphology. Mild splenomegaly. No ascites.\n3. Conventional hepatic arterial anatomy." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: Partially visualized liver is homogeneous in signal intensity without\nsuspicious mass. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. Gallbladder\nis surgically absent.\n\nPancreas: Pancreas is homogeneous in signal intensity without suspicious mass.\nNo pancreatic duct dilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: 0.7 cm T2 hyperintense nonenhancing renal cyst is seen in the\ninterpolar region of the right kidney (05:15). The kidneys are otherwise\nhomogeneous in signal intensity without suspicious mass. No hydronephrosis or\nperinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, and small bowel are\nunremarkable. Ascending and descending colonic diverticulosis noted without\nevidence of acute diverticulitis. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries are patent. Replaced right hepatic artery arising off the SMA.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. No evidence of renal artery stenosis bilaterally.\n2. Colonic diverticulosis without evidence of acute diverticulitis." }, { "input": "Lower Thorax: Lung bases are clear.\n\nLiver: There is mild drop of signal in the out of phase sequence suggestive of\nmild hepatic steatosis. There are a few cysts and a few regions of arterial\nhyper enhancement without correlate on additional sequences, likely\nperfusional there is no suspicious focal liver lesion.\n\nBiliary: The gallbladder is unremarkable. No biliary duct dilatation.\n\nPancreas: Unremarkable except for a 4 mm T2 hyperintense lesion along the\nanterior aspect of the pancreatic neck (series of 4, image 8) which likely\nrepresents a side branch IPMN.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: There are multiple bilateral renal cysts the largest measuring 8 cm. \nThe previously seen hyperdense lesion in the lateral aspect of the right\nkidney corresponds to a hemorrhagic cyst or a decreasing region of hemorrhage\nrelated to contusion on MRI. It has decreased in size in the interval now\nmeasuring 1.3 cm, previously 3.5 cm. There are smaller hemorrhagic cysts\nmeasuring 3 mm and 6 mm in the right upper pole and 2 mm in the right lower\npole. There is no solid renal mass.\n\nGastrointestinal Tract: No bowel obstruction or ascites.\n\nLymph Nodes: There are no enlarged retroperitoneal or mesenteric lymph nodes.\n\nVasculature: Normal caliber of the abdominal aorta. The major mesenteric\narteries are normal in caliber and patent. Renal arteries are patent. The\nsplenic vein, SMV and portal veins are patent.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions.", "output": "1. Interval decrease of a hemorrhagic lesion in the right kidney which may be\nrelated to a contusion or a hemorrhagic cyst. No solid renal mass\ndemonstrated.\n2. 4 mm pancreatic cystic lesion, likely a side branch IPMN. Follow-up MRI\nin ___ year is recommended to monitor stability.\n\nRECOMMENDATION(S): Follow-up MRI in ___ year for reassessment of pancreatic\nside branch IPMN." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Numerous hepatic cysts are present, several which are hemorrhagic or\nproteinaceous. There is diffuse associated fibrosis and capsular retraction\ninvolving the right lobe of the liver. There is no suspicious liver lesion. \nThe portal and hepatic veins are patent. There is diffuse drop in signal\nintensity on the in phase images with respect to the out of phase images\nconsistent with iron deposition.\n\nBiliary: There is no intrahepatic biliary ductal dilatation. Mild prominence\nof the extrahepatic common bile duct is likely attributable to post\ncholecystectomy status.\n\nPancreas: The pancreas is normal in signal intensity and morphology with\nmultiple cystic lesions with the largest measuring up to 9 mm in the\npancreatic body (03:15). Multiple smaller cysts are present as well.\n\nSpleen: There is diffuse drop in signal intensity on the in phase images with\nrespect to the out of phase images consistent with iron deposition. The\nspleen is normal in size without focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The native kidneys are largely replaced by innumerable cysts, the\nmajority of which are simple with numerous additional intrinsically T1\nhyperintense hemorrhagic or proteinaceous cyst. There is no suspicious or\nenhancing renal lesion. There is no hydronephrosis. A right lower quadrant\ntransplant is partially imaged.\n\nGastrointestinal Tract: The visualized loops of large and small bowel are\nunremarkable.\n\nLymph Nodes: There is no suspicious lymphadenopathy.\n\nVasculature: There are single renal arteries bilaterally (07:46), both of\nwhich are diminutive measuring approximately 3 mm in greatest diameter. There\nare single renal veins bilaterally.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion.", "output": "1. Polycystic kidney disease with multiple simple and hemorrhagic or\nproteinaceous renal cysts. No suspicious renal lesion or hydronephrosis. \nSingle diminutive native renal arteries bilaterally.\n2. Polycystic liver disease with substantial right hepatic fibrosis and\ncapsular retraction. No suspicious liver lesion.\n3. Evidence of secondary hemosiderosis involving the liver and spleen." }, { "input": "No effusions at the lung bases. Heart is normal in size.\n\nAt the region of the pancreatic neck, a T2 hyperintense structure is seen\narising from the main pancreatic duct. This measures 0.5 x 0.3 mm. There is\ndefinite communication with the main pancreatic duct, suggesting a prominent\nside branch. Remainder of the main pancreatic duct is normal in caliber. No\nsolid pancreatic masses or peripancreatic inflammatory changes. No\nsignificant pancreatic atrophy. The intrahepatic ducts are normal in caliber.\nExtrahepatic common duct measures up to 5 mm, within normal limits for age. \nThe gallbladder is unremarkable without apparent gallstones. Liver is normal\nin signal intensity on the T2-weighted imaging. The spleen is normal in size.\nThe right adrenal gland is normal. The left adrenal gland demonstrates a mass\nmeasuring 2.0 x 1.2 cm, previously characterized as an adenoma. This is\nstable in size. Tiny T2 hyperintense foci at the lower pole of the kidneys\nare likely cysts, but too small to further characterize. No hydronephrosis. \nNon-obstructive bowel loops are seen within the upper abdomen. There are\nright and left colonic diverticula. There is significant retained stool\nthroughout the visualized colon. No upper abdominal ascites.", "output": "1. 0.5 x 0.3 cm cystic lesion arising from the pancreatic neck, with\ncommunication with the main pancreatic duct. This most likely represents a\ndilated side branch or side branch IPMN, decreased in size from prior study.\nNo solid components are seen. Consider ___ year follow up to document continued\nstability.\n2. Left adrenal mass measuring 2 cm was previously characterized as an\nadenoma and is stable in size.\n3. Colonic diverticula involving the ascending, transverse, and descending\ncolons." }, { "input": "This examination is extremely limited due to patient motion, as well as the\ninability to complete the examination due to claustrophobia and hypoglycemia. \nWithin these limitations:\n\nLower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is cirrhotic in appearance. Evaluation for HCC is severely\nlimited without the administration of intravenous contrast. Within these\nlimitations, no focal liver lesions are visualized.\n\nBiliary: The numerous gallstones are seen within the gallbladder. No intra or\nextrahepatic biliary dilatation.\n\nPancreas: The no ductal dilatation. No focal pancreatic lesions visualized.\n\nSpleen: The spleen is not enlarged. No focal splenic lesions.\n\nAdrenal Glands: Adrenal glands are normal in size and shape bilaterally.\n\nKidneys: Multiple cysts are seen within the kidneys bilaterally.\n\nGastrointestinal Tract: Colonic diverticulosis. Otherwise, the stomach and\npartially imaged small and large bowel are unremarkable in appearance.\n\nLymph Nodes: No upper mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: Mild levoconvex scoliosis of the lumbar\nspine. Well-circumscribed T2 hyperintense lesions within the lumbar spine\nlikely represent hemangiomas. Well-circumscribed T2 hypointense lesion within\nthe L3 vertebral body demonstrates subtle sclerosis on the CT dated ___, likely benign.", "output": "1. Severely limited examination due to patient motion, as well as the\ninability to complete the examination due to claustrophobia and hypoglycemia. \nWithin these limitations, cirrhotic appearing liver without focal liver\nlesions. For future examinations, consider sedation or a multiphasic CT.\n2. Other incidental findings include gallstones and colonic diverticulosis." }, { "input": "The study is limited because of the large volume ascites causing artifact and\nthe patient's inability to consistently hold breath well.\n\nLower Thorax: Small left pleural effusion is relatively stable.\n\nLiver: Heterogeneous attenuation with nodular contour consistent with\ncirrhosis as seen on CT. There is heterogeneous mild fatty deposition within\nthe liver. In the dome of the liver abutting the IVC and immediately superior\nto the middle hepatic vein, mostly within segment 4A but also slightly within\nsegment 8, there is a T2 bright mass with restricted diffusion that is mildly\nhyperintense on the precontrast T1 weighted images, shows avid arterial\nenhancement, rapid washout, and has a capsule formation. This lesion measures\n2.6 x 2.0 cm on phase. No other concerning liver lesions on this slightly\nlimited evaluation. Portal vein is patent. Hepatic veins are patent. There\nappears to be conventional hepatic arterial anatomy. No additional liver\nlesions identified.\n\nBiliary: No intra or extrahepatic biliary ductal dilation. The gallbladder\nappears folded upon itself but without wall thickening. There appears to be a\nsmall amount of fundal adenomyomatosis. There appears to be a small gallstone\nwithin the gallbladder.\n\nPancreas: 5 mm T2 hyperintensity is seen within the pancreatic tail which\nlikely represents a side branch IPMN. No pancreatic duct dilation. There is\nmild pancreatic atrophy.\n\nSpleen: Spleen is within normal limits in size measuring up to 11.6 cm. No\nfocal splenic lesion.\n\nAdrenal Glands: Normal in size and contour without mass.\n\nKidneys: 5 mm left renal cyst is noted. No hydronephrosis. No concerning\nrenal lesion.\n\nGastrointestinal Tract: Visualized loops of bowel are grossly normal. Large\nvolume ascites as seen on prior CT.\n\nLymph Nodes: No evidence of lymphadenopathy with multiple small nodes within\nthe porta hepatis.\n\nVasculature: The aorta is normal in caliber. Major arteries of the abdomen\nare widely patent. Esophageal varices are noted. Major veins are normal in\nappearance.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal.", "output": "2.6 cm avidly arterially enhancing mass with rapid washout just superior to\nthe middle of attic vein, predominantly in segment 4A but also in segment 8 is\nconsistent with hepatocellular carcinoma (OPTN class 5B). No additional liver\nlesions identified. Patent portal vein. Conventional hepatic arterial\nanatomy.\n\nStable appearance of left pleural effusion and large volume ascites. No\nsplenomegaly. There are esophageal varices.\n\n5 mm pancreatic tail cystic lesion is likely a side branch IPMN. No further\nfollow-up is indicated in a patient of this age without symptoms or increased\nrisk for pancreatic cancer.\n\nCholelithiasis within folded gallbladder without evidence of acute\ncholecystitis." }, { "input": "Lower Thorax: There is a moderate left pleural effusion. No pericardial\neffusion. No right pleural effusion.\n\nLiver: Redemonstration of nodular hepatic contour and heterogeneous\nattenuation consistent with cirrhosis. Near the dome of the liver located\nsuperiorly and medial to the middle hepatic vein, there is a 4.4 x 3.5 cm T1\nhyperintense treatment cavity involving segments 4A/8 which does not\ndemonstrate abnormal arterial enhancement or pseudo capsule on postcontrast\nimages. The portal venous vasculature is patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder contains a likely stone without secondary signs of acute\ncholecystitis.\n\nPancreas: There is mild generalized pancreatic atrophy with otherwise normal\nsignal intensity. No ductal dilatation. A 0.5 cm T2 hyperintense lesion\nwithin the pancreatic tail consistent with previously described side-branch\nIPMN, no significant interval change.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is no hydronephrosis. Bilateral simple renal cysts are again\ndemonstrated. The focal area of scarring along the interpolar region of the\nright kidney (series 2, image 29) which appears new from the prior study.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal in caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality. There is bilateral gynecomastia.", "output": "1. Nonenhancing treatment cavity within segments 4A/8 measuring 4.4 x 3.5 cm\nrepresenting treated HCC. No other suspicious enhancement or lesions meeting\nOPTN criteria are demonstrated.\n2. Redemonstration of cirrhotic morphology of the liver, with moderate\nintra-abdominal ascites and a moderate left pleural effusion. Prominent\nvarices are again demonstrated. The portal venous vasculature is patent.\n3. 0.5 cm pancreatic tail cystic lesion consistent with previously described\nside-branch IPMN is unchanged, no further dedicated follow-up is necessary.\n4. Cholelithiasis without evidence of cholecystitis." }, { "input": "There is slight limitation due to motion artifact.\n\nLower Thorax: There is a moderate left pleural effusion with associated basal\natelectasis, slightly improved from the previous MRI.\n\nLiver: There is cirrhotic liver morphology. There is a stable ablation cavity\nin segment ___. There is no new arterial enhancement to suggest local\nrecurrence. No arterially enhancing lesions are seen elsewhere in the liver.\n\nBiliary: There is no biliary dilation. Cholelithiasis is again noted.\n\nPancreas: Unremarkable.\n\nSpleen: The spleen is normal in size at 12.4 cm in coronal dimension. \nEnhancement is homogeneous.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: There is stable cortical scarring in the right kidney. A small T2\nhyperintensity in the right lower pole is not captured on the postcontrast\nimaging, but is most likely a cyst.\n\nGastrointestinal Tract: Visualized bowel is grossly unremarkable aside from\ncolonic diverticulosis. There is moderate ascites, grossly similar to prior.\n\nLymph Nodes: No enlarged nodes are identified.\n\nVasculature: There are portosystemic collaterals in the upper abdomen.\n\nOsseous and Soft Tissue Structures: Bilateral gynecomastia noted.", "output": "1. Stable post-ablation changes with no evidence of residual/recurrent tumor.\n2. Cirrhotic liver morphology with sequelae of portal hypertension." }, { "input": "Lower Thorax: Left pleural effusion is again noted. Bilateral gynecomastia is\nnoted.\n\nLiver: The liver is cirrhotic and there is no hepatic steatosis. There is a\ntreatment cavity at the junction of segment ___ with coagulative necrosis\nmeasuring 4.3 x 2.2 cm.\n\nAdjacent to the upper part of the treatment cavity there is a small enhancing\nfocus measuring 7 mm that shows washout and a pseudo capsule (series 1001\nimage 40). Given its size, this lesion does not meet OPTN 5 criteria.\n\nBiliary: No intra or extra biliary duct dilatation. Uncomplicated\ncholelithiasis.\n\nPancreas: The pancreas is homogeneous and normal in signal and bulk. No main\nduct dilatation.\n\nSpleen: The spleen is homogeneous and normal sizes measuring 11.6 cm.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: 7 mm right inferior pole cortical cyst is noted as well as other few\ntiny cortical cysts on the left. No hydronephrosis. No enhancing lesion. \nThere is cortical scaring at the right interpolar.\n\nGastrointestinal Tract: No bowel obstruction. Uncomplicated colonic\ndiverticulosis are noted.\n\nLymph Nodes: No abdominal lymphadenopathy. Small amount of ascites is noted.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No concerning bone lesions.", "output": "1. Cirrhotic liver morphology.\n2. 7 mm arterial-enhancing lesion showing washout and pseudocapsule. Given\nit's size, this lesion does not meet OPTN 5 criteria.\n3. Uncomplicated cholelithiasis." }, { "input": "Lower Thorax: Small left pleural effusion and trace right pleural effusion. \nNote is made of bilateral gynecomastia.\n\nLiver: Nodular contour and segmental hypertrophy and atrophy, consistent with\ncirrhosis.\nFollowing lesions are noted:\n\n-0.6 cm arterially enhancing lesion with washout and pseudocapsule in segment\n7 (1101; 23), stable from 3 months prior.\n-0.7 cm arterially enhancing lesion with washout and pseudocapsule at the\nanteromedial margin of the segment 4A ablation zone is unchanged in size\ncompared to 3 months ago (1101:34).\n-Stable 4.4 x 2.2 cm ablation zone in segment 4A.\nNo new focal lesion.\n\nBiliary: Gallstones. There is intrahepatic biliary ductal dilatation\nperipheral to the segment 4A ablation cavity. There is no extrahepatic\nbiliary dilatation.\n\nPancreas: Pancreas shows moderate diffuse atrophy, without evidence of focal\nlesion or ductal dilatation.\n\nSpleen: Normal.\n\nAdrenal Glands: Normal.\n\nKidneys: Inferior poles of the kidneys are not included. A couple\nsubcentimeter tiny cysts remain stable. The right kidney shows focal area of\nscarring along the posterolateral aspect of the interpolar region. No\nevidence of hydronephrosis or suspicious appearing renal mass.\n\nGastrointestinal Tract: There is moderate diverticulosis along the visualized\ncolon. No evidence of obstruction.\n\nLymph Nodes: Few prominent para-aortic nodes are unchanged. There is minimal\nperihepatic ascites, similar to previous exam.\n\nVasculature: Included abdominal aorta and branches are within normal limits\nwithout aneurysmal dilatation. Hepatic arterial anatomy is conventional. \nSmall para esophageal varices are noted.\n\nOsseous and Soft Tissue Structures: No suspicious appearing osseous lesion is\nidentified.", "output": "1. Two subcentimeter arterially enhancing lesions with washout and\npseudocapsule in segments 7 and 4A are stable compared to 3 months ago, not\nmeeting OPTN 5 criteria given their sizes. No new suspicious hepatic lesions.\n2. Cirrhotic liver." }, { "input": "Lower Thorax: There is a moderate left pleural effusion with subjacent\natelectasis which has decreased compared to prior. No pericardial effusion.\n\nLiver and biliary: Cirrhotic liver morphology. There is no significant\nsteatosis. An ablation cavity is seen in hepatic segment 4A/8 with associated\nintrahepatic ductal dilation and internal coagulation necrosis, unchanged\n(9:36, 3:20).\n-A 1 cm arterially enhancing lesion in hepatic segment 7 demonstrates washout\nwith pseudocapsule and mild restricted diffusion, previously measuring 6 mm\n(1103:19). This meet OPTN-5A criteria for HCC.\n-A 7 mm arterially enhancing lesion in hepatic segment 7 demonstrates washout\nand pseudocapsule, new compared to prior (1103:19).\n-A 4 mm arterially enhancing lesion in hepatic segment 4A demonstrates washout\nand is more conspicuous than prior (1101:40).\n-A 1.1 cm arterially enhancing lesion in hepatic segment 4A demonstrates\nwashout and pseudocapsule, similar to prior, meeting OPTN-5A criteria (29).\n\nSmall scattered foci of arterial enhancement without washout or T2 correlate\nare consistent with transient hepatic intensity differences. There is no\nextrahepatic biliary ductal dilation. The gallbladder contains gallstones.\nSmall volume ascites.\n\nPancreas: There is moderate diffuse atrophy without main duct dilation. A 4-5\nmm T2 hyperintense cystic lesion is seen in the pancreatic tail, unchanged\n(3:20).\n\nSpleen: Normal in size without concerning focal lesion.\n\nAdrenal Glands: Normal in size and shape without focal lesion.\n\nKidneys: There is unchanged right upper pole scarring. Bilateral simple\ncortical cysts and a hemorrhagic/proteinaceous cyst in the upper pole the\nright kidney are seen. There is no hydronephrosis or solid renal lesion.\n\nGastrointestinal Tract: Diverticulosis of the colon without evidence of acute\ndiverticulitis.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Paraesophageal varices are noted. \nThere is mild narrowing of the SMA at its origin.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesion. Bilateral\ngynecomastia.", "output": "1. 1 cm segment VII lesion has slightly enlarged since the prior study and now\nmeets OPTN 5A criteria.\n2. 1.1 cm segment ___ lesion is unchanged in size but now meets OPTN 5A\ncriteria.\n3. 2 additional subcentimeter lesions in segments 7 and 4A do not meet OPTN 5\ncriteria but are suspicious for HCC and warrant continued attention on\nfollow-up.\n4. Cirrhotic liver with sequelae of portal hypertension including small volume\nascites and varices.\n5. Moderate left pleural effusion, decreased compared to prior.\n6. Stable 4-5 mm cystic lesion in the pancreatic tail, statistically likely a\nside branch IPMN.\n7. For chest findings reference is made to CT chest report of the same day\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:02 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "Lower thorax: Bilateral pleural effusions, left greater than right, also\nloculated on the left. Please refer to separate report of CT chest performed\nthe same day for description of intrathoracic findings.\n\nHepatobiliary: The liver demonstrates cirrhotic morphology.\nThe patient is most recently status post ablation to hepatic segments ___ and\n___, performed on ___. The pre-existing ablation cavity in\nhepatic segments ___ is larger (10:53), measuring up to 7.3 x 2.8 cm, and\nthere is a new ablation cavity in segment ___ (10:47) measuring up to 4.9 x\n2.7 cm, both demonstrating T1 hyperintense coagulation necrosis, and no\nnodular enhancement concerning for residual or locally recurrent disease. \nThere is adjacent associated intrahepatic ductal dilatation.\n\nA 5 mm arterially enhancing lesion with washout in hepatic segment ___ at the\nmedial margin of the ablation cavity is unchanged (1201:51). There is a 10 mm\narterially enhancing lesion along the posterior margin of segment II (1201:70)\nwith washout and pseudocapsule (1202:71), meeting OPTN 5 criteria for\nhepatocellular carcinoma, new from prior. There is a new 9 mm arterially\nenhancing, diffusion restricting lesion in hepatic segment II (1201:53),\nwithout definite washout or a pseudocapsule, new from prior. There is a new 7\nmm arterially rim-enhancing subcapsular lesion in segment III (1201:78).\nAdditionally, there are multiple new subcentimeter, arterially enhancing\nlesions with washout, not meeting strict OPTN 5 criteria due to size, but\nremain concerning for hepatocellular carcinoma, as follows:\n\n-7 mm lesion in hepatic segment ___ (1201:65)\n-Two adjacent lesions measuring 9 mm and 7 mm at the border of hepatic\nsegments ___ (1201:69, 72)\n-A cluster of three lesions, the largest measuring 9 mm, in hepatic segment V\n(1201:80)\n\nThere are multiple other scattered arterially enhancing foci throughout the\nliver without washout or pseudocapsule.\n\nThere is small volume ascites, mostly perihepatic.\n\nThe gallbladder is contracted and contains a small stone. There is no\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas demonstrates moderate diffuse atrophy without main duct\ndilatation. There is redemonstration of a 4 mm T2 hyperintense cystic lesion\nin the pancreatic tail (4:31), unchanged compared to prior.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: There is redemonstration of right upper pole cortical scarring. \nThere is a 5 mm T1 hyperintense hemorrhagic/proteinaceous cyst in the upper\npole of the right kidney. There is also a tiny cortical cyst in the upper\npole of the left kidney. There is no hydronephrosis.\n\nBowel: There are scattered diverticula throughout the colon. Imaged small and\nlarge bowel loops are normal in caliber.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. Hepatic arterial\nanatomy is conventional. There are small paraesophageal varices.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or suspicious osseous\nlesion. There is bilateral gynecomastia.", "output": "1. The patient is most recently status post ablation to hepatic segments ___\nand ___, performed on ___. No evidence of residual or locally\nrecurrent disease.\n2. Findings concerning for multifocal hepatocellular carcinoma. A 10 mm\narterially enhancing lesion along the posterior margin of hepatic segment II\nwith washout and pseudocapsule meets OPTN 5 criteria for hepatocellular\ncarcinoma, new from prior. Multiple other subcentimeter lesions in the right\nand left hepatic lobes do not meet strict OPTN 5 criteria but remain\nsuspicious, as detailed above.\n3. Small volume ascites, mostly perihepatic.\n4. Stable 4 mm cystic lesion in the pancreatic tail, likely a side branch\nIPMN.\n5. Please refer to separate report of CT chest performed the same day for\ndescription of intrathoracic findings.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 13:28 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "Lower Thorax: There no significant abnormalities at the lung bases. There is\nno pleural effusion.\n\nLiver: Hepatic contours and signal intensity dementia significant abnormality.\nNo suspicious, enhancing focal hepatic lesions are identified. There is no\nascites.\n\nBiliary: The intra and extrahepatic bile ducts are normal in caliber. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas shows normal signal intensity without focal lesions.\n\nSpleen: Incidentally noted is a splenic hemangioma. The spleen is not\nenlarged.\n\nAdrenal Glands: The adrenal glands are symmetric without nodularity.\n\nKidneys: The kidneys are symmetric. A right renal cyst is identified.\n\nGastrointestinal Tract: A large amount of ingested material is seen within\nthe stomach. The stomach and visualized portions of the small and large bowel\nare unremarkable.\n\nLymph Nodes: No enlarged lymph nodes are seen in the mesentery or\nretroperitoneum.\n\nVasculature: Hepatic arterial anatomy is conventional. The aorta and its\nmajor branches are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified.", "output": "1. No suspicious hepatic lesions identified." }, { "input": "Liver: The visualized portion of the liver is homogeneous in signal\ncharacteristics. There is no definite chemical shift on the in or out of\nphase sequences to suggest the presence of hepatic steatosis or iron\ndeposition. The liver contours are smooth. No solid or cystic lesions are\nseen.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. There is a 3 mm cyst arising\nfrom the uncinate process. No nodularity or ductal abnormality is seen. \nStatistically, this finding most likely represents a side-branch IPMN.\n\nSpleen: Mild splenomegaly measuring up to 15.4 cm. No focal lesions are\nidentified. There is a 12 mm accessory spleen.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no concerning solid or cystic\nlesions. In the lower pole of the right kidney, there is a 4 x 4 mm round\nlesion which is hyperintense on the T2 weighted images and isointense to the\nperinephric fat on the pre-contrast T1 weighted images. This likely\ncorrelates to the echogenic lesion seen on the recent ultrasound from ___. The lesion does not definitely enhance on the post-contrast images. \nThis lesion is not well assessed on the in and out of phase sequences. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The visualized portion of the GI tract is\nunremarkable.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation. \nSusceptibility artifact at the origin of the celiac artery likely represents\ncalcified atherosclerosis.\n\nOsseous and Soft Tissue Structures: There is mild levoscoliosis. The bone\nmarrow demonstrates normal signal characteristics. No concerning osseous\nlesions.", "output": "1. The previously described 6 mm echogenic lesion in the lower pole the right\nkidney is too small to fully characterize on MRI but based on the combination\nof the pre-contrast MR and ultrasound appearances, most likely represents an\nangiomyolipoma. If desired, a follow-up ultrasound or MR in ___ year could be\nperformed.\n2. 3 mm cyst arising from the uncinate process. No nodularity or ductal\nabnormality is seen. Statistically, this finding most likely represents a\nside-branch IPMN. Follow-up MRCP in ___ year is recommended.\n\nRECOMMENDATION(S): Follow-up MRCP in ___ year. The renal lesion can be\nassessed simultaneously." }, { "input": "A T1 hyperintense, enhancing structure overlying the abdominal wall\nmusculature in the anterior lower right aspect of the abdomen, measures\napproximately 7 mm, and is more linear, compared to the prior exam from ___ at which time this measured 16 mm. Postoperative changes are again noted\nalong the anterior abdominal wall.\n\nThe liver is normal without evidence of focal lesions or intrahepatic biliary\nductal dilatation. The gallbladder is normal. The spleen is homogeneous and\nnormal in size. The adrenal glands bilaterally are normal. Multiple T2\nhyperintense lesions within the kidneys bilaterally are consistent with simple\nrenal cysts, overall unchanged compared to the prior exam. There is no\nevidence of hydronephrosis. No focal renal lesions concerning for malignancy\nare identified. The pancreas has a normal T1 signal. There is no evidence of\npancreatic ductal dilatation.\n\nThe IVC stent is grossly patent, without evidence of a intraluminal thrombus.\n\nNormal marrow signal is identified. A 2 cm T1 and T2 hyperintense,\nnonenhancing target shaped intramuscular lesion within the right upper lateral\nabdominal wall, is overall unchanged in size compared to the exam from ___, and likely represents a focus of fat.", "output": "1. The previously noted T1 hyperintense, enhancing lesion overlying the\nabdominal wall musculature, has improved in size, measuring 7 mm (19;68)\ncompared to the prior exam at which time this measured 16 mm. This is likely\nsecondary to post surgical changes, however continued attention on followup is\nrecommended.\n\n2. No findings to confirm the presence of thrombus within the IVC stent. A\nsubtle abnormality might not be apparent on these views. No evidence of\nrecurrent tumor surrounding the IVC in the region of the surgical bed is\nidentified.\n\n3. 2-cm right upper lateral abdominal lesion (9;32) is unchanged in size\ncompared to the prior exam from ___, and likely represents a focus\nof fat. Attention to this area on followup films is requested." }, { "input": "Lung bases: Lung bases are included and appear unremarkable. No suspicious\npulmonary nodules or pleural effusions are seen.\n\n\nAbdomen: The liver and spleen are normal in size. No focal hepatic lesions are\nidentified. The intra and x-ray water bile ducts are unremarkable. The\ngallbladder is normal appearance and the pancreas appears normal in signal\nintensity. The adrenals are normal. Both kidneys are normal in size and\ncontains stable renal cysts of which few of them are slightly complicated\nbased on the fact that the are high in signal intensity on the T1 weighted\nimages. There is no retroperitoneal or mesenteric lymphadenopathy. The\nresection area appears unremarkable. There is no evidence of thrombosis within\nthe IVC stent. There is no evidence for hydronephrosis. The visualized portion\nof the GI tract and axial skeleton is unremarkable. There is a stable 9 mm\nenhancing nodule in the right side lateral aspect of the scar\n, most likely postsurgical in nature.", "output": "1. No evidence for tumor recurrence. No evidence for thrombosis in the IVC\nstent. 2. Stable 9 mm enhancing nodule along the right lateral a subcostal\nscar, most likely postsurgical in nature. 3. Stable bilateral renal cysts." }, { "input": "Motion limited examination.\n\nLOWER THORAX: Clear visualized lungs.\n\nLIVER: Slightly increased enhancement of segments 1, 4b and 5, post radiation\nchanges. Normal contour and signal otherwise. No discrete lesion.\n\nBILIARY: Unremarkable gallbladder. No ductal dilation.\n\nPANCREAS: No discrete lesion or ductal dilation.\n\nSPLEEN: No splenomegaly.\n\nADRENAL GLANDS: No nodules.\n\nKIDNEYS: Simple bilateral renal cysts. Right subcentimeter inferior pole\nhemorrhagic cyst, unchanged.\n\nGASTROINTESTINAL TRACT: No obstruction. Unremarkable appendix. Partially\nvisualized IUD in situ.\n\nLYMPH NODES: No adenopathy.\n\nVASCULATURE: Patent aorta and major branches.\n\nS/p infrahepatic and suprarenal IVC resection and graft reconstruction. \nPatent IVC. No lesion or abnormal enhancement.\n\nOSSEOUS AND SOFT TISSUE STRUCTURES: Right upper quadrant scar. No soft tissue\nmass or nodularity. Normal bone marrow signal.", "output": "Motion limited. S/p infrahepatic - suprarenal IVC resection with graft\nreconstruction. Patent IVC without evidence of recurrence." }, { "input": "Motion mildly limits evaluation.\n\nLower Thorax: Atelectasis in the right lower lobe is mild. Remaining\nvisualized lungs are clear. No pericardial or pleural effusion.\n\nLiver: There is no significant hepatic steatosis (fat fraction less than 2%). \nNo focal lesions are identified.\n\nBiliary: The gallbladder is normal without stones. There is no intrahepatic\nor extrahepatic biliary dilation.\n\nPancreas: Normal parenchymal signal without focal lesions or ductal dilation.\n\nSpleen: Normal in size and appearance without focal lesions. Measures 9.2 cm.\n\nAdrenal Glands: Normal in size and appearance.\n\nKidneys: Multiple bilateral cortical cysts are stable from ___, the\nlargest is in the upper pole of the left kidney measuring 2.1 x 2.1 cm. In\nthe right kidney, a 9 mm focus of hyperintense signal on T1 weighted imaging\nis consistent with a hemorrhagic or proteinaceous cyst, stable from ___. \nNo solid masses, hydronephrosis, or perinephric abnormality.\n\nGastrointestinal Tract: The stomach is normal. Visualized loops of large and\nsmall intestine demonstrate normal caliber and wall thickness.\n\nLymph Nodes: No mesenteric, retroperitoneal, or porta hepatis lymphadenopathy\nby size criteria.\n\nVasculature: Post resection and reconstruction of the intrahepatic suprarenal\nIVC with patent graft and no evidence of recurrence. Hepatic arterial\nvasculature is conventional. The celiac axis, SMA, and renal with arteries\nare patent. Portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No soft tissue or osseous abnormality\nconcerning for neoplasm.", "output": "Post resection and reconstruction of the intrahepatic suprarenal IVC with\npatent graft and no evidence of recurrence or metastasis." }, { "input": "Lower Thorax: Minimal bibasilar atelectasis.\n\nLiver: Unremarkable. No significant hepatic steatosis.\n\nBiliary: No intrahepatic or extrahepatic biliary dilatation. The gallbladder\nis unremarkable.\n\nPancreas: Unremarkable.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The kidneys are unremarkable, except for multiple a few stable\nbilateral cortical cysts. The largest cyst measures up to 2.0 cm in the left\nupper pole. There are a few diminutive hemorrhagic cysts.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes and Mesentery: No lymphadenopathy by size criteria. Similar mild\nnodularity of left celiac axis ganglion.\n\nVasculature: The patient is status post resection and reconstruction of the\nintrahepatic suprarenal IVC with patent graft with no evidence of recurrence. \nPatent celiac axis, SMA and renal arteries. Patent portal and hepatic veins.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions.\n\nIncidentally noted is an IUD.", "output": "1. Status post resection and reconstruction of the intrahepatic suprarenal IVC\nwith patent graft.\n2. No evidence of recurrence or metastasis." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: Liver is homogeneous in signal intensity without suspicious mass. No\nimaging features suggestive of advanced cirrhosis. Mild signal drop on out of\nphase imaging consistent with diffuse hepatic steatosis (fat fraction 7%). \nThere is 0.8 cm arterially hyperenhancing person located area within segment 5\nwhich is without correlate on additional sequences and is consistent with a\ntransient hepatic intensity difference (11:83). No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The common\nbile duct smoothly tapers to the level of the ampulla without obstructing\nstone or large periampullary mass. The gallbladder is unremarkable without\ngallstones or biliary sludge.\n\nPancreas: Pancreas is homogeneous in signal intensity without suspicious mass.\nNo pancreatic duct dilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands symmetric in size without discrete\nnodule.\n\nKidneys: There are bilateral simple renal cysts. Kidneys are otherwise\nhomogeneous in signal intensity without suspicious mass. No hydronephrosis or\nperinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, and visualized small and\nlarge bowel are unremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and proximal ___ are patent. Hepatic anatomy is a conventional. \nHepatic veins, main portal vein, SMV, and splenic vein are patent. Status\npost IVC reconstruction without abnormal enhancement to suggest residual or\nrecurrent disease.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions. Sacral\nTarlov cysts noted. Soft tissues are unremarkable.", "output": "1. Status post intrahepatic suprarenal IVC resection and reconstruction\nwithout evidence of residual recurrent disease.\n2. No evidence of metastatic disease within abdomen.\n3. Mild hepatic steatosis." }, { "input": "The lung bases are grossly clear. There is no pleural effusion. The heart\nsize is normal. Bilateral gynecomastia is reidentified.\n\nThe liver contour is markedly nodular in keeping with known history of\ncirrhosis. Diffuse reticular contrast enhancement of the hepatic parenchyma in\ndelayed sequences is compatible with confluent fibrosis. There is no intra or\nextrahepatic biliary duct dilatation.\n\nThe patient is status post RF ablation to a large area of liver segments II\nand III, measuring up to 8.4 x 6.9 cm (11:35), denoted by a non-enhancing area\nof heterogeneously increased signal intensity on T1 and T2 weighted sequences,\ncompatible with coagulation necrosis. No internal arterially enhancing\ncomponents are seen to suggest residual tumor. Capsular disruption is again\nseen on the anterior aspect of segment II, with associated stable fluid\ncollections measuring up to 13 mm in thickness (8:34). Thrombus within the\nleft portal vein is again seen. The right portal veins are diminutive but\nremain patent. Conventional hepatic arterial anatomy is demonstrated.\n\nA 2.5 x 2.3 cm focus of non-enhancement in the hepatic dome represents a focus\nof prior chemoembolization. No new focus of enhancement is seen adjacent to\nthis region to suggest local recurrence. Prominent porta hepatis lymph nodes\nare unchanged. The gallbladder is unremarkable without gallstones\n\nMultiple pancreatic cystic lesions throughout the body and tail are again\nseen, with the largest discrete lesion measuring 1.7 x 1.3 cm in diameter\n(7:26). These appear stable since at least ___. The pancreatic duct\nremains normal in caliber. The spleen is mildly enlarged but unchanged from\nprior exam, measuring 16 cm of cranio-caudal dimension. Extensive perisplenic,\nperigastric, periesophageal varices are unchanged and secondary to chronic\nportal hypertension. There is no evidence of ascites.\n\nThe adrenal glands are normal. Simple renal cysts are again seen and appear\nstable from previous examinations, with the largest seen in the lower pole of\nthe left kidney measuring 2.9 x 2.7 cm (13:55). The abdominal aorta, celiac\ntrunk, SMA, renal arteries are patent and normal in caliber. There is no\nsignificant mesenteric or retroperitoneal lymphadenopathy.\n\nOSSEOUS STRUCTURES: No bone marrow signal abnormality is identified.", "output": "1. No significant interval change compared with ___ of extensive\npost-RF ablation changes encompassing a large area of segments II and III with\nfocal disruption on the anterior aspect of segment II.\n2. Left portal vein thrombus is stable from prior exam. The right portal\nveins remain patent.\n3. Extensive hepatic cirrhosis with confluent fibrosis and sequela of chronic\nportal hypertension are re-identified.\n4. Stable pancreatic cystic lesions measuring up to 17 mm which can be\nfollowed on subsequent liver MRI examinations." }, { "input": "No pleural effusions.\n\nCirrhotic appearing liver with capsular nodularity, delayed reticular\nenhancement consistent with fibrotic changes, and fissural widening are again\nseen. The patient is post RF ablation to hepatic segments II/III. Again\ndemonstrated is a large heterogeneously T1/T2 hyperintense region throughout\nsegments II/III/IV, measuring 6.3 x 5.2 cm, compatible with coagulation\nnecrosis, without internal nodular arterial enhancing components or washout to\nsuggest residual or recurrent disease. A 1.8 x 2.1 cm nonenhancing focus at\nthe hepatic dome represents a chemoembolized lesion, without local recurrence.\nMultiple T1 hyperintense foci, greater in number throughout the right hepatic\nlobe, are compatible with regenerative nodules.\nPatent main and right portal veins. The lateral segment left portal vein is\nagain not well seen and is likely thrombosed.\n\nDecompressed gallbladder. No common bile duct dilatation. Multiple lobulated\ncystic pancreatic lesions are again demonstrated throughout the pancreas. The\nlargest measure 2.1 x 1.6 cm within the body (6, 23), prior 2 x 1.6 cm.\nAnother measures 2.2 x 1.6 cm (6, 21), prior 2.1 x 1.6 cm.\n\nSplenomegaly, 13.7 cm. Multiple perigastric, periesophageal, perisplenic and\nanterior abdominal varices are present. Normal adrenals.\n\nNo hydronephrosis. Multiple simple appearing renal cysts are again\ndemonstrated.\n\nLoculated ascites adjacent to the embolized left liver is again seen.\n\nReplaced left hepatic artery arising from left gastric. Single bilateral renal\narteries. No significant upper abdominal adenopathy.", "output": "1. Post RFA changes with findings of coagulation necrosis within the left\nlobe of the liver. Embolized lesion at the right hepatic dome. No associated\nsuspicious nodular enhancement with washout to suggest local recurrence. No\nnew OPTN-5 lesions.\n2. Hepatic cirrhosis with chronic portal hypertension. Chronic thrombosis of\nthe lateral left portal vein.\n3. Pancreatic cystic lesions are most compatible with sidebranch IPMNs, and\ncan be followed on subsequent liver surveillance imaging." }, { "input": "There is atelectasis at the lung bases. The liver is nodular and shrunken\ncompatible with the known history of cirrhosis. Delayed reticular enhancement\nis consistent with confluent fibrosis. The patient is post RF ablation to\nsegments II and III. Again seen is a large heterogeneously T1/T2 hyperintense\nregion in segments II, III and IV compatible with coagulation necrosis. This\nmeasures approximately 6.0 x 5.7 cm, similar to the prior exam. There is no\ninternal enhancement to suggest recurrence. A nonenhancing focus near the\nhepatic dome measuring 1.7 x 1.5 cm represents a chemo embolized lesion\nwithout evidence of local recurrence. Multiple T1 hyperintense nodules\nscattered throughout the liver are compatible with regenerating nodules. The\nmain and right portal veins are patent. The left portal vein remains\nchronically occluded. There is no intra or extrahepatic biliary dilatation.\n\nMultiple cystic lesions are seen throughout the pancreas, slowly increasing in\nsize when compared to prior exams For example a multi lobulated lesion in the\npancreatic body measures 2.3 x 1.7 cm previously 2.1 x 1.6 cm in ___ but 11 x 9 mm in ___. Similar cystic lesions within the tail and\nthe uncinate process of the pancreas are more prominent compared to ___.\n\nThe spleen remains enlarged measuring 15.2 cm. Multiple periesophageal,\nperisplenic and interior abdominal varices are present.\n\nAgain seen are multiple bilateral renal cysts without concerning lesions. \nThere is diverticulosis throughout the colon.\n\nA replaced left hepatic artery arising from the left gastric artery is not\nwell visualized on today's exam. Prominent periportal and aortocaval lymph\nnodes are unchanged.", "output": "1. Post RFA within the left lobe of the liver, unchanged from the prior exam.\nEmbolized lesion at the right hepatic dome. No evidence of local recurrence or\nnew mass.\n2. Hepatic cirrhosis with chronic portal hypertension. Chronic thrombosis of\nthe left portal vein.\n3. Multiple pancreatic cystic lesions more prominent since prior exams and\nmost compatible with side branch IPMNs. Given recent slight growth, continued\nfollowup is recommended." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion. Within the limits\nof evaluation by MRI, the lung bases are grossly clear.\n\nLiver: The transplanted liver is smooth in contour. No focal hepatic lesion\nis seen. There is heterogeneous parenchymal enhancement on the late arterial\nphase. The hepatic and portal veins are patent. The hepatic artery is also\npatent, with a stent in place.\n\nBiliary: The gallbladder is surgically absent. There is mild central\nintrahepatic biliary ductal dilatation. There is a 7 mm stone in the common\nhepatic duct (series 7, image 20). There is narrowing of the midportion of\nthe common bile duct (series 2, image 21) in the region of the anastomosis.\n\nPancreas: There is diffuse fatty replacement pancreas. Again seen are\nnumerous cystic lesions throughout the pancreas, likely representing\nside-branch IPMNs, some of which are decreased size compared to the prior MRI\nfrom ___. For example, a 1.6 x 1.3 cm lesion in the pancreatic head\n(series 7, image 32) previously measured 2.2 x 1.4 cm, and a 1.0 x 0.8 cm\ncystic conglomerate in the pancreatic body (series 7, image 22) previously\nmeasured 2.1 x 1.4 cm. These can be followed on liver transplant surveillance\nstudies.\n\nSpleen: The spleen is enlarged, measuring 15.9 cm in length. There are\ntortuous collateral vessels in the region of the splenic hilum. Findings are\nin keeping with portal hypertension.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: There are multiple bilateral renal cysts. A 1.4 x 1.3 cm simple cyst\nin the posterior upper pole of the right kidney (series 7, image 24) has\nincreased in size compared to the prior MRI from ___, previously 0.9 x\n0.9 cm. A 2.0 x 1.9 cm exophytic cyst in the interpolar region of the left\nkidney demonstrates layering T1 hyperintense material, representing\nhemorrhagic or proteinaceous debris, unchanged in size and appearance. \nBilateral renal calculi are better appreciated on noncontrast CT performed the\nsame day.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are\nnondilated. There are numerous scattered colonic diverticula.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: The bone marrow is overall normal in\nsignal. No suspicious osseous lesions are identified. There are incisional\nchanges of the midline anterior abdominal wall. There is moderate bilateral\ngynecomastia.", "output": "1) No focal hepatic lesion in the transplanted liver. Patent hepatic\nvasculature.\n2) 7 mm stone in the common hepatic duct. No intrahepatic bile duct dilation\nor cholangitis.\n3) Splenomegaly with tortuous collateral vessels in the region of the splenic\nhilum, in keeping with portal hypertension.\n4) Numerous cystic lesions throughout the pancreas, likely representing\nside-branch IPMNs, some of which are decreased size compared to the prior MR\nfrom ___. These can be followed on liver transplant surveillance\nstudies.\n5) 2.0 cm exophytic cyst in the interpolar left kidney with layering\nhemorrhagic or proteinaceous debris, unchanged." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. No pleural\neffusion.\n\nLiver: Liver is homogeneous in signal intensity without suspicious mass. No\nsignal drop on out of phase imaging to suggest hepatic steatosis. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. The\ngallbladder is unremarkable.\n\nPancreas: Homogeneous in signal intensity without suspicious mass. No\npancreatic duct dilatation. No peripancreatic fat stranding.\n\nSpleen: Normal in size without suspicious mass.\n\nAdrenal Glands: The right adrenal gland is unremarkable. Within the left\nadrenal gland is a 2.3 x 1.7 cm nodule which demonstrates diffuse homogeneous\nsignal drop on out of phase imaging consistent with intra voxel fat (signal\nintensity index ___ consistent with an adrenal adenoma, unchanged from ___ CT (06:16).\n\nKidneys: Kidneys are homogeneous in signal intensity without suspicious mass. \nNo hydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small and large\nbowel are unremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries, and ___ are patent. Hepatic anatomy is conventional. Hepatic\nveins, main portal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues unremarkable.", "output": "2.3 cm left adrenal adenoma." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is mild drop in signal on the out of phase\nimages in comparison to the in phase images, suggesting mild hepatic\nsteatosis. Multiple well-circumscribed T2 hyperintense nonenhancing lesions\nin both lobes of the liver measuring up to 12 mm (4, 27) are compatible with\ncysts or biliary hamartomas. No worrisome liver lesions are identified. The\nliver parenchyma enhances heterogeneous on the arterial phase, which is likely\nperfusional. The hepatic arterial anatomy is conventional. The portal and\nhepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal. No stones are identified.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is mild fatty atrophy. There is no duct dilation or\nmass.\n\nSpleen: The spleen is normal in size, measuring 10.4 cm. There are no focal\nlesions.\n\nAdrenal Glands: The right adrenal gland is normal. In the expected region of\nthe left adrenal gland, there is a 34 x 38 x 30 mm fluid collection (7, 17 and\n1302, 48). The collection is nonenhancing. The rim is not particularly\nthick. It demonstrates intrinsic high signal on the precontrast T1 weighted\nimages. This is compatible with an adrenal hemorrhage. There is no normal\nenhancement of normal adrenal parenchyma, suggesting the hemorrhage is likely\ndue to infarction. No obvious underlying mass identified, though a small\nlesion cannot be excluded with certainty. In comparison the prior CT, the\namount of hemorrhage has very slightly increased. There continues to be mild\nstranding around the gland, which is presumably reactive.\n\nKidneys: The kidneys are normal in size. In the mid left kidney, there is a\n15 mm cyst. There are no worrisome renal lesions, hydronephrosis, or\nperinephric abnormalities.\n\nGastrointestinal Tract: There is a small hiatal hernia. The stomach and\nsmall bowel are otherwise normal in course and caliber. There is no evidence\nof obstruction. The imaged portions of the large bowel are normal. There is\nno ascites.\n\nLymph Nodes: There are numerous subcentimeter retroperitoneal lymph nodes\ninferior to the renal veins. These are nonspecific. None meet size criteria\nfor pathologic enlargement. Similar lymph nodes are noted around the lower\nesophagus at the level of the diaphragm. There is no other lymphadenopathy in\nthe abdomen.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild degenerative changes are noted throughout the spine. The soft tissues\nare unremarkable.", "output": "1. Interval increase in size of the left adrenal hemorrhage, as described\nabove. The most likely cause is hemorrhagic infarction of the gland. No\ndefinite mass is identified.\n2. Numerous unchanged subcentimeter retroperitoneal lymph nodes, which are\nnonspecific. Short term imaging follow-up is recommended to ensure\nresolution.\n\nRECOMMENDATION(S): Short term imaging follow-up for nonspecific\nlymphadenopathy." }, { "input": "Lower Thorax: The lung bases are clear. No pericardial effusion. There are\nsmall bilateral, right greater than left, pleural effusions.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are smooth. No\ndiscrete masses are appreciated, although evaluation is limited by noncontrast\ntechnique. No evidence of an abscess.\n\nThere is redistribution of a small to moderate amount of ascites.\n\nBiliary: A right percutaneous transhepatic biliary drainage catheter with the\ntip terminating in the distal common bile duct is noted. There is reflux of\ncontrast traversing the entire catheter indicating patency of the catheter. \nThe right intrahepatic and common bile ducts remain decompressed. A partially\nobstructing calculus in the left main hepatic duct (14:59) with mild upstream\nintrahepatic duct dilation is unchanged compared to the previous exam. There\nare no abnormal areas of restricted diffusion to suggest inflammation of the\nbile ducts. Within the limitations of this non-contrast, there is no definite\nevidence of cholangitis. The gallbladder measures up to 5.3 cm which is\nsignificantly larger compared to the post-procedure images on ___. There is mild-moderate mural edema which is more conspicuous compared\nto the previous exam. A focal defect near the fundus is again noted. \nRestricted diffusion around the gallbladder wall is in keeping with\ninflammation. The small fluid collection adjacent to the fundus is not\nsignificantly changed and measures approximately 13 x 20 mm. There is\nadjacent stranding.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. In the head of the pancreas,\nthere is a stable 5 mm cystic lesion which appears to communicate with the\npancreatic duct. Statistically, this finding most likely represents a\nside-branch IPMN. No nodularity or main ductal abnormality is otherwise seen. \nIn the pancreaticoduodenal groove a cluster of cystic structures measuring 2.1\nx 2.2 cm is similar.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: There is a parapelvic cyst in the right interpolar region measuring\napproximately 24 x 30 mm. There are no concerning solid or cystic lesions. \nThe kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. No hydronephrosis or hydroureter.\n\nGastrointestinal Tract: Cystic change in the pancreaticoduodenal groove\nconsistent with cystic dystrophy is unchanged compared to the previous exam. \nPatient is status post colectomy and right lower quadrant ileostomy with a\nparastomal hernia.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation. There\nis non-specific stranding around the SMA of uncertain significance.\n\nOsseous and Soft Tissue Structures: A 7 mm T2 hyperintense lesion in T8 and a\n13 mm T2 hyperintense lesion in T11 likely represent hemangiomas and are\nunchanged compared to the previous exam. The bone marrow demonstrates normal\nsignal characteristics. No concerning osseous lesions.", "output": "1. There is reflux of contrast traversing the right percutaneous transhepatic\nbiliary drainage catheter catheter indicating patency. The right intrahepatic\nand common bile ducts remain decompressed and the left ducts remain mildly\ndistended. Within the limitations of a non-contrast study, there is no\ndefinite evidence of cholangitis or identification of a discrete obstructing\nmass.\n2. The gallbladder measures up to 5.3 cm which is significantly larger\ncompared to the post-procedure images on ___. Correlation with\ndrain function is recommended. The size of the contained perforation of the\ngallbladder fundus is similar.\n3. In the head of the pancreas, there is a stable 5 mm cystic lesion which\nappears to communicate with the pancreatic duct. Statistically, this finding\nmost likely represents a side-branch IPMN. Follow-up MRCP in ___ year is\nrecommended.\n4. Similar appearance of a complex cystic lesion in region of\npancreaticoduodenal groove which may represent cystic dystrophy of the\nduodenal wall, IPMN in accessory pancreatic tissue or sequelae of prior groove\npancreatitis.\n4. Small ascites. Nonspecific stranding about the SMA is of uncertain\nsignificance, although close attention at follow up is recommended as\nmalignancy remains in the differential diagnosis for cause of biliary\nnarrowing." }, { "input": "Liver: There are scattered, vague T2 hyperintense lesions, best seen on the\ndiffusion weighted sequences, which demonstrate subtle rim enhancement on the\npostcontrast sequences. The largest lesion is seen in segment ___ of the\nliver, measuring up to 1.6 cm.\n\nBiliary: There is no intra or extrahepatic biliary duct dilatation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas is normal in signal intensity and morphology. There\nare no focal pancreatic lesions.\n\nSpleen: There is no splenomegaly.\n\nAdrenal Glands: The adrenal glands are unremarkable\n\nKidneys, Ureters, and Bladder: There are bilateral cortical renal cysts, the\nlargest measuring up to 1.9 cm at the lower pole of the left kidney.\n\nGastrointestinal Tract: There is no evidence of bowel obstruction.\n\nPelvis: Locules is of fluid are seen interdigitating between the bowel loops\nin the pelvis.\n\nLymph Nodes: There are prominent retroperitoneal lymph nodes measuring up to 1\ncm in the aortocaval region. The mesenteric lymph nodes seen on the recent CT\nare not as well visualized on MRI.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious bone lesions.", "output": "Multiple scattered liver lesions, best seen on the diffusion-weighted\nsequence, which demonstrate subtle peripheral enhancement post contrast. The\nappearances are suspicious for metastatic disease. The largest lesion is seen\nin segment ___, measuring 1.6 cm in diameter.\n\nProminent retroperitoneal lymphadenopathy measuring up to 1 cm in the\naortocaval region.\n\nThe mesenteric lymph nodes are better seen on CT." }, { "input": "Lower Thorax: Visualized lower lungs are clear. There is no pleural effusion.\n\nLiver: There is mild diffuse drop in signal in the out of phase sequence\nconsistent with mild hepatic steatosis. No focal liver lesion seen.\n\nBiliary: The gallbladder and biliary tree are unremarkable.\n\nPancreas: Pancreas is normal in size, morphology and signal intensity. There\nis no focal pancreatic lesion.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: The adrenal glands are unremarkable. There is no adrenal\nmass.\n\nKidneys:\nThere is a 7.3 x 7 x 8 cm mass arising from the upper left kidney\ndemonstrating heterogeneous T2 signal and postcontrast enhancement. The mass\npartially extends into the left renal pelvis. There is no evidence of\nextracapsular extension. There is no thrombus within the left renal vein or\nIVC.\n\nThe right kidney is normal in size. There is a 2.6 cm exophytic simple cyst\narising from the lower pole of the right kidney. There is no hydronephrosis.\n\nGastrointestinal Tract: The visualized small and large bowel loops are\nunremarkable.\n\nLymph Nodes: There is no retroperitoneal lymphadenopathy.\n\nVasculature: Normal caliber of the abdominal aorta. Mesenteric arteries are\npatent. There are single renal arteries bilaterally. There is thrombus with\nrenal vein or IVC.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion seen. Soft\ntissues are unremarkable.", "output": "8 cm mass arising from the upper left kidney consistent with clear cell RCC. \nLeft renal vein and IVC are patent. There is no evidence of metastatic\ndisease in the abdomen." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nSusceptibility artifacts from a splenic aneurysm coil obscures assessment of\nthe mid-abdomen (series 3, image 10). In addition, difficulty with breath hold\nsecondary to abdominal pain results of the substantial motion artifacts\nthroughout the dynamic series.\n\nAgain seen is moderate intrahepatic and extrahepatic bile duct dilation, with\na CHD measuring up to 11 mm (series 4, image 25, series 7, image 3), unchanged\nin configuration in comparison to the MRCP from ___. This tapers\nrapidly at the level of the ampulla, with again poor visualization of the\nintersphincteric component, suggestive of sphincter of Oddi dysfunction or\nampullary stenosis. No ductal stones are detected. The gallbladder is\ndistended, but otherwise appears normal, and does not contain stones. There is\nno obvious peribiliary enhancement. Aberrant intrahepatic ductal dilation is\nagain seen with the right posterior duct appearing to drain into the left\n(series 7, image 2).\n\nOral contrast progresses unobstructed throughout the gastroduodenostomy\n(series 13, image 94).\n\nA replaced left hepatic artery arises from left gastric (series 1501, image\n62). The abdominal aorta and renal arteries are appear patent. The celiac\ntrunk and SMA are obscured by the artifacts from a splenic aneurysm clip.\n\nThere is no mesenteric or retroperitoneal lymphadenopathy, and no ascites.\n\nThe spleen, adrenal glands, kidneys, and intra-abdominal loops of small and\nlarge bowel are normal.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "1. Moderate intra and extrahepatic bile duct dilation is unchanged since the\nMRCP from ___. Underlying sphincter of Oddi dysfunction or\nampullary stenosis remains a possibility.\n2. Distended gallbladder without evidence for cholecystitis.\n3. There is aberrant intrahepatic ductal anatomy, with a right posterior duct\ndraining into the left duct.\n4. Patent gastroduodenostomy. No obstruction." }, { "input": "Lower Thorax: Included lung fields are grossly clear. There is no pleural or\npericardial effusion.\n\nLiver: The liver enhances normally. There are punctate T2 bright foci\nmeasuring 3 mm in the right lobe of (1003:28) and 3 mm the left lobe (1000\n03:29) likely reflecting benign biliary hamartomas. Masses seen on MRI of ___ are no longer seen\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal without stones or wall thickening.\n\nPancreas: Normal signal intensity without focal lesions.\n\nSpleen: Normal in size and signal intensity.\n\nAdrenal Glands: Normal.\n\nKidneys: Normal without hydronephrosis or worrisome mass. There is 3 mm\nsimple cyst in the interpolar region of the right kidney and 4 mm cyst in the\nupper pole of the left kidney.\n\nGastrointestinal Tract: The stomach and included loops of small and large\nbowel are normal in caliber without obstruction.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber and well opacified. \nAgain there is variant hepatic arterial anatomy with replaced common hepatic\nand accessory right hepatic artery arising from the SMA.\n\nThere is a 1.3 cm cyst in the right ovary (03:23) stable since at least ___.\n\nOsseous and Soft Tissue Structures: Unchanged 1.1 cm probable hemangioma in\nthe L1 vertebral body (03:25). Bone marrow signal is otherwise normal", "output": "1. No worrisome liver lesion is detected. Previous hepatic masses are no\nlonger visualized.\n2. Stable 1.3 cm right adnexal cyst." }, { "input": "Lower Thorax: The lung bases are clear.\n\nLiver: Postsurgical changes from right hepatectomy noted. No perihepatic\nfluid collection or inflammatory change is noted. There are scattered\nnon-enhancing T2 hyperintense lesions in the liver, consistent with cysts\nversus biliary hamartomas. No suspicious hepatic lesion is seen. There is no\nascites.\n\nBiliary: Gallbladder is absent. No intra or extrahepatic biliary duct\ndilation.\n\nPancreas: The pancreas is normal in signal intensity and enhancement. There\nis a 4 mm cystic lesion in the pancreatic head. There is no pancreatic duct\ndilation.\n\nSpleen: Mild splenomegaly is unchanged, spleen measures up to 13.5 cm. Note\nis made of an accessory spleen.\n\nAdrenal Glands: 1.2 cm left adrenal nodule, previously characterized as an\nadenoma is unchanged. There is mild thickening of the right adrenal gland,\nunchanged.\n\nKidneys: The kidneys are symmetric in size. No suspicious renal lesion is\nseen. There are subcentimeter T2 hyperintense lesions, consistent with cysts.\nNo hydronephrosis is present.\n\nGastrointestinal Tract: Views of the small and large-bowel are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal adenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Celiac axis is normal in\ncaliber on both inspiratory and expiratory phase images. SMA remains normal\nin caliber throughout the examination. Portal vein is patent. There is 1\nrenal artery bilaterally.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. \nThere is no superficial soft tissue abnormality.", "output": "1. No MR evidence of SMA or median arcuate ligament syndrome. No MR\nexplanation for patient's symptoms.\n2. Surgical changes from prior right hepatectomy.\n3. 4 mm cystic lesion in the pancreatic head, likely a side branch IPMN,\nfollow-up MRCP can be obtained in ___ year.\n4. Unchanged mild splenomegaly.\n\nRECOMMENDATION(S): MRCP in ___ year to re-evaluate pancreatic cystic lesion." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology. There is a mild hepatic\nsteatosis with a fat fraction of 5.8%. No suspicious focal liver lesion\nidentified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder is surgically absent.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: Spleen is normal in size. There is redemonstration of two T1\nhypointense round lesions in the anterior aspect of the spleen. They are \nstable in size, measuring 8 mm and 13 mm (previously, 8 mm and 14 mm,\nrespectively, on MRI scan from ___. The larger lesion demonstrates subtle\nhyperintensity on the T2 weighted images and areas of susceptibility are seen\nwithin it on T1 weighted images suggestive of hemosiderin. This lesion shows\nperipheral enhancement with progressive centripetal enhancement on delayed\nphase images. The smaller nodule appears to grossly exhibit similar imaging\nfeatures, but is too small to be accurately characterized.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: T2 hyperintense lesions measuring less than 5 mm bilaterally are\nconsistent with simple cysts. Other than these, the kidneys enhance and\nexcrete symmetrically without suspicious lesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Two splenic lesions measuring 8 mm and 13 mm are stable in size when\ncompared with the MRI study from ___. Imaging features and interval\nstability suggests that these are benign in etiology and may reflect fibrosed\nhemangiomas or littoral cell angiomas.\n2. Mild hepatic steatosis." }, { "input": "Lower Thorax: There is a moderate right pleural effusion with associated\natelectasis which appears slightly decreased in size compared to the CT from ___.\n\nLiver: The liver is shrunken with hypertrophy of the left hepatic lobe and\nnodular contour, compatible with cirrhosis. Again seen is a prominent\nparaumbilical vein which was recannulized on the prior CT. There is no\nevidence of signal dropout on out of phase imaging to suggest diffuse hepatic\nsteatosis. No focal hepatic lesions are seen within the limitation of\nnoncontrast imaging.\n\nBiliary: The gallbladder is present and contains gallstones There is no\nintrahepatic or extrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in signal intensity without pancreatic ductal\ndilatation or peripancreatic fluid.No pancreatic lesions are seen.\n\nSpleen: The spleen is enlarged.\n\nAdrenal Glands: The adrenal glands are normal in shape and size.\n\nKidneys: The kidneys demonstrate normal corticomedullary differentiation and\nare symmetric and normal in size without hydronephrosis.No renal lesions are\nseen.\n\nGastrointestinal Tract: The visualized large and small bowel demonstrate\nnormal thickness and caliber.\n\nLymph Nodes: Again seen are prominent upper abdominal lymph nodes, likely\nrelated to cirrhosis and portal hypertension.\n\nVasculature: The abdominal aorta is normal in size.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen. \nThe body wall is within normal limits.\n\nThere is moderate ascites.", "output": "Limited exam. The patient declined both breath holding and IV contrast citing\nprior issues with venous access and multiple repeated prior attempts.\n\nCirrhosis with the sequela of portal hypertension including splenomegaly,\nmoderate ascites, and prominent paraumbilical vein which was recannulized on\nthe prior abdomen CT from ___. No suspicious masses are seen on\nT2 or diffusion-weighted imaging, however evaluation is limited due to the\nlack of intravenous contrast and the presence of respiratory motion artifact.\n\nMultiphasic CT would be a better study for evaluation of HCC in a patient who\nis unable to breath hold if IV access could be addressed.\n\nCholelithiasis.\n\nRECOMMENDATION(S):\nMultiphasic CT would be a better study for evaluation of HCC in a patient who\nis unable to breath hold if IV access could be addressed.\n\nNOTIFICATION: The impression and recommendation above was e-mailed by Dr.\n___ on ___ at 14:02 to Dr. ___." }, { "input": "Lower Thorax: Lung bases are clear. No pleural or pericardial effusion.\n\nLiver: Liver capsule is smooth. Hepatic parenchyma is homogeneous. A few\npunctate T2 hyperintense lesions within the liver likely represent cysts or\nbiliary hamartomas. 1.1 cm T2 hyperintense arterially hyperenhancing lesion\nwithin the left lobe of the liver likely represents a hemangioma, unchanged\ncompared to prior (series 5, image 12 and series 14, image 41). However,\nthere is an additional 11 mm hypoenhancing lesion within the left lobe of the\nliver, which fills in on the delayed phase images, likely a hemangioma,\nhowever this lesion is not seen on the T2 weighted images (series 1201, image\n39).\n\nBiliary: No intra or extrahepatic biliary dilatation. Gallbladder\nunremarkable in appearance.\n\nPancreas: Pancreas is normal in bulk and signal intensity. No focal\npancreatic lesions. No ductal dilatation. No peripancreatic stranding.\n\nSpleen: Spleen is not enlarged. No focal splenic lesions.\n\nAdrenal Glands: Adrenal glands are normal in size and shape bilaterally.\n\nKidneys: 3.5 cm cyst arising from the upper pole of the right kidney with a\nfew thin septations. Additional subcentimeter simple cysts within the kidneys\nbilaterally. Otherwise, the kidneys enhance homogeneously and symmetrically. \nNo enhancing renal lesions. No hydronephrosis. No perinephric stranding.\n\nGastrointestinal Tract: There is a large heterogeneously enhancing pelvic\nmass, which measures approximately 10.9 x 10.7 x 10.9 cm, and is similar in\nsize compared to the CT dated ___ given differences in technique. \nThere are central nonenhancing components, likely reflecting necrosis. This\nmass appears to have a large sigmoid intraluminal component, making\ngastrointestinal origin likely (series 1202, image 44 and series 9, image 69).\nThere is a smaller heterogeneously enhancing mass just superior to the pelvic\nmass measuring 3.7 x 2.6 cm, either a lobulated component of the dominant\npelvic mass or an adjacent metastatic lymph node, which is also unchanged\ncompared to the prior CT (series 1201, image 42). The stomach, small, and\nproximal large bowel are unremarkable in appearance. No bowel obstruction.\n\nLymph Nodes: No new upper mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Major abdominal branches are\npatent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. \nSurrounding soft tissues are unremarkable in appearance.", "output": "1. 10.9 cm heterogeneously enhancing pelvic mass with central necrosis,\nunchanged in size compared to the prior CT dated ___. Large sigmoid\nintraluminal component, suggesting this mass is of gastrointestinal origin.\n2. 3.7 cm mass just superiorly, either a lobulation from the dominant pelvic\nmass, or an adjacent metastatic lymph node, also unchanged.\n3. 11 mm hypoenhancing lesion within the left lobe of the liver, which fills\non the delayed phase images, likely a hemangioma, however this lesion is not\nseen on the T2 weighted images. Attention on follow-up is recommended. \nAlternatively, a dedicated liver MRI could be performed for further\ncharacterization.\n4. 3.5 cm Bosniak II lesion within the upper pole the right kidney, for which\nno dedicated follow up is needed." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are smooth. No solid\nor cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: There are three stable pancreatic cystic lesions in the head, body,\nand tail of the pancreas most in keeping with side-branch IPMN. In the head\nand tail, the cysts measure 3 and 2 mm respectively. In the body of the\npancreas, the cyst measures 13 x 16 mm. No nodularity or duct abnormality. \nThe pancreatic parenchyma maintains normal bulk, intrinsic hyperintense T1\nsignal and enhancement pattern.\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid or cystic lesions. \nNo hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "Multiple stable pancreatic cystic lesions are most in keeping with side-branch\nIPMN. Follow-up MRCP in ___ year is recommended." }, { "input": "Lower Thorax: Visualized lung bases are clear without pleural or pericardial\neffusion.\n\nLiver: Multiple nonenhancing T2 hyperintensities scattered throughout the\nliver, the largest in segment VI of the liver measuring up to 6 mm (04:25),\nare similar to prior examination in most likely represent simple cysts or\nbiliary hamartomas. Otherwise, the liver demonstrates normal contour and\nsignal intensity.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nNo bile duct strictures or other findings to suggest large duct primary\nsclerosing cholangitis. The gallbladder is unremarkable.\n\nPancreas: 1.9 x 1.7 T2 hyperintensity in the pancreatic body (8:25)\npreviously measured 1.6 x 1.5 cm most likely a side-branch IPMN. Previously\nseen subcentimeter cystic lesion in the pancreatic neck is not well visualized\non current examination. Otherwise, the pancreas demonstrates intrinsic T1\nhyperintensity without concerning lesions. The main pancreatic duct is not\ndilated.\n\nSpleen: The spleen is normal in size with normal signal intensity. No focal\nsplenic lesion identified.\n\nAdrenal Glands: The adrenal glands are normal in size and signal intensity\nwithout discrete lesions or nodularity.\n\nKidneys: The bilateral kidneys demonstrate normal size and corticomedullary\ndifferentiation. No concerning renal lesions identified. There is no\nhydronephrosis or proximal hydroureter.\n\nGastrointestinal Tract: The stomach and visualized loops of small large bowel\nare unremarkable without wall thickening or bowel obstruction.\n\nLymph Nodes: There are no prominent or pathologically enlarged porta hepatis,\nmesenteric or retroperitoneal lymph nodes.\n\nVasculature: The aorta and major branches demonstrate normal T2 vascular flow\nvoids without stenosis, ectasia or aneurysm formation. Conventional hepatic\narterial anatomy. The portal vein is patent.\n\nOsseous and Soft Tissue Structures: T12 vertebral hemangioma is noted. \nNormal bone marrow signal intensity. No concerning osseous lesions\nidentified. No soft tissue abnormalities.", "output": "Slight interval increase in size of cystic lesion in the pancreatic body, now\nmeasuring up to 1.9 cm. No new or concerning pancreatic lesions identified.\nPer departmental guidelines, follow-up MRCP in 6 months is recommended.\n\nRECOMMENDATION(S): Per departmental guidelines, follow-up MRCP in 6 months is\nrecommended." }, { "input": "Lower Thorax: Visualized lung bases are clear. Cardiomediastinal structures\nare normal.\n\nLiver: Normal in size. Parenchyma is normal in signal. There are a few\nscattered foci of high T2 signal consistent with biliary hamartomas. No solid\nmass noting limitations of non contrast exam.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nwall is of normal caliber. No gallstone.\n\nPancreas: Normal in size. Parenchyma is normal in signal. Main pancreatic duct\nis not dilated. At the body/tail of the pancreas there is a 1.8 cm cystic\nlesion which is unchanged in size when compared to prior consistent with a\nside-branch IPMN.\n\nSpleen: Normal in size and signal.\n\nAdrenal Glands: Normal in size and signal. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size and signal.\n\nGastrointestinal Tract: Normal caliber loops of small bowel and colon.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal. \nIncidentally noted is a butterfly vertebra anomaly of the S1 vertebral body.", "output": "Again seen is the 1.8 cm cystic lesion at the pancreas unchanged when compared\nto prior consistent with side-branch IPMN. Follow-up in ___ year is\nrecommended.\n\nRECOMMENDATION(S): MRI in ___ year to follow-up pancreatic cystic lesion." }, { "input": "Lower Thorax: There is mild bibasilar atelectasis and a trace right pleural\neffusion. Within the limitations of MRI, no large consolidation or nodule is\nidentified. The base of the heart is normal in size. There is no pericardial\neffusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is mild hepatic steatosis with a fat fraction of\napproximately 5%. In segment 7, there is a 13 x 13 mm T2 hyperintense\nnonenhancing lesion, which is compatible with a cyst. There is a similar 5 mm\nlesion in segment ___ (1102, 68). In segment 2, it there is a 7 mm focus of\narterial hyperenhancement which is slightly hyperintense on the T2 weighted\nimages (6, 18). The enhancement persists and slightly increases on the\ndelayed phases, and is most compatible with a hemangioma. The hepatic\narterial anatomy is conventional. The portal and hepatic veins are patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal. No stones are identified.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or solid mass. In the inferior head\nof the pancreas, there is a 3 mm cystic lesion, which is likely a side-branch\nIPMN.\n\nSpleen: The spleen is normal in size, measuring 8.6 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are both mildly thickened without\na discrete nodule.\n\nKidneys: The kidneys are normal in size. There are multiple subcentimeter\nsimple cysts. There are no worrisome renal lesions, hydronephrosis, or\nperinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction tissue. The imaged portions of\nthe large bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild multilevel degenerative changes are noted in the spine. Enhancement\naround a healing nondisplaced right posterior tenth rib fracture is noted, and\nin keeping with the fracture seen on the recent CT. No other fractures are\nidentified. There is abnormal ill-defined T2 hypointense signal in the\nperiphery of the subcutaneous fat circumferentially around the abdomen. It is\nmildly enhancing. This is nonspecific.", "output": "1. Hepatic cysts and a single hepatic hemangioma. No worrisome liver\nlesions.\n2. Mild hepatic steatosis.\n3. Healing right tenth rib fracture.\n4. Subcentimeter pancreatic cystic lesion, which is likely a side-branch\nIPMN. Per departmental protocol, a follow-up MRCP is recommended in ___ year.\n5. Ill-defined abnormal low T2-signal in the subcutaneous fat of the abdomen,\nwhich is nonspecific. Correlation with prior procedures and a skin exam is\nrecommended.\n\nRECOMMENDATION(S): MRCP in ___ year." }, { "input": "Lower Thorax: No pleural or pericardial effusion.\n\nLiver: The liver appears homogeneous in signal intensity. There is a stable\n1.4 cm T2 hyperintense lesion at the liver dome (segment 7) which on prior\nexam was compatible with a hepatic cyst. Multiple additional smaller hepatic\ncysts are noted.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. The\ngallbladder appears within normal limits.\n\nPancreas: The pancreas appears homogeneous in signal intensity. There is no\npancreatic ductal dilatation. There is a stable 7 mm cystic lesion in the\nuncinate process of the pancreas. No peripancreatic fluid collections are\nnoted.\n\nSpleen: The spleen appears homogeneous in signal intensity and normal in size.\n\nAdrenal Glands: The adrenal glands appear symmetric in size and normal in\nsignal intensity.\n\nKidneys: The kidneys are symmetric in size. There are numerous small\nbilateral renal cysts, the largest in the upper pole of the right kidney\nmeasuring 8 mm. There is no hydronephrosis bilaterally.\n\nGastrointestinal Tract: The visualized portions the gastrointestinal tract\nappear within normal limits.\n\nLymph Nodes: No pathologic lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Visualized\nsubcutaneous soft tissues are unremarkable.", "output": "Stable 7 mm cystic lesion in the uncinate process of the pancreas. This again\nmay reflect side-branch IPMN and follow-up MRI in ___ years is recommended.\n\nRECOMMENDATION(S): Follow-up MRCP in ___ years is recommended." }, { "input": "Lower Thorax: The lung bases are clear. Heart size is normal.\n\nLiver: The liver is normal in morphology and signal intensity. There is no\ndrop of signal on out-of-phase imaging to suggest steatosis. There are no\nfocal hepatic lesions. Foci of FDG uptake in the caudate lobe on PET-CT does\nnot have an MRI correlate. There is no ascites.\n\nBiliary: The gallbladder is unremarkable without stones. There is no intra or\nextrahepatic biliary duct dilation.\n\nPancreas: The pancreas is normal in morphology and signal intensity. There is\nno main pancreatic duct dilation. There is no evidence of pancreas divisum. \nNote is made of a 0.3 cm cystic pancreatic lesion in the head (series 3, image\n17).\n\nSpleen: The spleen is normal in size and signal intensity. Note is made of\ntwo millimetric T2 hyperintense lesions in the inferior aspect of the spleen,\nlikely cysts.\n\nAdrenal Glands: The right adrenal gland is unremarkable. There is mild\nthickening of the inferior aspect of the left adrenal gland without discrete\nnodularity.\n\nKidneys: The kidneys are symmetric in size. No focal renal lesion is seen. \nThere is no hydronephrosis.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable.\n\nLymph Nodes: Prominent left retroperitoneal lymph nodes measuring up to 0.7 cm\nare unchanged and were without FDG avidity on recent PET. There is no\nmesenteric adenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional. There is a single renal artery bilaterally. The portal vein\nand hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. There\nis a small fat containing umbilical hernia.", "output": "1. No suspicious liver lesions. No correlate to caudate lobe lesion on PET.\n2. 0.3 cm cystic lesion in the pancreatic head, likely a side-branch IPMN. \nPer departmental protocol an MRCP without contrast is recommended in ___ year to\nevaluate for stability.\n\nRECOMMENDATION(S): Noncontrast MRCP in ___ year" }, { "input": "Lower thorax: There is no pleural effusion.\n\nLiver: The liver demonstrates homogeneous signal intensity throughout. There\nis no significant drop in signal on opposed phase imaging to suggest hepatic\nsteatosis. No suspicious hepatic lesions are identified.\n\nBiliary: There is no biliary dilation. Gallbladder is unremarkable in\nappearance.\n\nPancreas: The pancreas is atrophic. No focal parenchymal lesions are\nidentified. There is no main duct dilation.\n\nSpleen: Spleen is normal in size, without focal lesions.\n\nAdrenal Glands: There is a 1.4 x 1.4 cm right adrenal nodule with drop in\nsignal on opposed phase imaging, compatible with an adenoma (1301:67). Left\nadrenal gland is normal in size and shape.\n\nKidneys: Right-sided nephroureteral stent is noted. No solid parenchymal\nlesions are identified. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable in appearance. Patient\nis status post colectomy, with a right lower quadrant ileostomy..\n\nPelvis: Patient is post prostatectomy and radical cystectomy with ileal\nconduit creation and left lower quadrant urostomy. Ill-defined soft tissue\nwith restricted diffusion in the presacral space appears overall improved\ncompared to the prior CT performed on ___, and likely represent\npost-treatment changes (8:65, 9:31). No new areas of soft tissue nodularity\nare seen to suggest local recurrence.\n\nLymph Nodes: There is no abdominal or pelvic lymphadenopathy.\n\nVasculature: Abdominal aorta is not aneurysmal. Celiac artery, SMA, and\nbilateral renal arteries are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified.", "output": "1. Post pelvic exenteration, without evidence of local recurrence or distal\nabdominopelvic metastases.\n2. Ill-defined soft tissue with restricted diffusion in the presacral space\nhas improved from ___, and is likely related to prior treatment.\n3. 1.4 cm right adrenal adenoma." }, { "input": "Lower thorax: Lung bases are clear. No pleural pericardial effusion.\n\nLiver: Liver capsule is smooth. Liver parenchyma is homogeneous. No focal\nliver lesions.\n\nBiliary: No intra or extrahepatic biliary dilatation. Gallbladder is\nunremarkable in appearance.\n\nPancreas: The pancreas is markedly atrophic. No ductal dilatation. No\nperipancreatic stranding.\n\nSpleen: Spleen is not enlarged. No focal splenic lesions.\n\nAdrenal Glands: There is a 1.7 x 1.1 cm right adrenal nodule which drops in\nsignal on the out of phase images, compatible with an adenoma. The left\nadrenal gland is normal in size and shape.\n\nKidneys: A percutaneous nephrostomy is seen terminating within the proximal\ncollecting system of the right kidney. There is mild right\nhydroureteronephrosis to the level of the neobladder. There are multiple foci\nof scarring throughout the right kidney, likely reflecting chronic\nobstruction. There is also enhancement along the length of the right ureter,\nlikely related to chronic inflammation. There is no left hydronephrosis. \nMultiple cysts are seen within the kidneys bilaterally. No enhancing lesions.\nNo perinephric fluid collections.\n\nGastrointestinal Tract: The patient is status post total colectomy. A right\nlower quadrant ileostomy is unremarkable in appearance. Otherwise, the\nstomach and small bowel loops are unremarkable in appearance without evidence\nof bowel obstruction.\n\nPelvis: The patient is status post pelvic exenteration with prostatectomy and\nradical cystectomy. A neobladder is visualized with a left lower quadrant\nileal conduit, which is unremarkable in appearance without evidence of\nparastomal hernia. There is minimal pelvic free fluid. Presacral\nposttreatment changes are unchanged. There is no evidence of local\nrecurrence.\n\nLymph Nodes: No new mesenteric, retroperitoneal, pelvic, or inguinal\nlymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Major abdominal branches appear\npatent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Right\nlower quadrant ileostomy and left lower quadrant urostomy are unremarkable in\nappearance.", "output": "1. Status post pelvic exenteration with prostatectomy, radical cystectomy,\nneobladder formation and left lower quadrant urostomy without evidence of\nlocal recurrence or distant metastatic disease within the abdomen or pelvis.\n2. Mild right hydroureteronephrosis to the level of the neobladder.\n3. 1.7 cm right adrenal adenoma." }, { "input": "Lower thorax: Please refer to the separate chest CT dictation regarding\nintrathoracic findings.\n\nLiver: The hepatic parenchyma demonstrates signal intensity on T1 and T2\nweighted sequences. No focal hepatic lesion is detected.\n\nBiliary: There is no intra or extrahepatic bile duct dilation. The\ngallbladder demonstrates minimal wall thickening at the fundus, compatible\nwith adenomyomatosis. No ductal stones are detected.\n\nPancreas: The pancreas is severely atrophic, as seen on the prior\nexaminations. No focal mass or duct dilation is detected.\n\nSpleen: The spleen size is within normal limits. There are no focal splenic\nlesions.\n\nAdrenal Glands: The patient is post right adrenalectomy. The left adrenal\ngland appears normal.\n\nKidneys: The right kidney has been resected. The left kidney enhances\nnormally, without hydronephrosis or atrophy. There is a 1.1 cm left upper\npole simple renal cyst (series 6, image 24). No focal renal mass is detected.\nThe remnant distal right ureter is visualized (series 19, image 26).\n\nGastrointestinal Tract: The stomach and intra-abdominal and intrapelvic loops\nof small bowel are normal in caliber. The patient is post total\nproctocolectomy.\n\nPelvis: The patient is post total pelvic exenteration. There is a left lower\nquadrant urostomy and right lower quadrant ileostomy, without evidence of\nhernia or obstruction.\n\nLymph Nodes: There is no mesenteric, retroperitoneal, inguinal, or intrapelvic\nlymphadenopathy, and no ascites.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, renal arteries, and iliac\nbranches are patent and normal in caliber.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. Post right total nephrectomy, right adrenalectomy, and total pelvic\nexenteration. No abdominopelvic metastasis or lymphadenopathy.\n2. Please refer to the separate chest CT dictation regarding intrathoracic\nfindings." }, { "input": "LOWER CHEST: Please refer to separate report of CT chest performed on the same\nday for description of the thoracic findings.\n\nABDOMEN:\n\nLIVER: The liver is normal in signal intensity and enhancement. No hepatic\nsteatosis. No focal concerning lesions. The portal veins and hepatic veins\nappear patent. Hepatic arterial anatomy is conventional.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation. There\nis fundal adenomyomatosis. The gallbladder is otherwise normal.\n\nPANCREAS: The pancreas is severely atrophic. No main pancreatic duct\ndilation. No focal pancreatic lesions identified.\n\nSPLEEN: The spleen is normal size and signal intensity. No focal concerning\nlesions.\n\nADRENALS: Patient appears status-post right adrenalectomy. The left adrenal\ngland is normal.\n\nURINARY: Patient appears status-post right nephrectomy. The left kidney is\nnormal in nephrogram, excepting a small unchanged defect in the lateral\ninterpolar kidney likely reflecting prior infectious or ischemic insult\n(series ___, image 87). There is a simple anterior interpolar renal cyst\nmeasuring up to 1.2 cm. No hydronephrosis. No concerning lesions. A remnant\nmid and distal right ureter is again seen with a hyperenhancing wall, but\nwithout focal nodularity, likely reflecting inflammation given a presumed\nanastomosis to the diverting ileal loop.\n\nGASTROINTESTINAL: Patient is status-post total proctocolectomy and right lower\nquadrant ileostomy. Non masslike irregular soft tissue in the presacral\npelvis tethering loops of small bowel is unchanged, likely postsurgical\nfibrosis. Small bowel loops are normal in caliber and wall thickness. No\nobstruction. The stomach is unremarkable.\n\nPELVIS: Patient is status-post pelvic exenteration. There is a left lower\nquadrant urostomy.\n\nLYMPH NODES: No abdominopelvic lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm.\n\nBONES: No concerning osseous lesion. A sacral osseous lesion is unchanged\nsince at least ___.\n\nSOFT TISSUES: No concerning soft tissue lesions.", "output": "1. Stable postoperative changes without evidence of abdominopelvic recurrence\nor metastasis.\n2. Diffuse abnormal enhancement of the remnant mid and distal right ureter\nlikely reflects inflammation related to reflux and stasis given presumed\nanastomosis to a diverting ileal loop." }, { "input": "A previously-seen fungating intraluminal bladder mass arising from the left\nlateral bladder wall appears resected, with residual asymmetric thickening up\nto 9 mm (17: 36-44), smoother in contour, with mild mucosal hyperenhancement\n(1303:23). There is mild stranding along the adjacent perivesicular fat\n(17:42). The left ureteral orifice lies approximately 1.5 cm from the\nthickened area.\n\nPreviously seen external iliac node with diameter of 7 mm is unchanged\n(08:17). Additional smaller external iliac nodes are seen more superiorly.\n\nThere is no hydroureteronephrosis. No urothelial wall thickening or filling\ndefect is identified within the ureters or renal pelvises bilaterally.\n\nThere are bilateral renal cysts, the largest measuring 5.4 cm within the\nlateral aspect of the left mid kidney. The majority are simple in appearance\nwith T2 hyperintensity, T1 hypointensity and lack enhancement. There is a\nsingle 3.4 cm cyst at superior pole of the left kidney which demonstrates\nintermediate signal on both T1 and T2 weighted sequences prior to\nadministration of gadolinium. This also is nonenhancing, and is thought to\nrepresent a cyst with proteinaceous or hemorrhagic contents. There is no solid\nrenal parenchymal lesion.\n\nThere are degenerative changes of the lower lumbar spine. Asymmetric right\nsided synovial enhancement surrounding the hip joint is also noted.", "output": "1. Focal thickening and hyperenhancement of the left bladder wall, with\nperivesicular fat stranding, are at least partially due to post-treatment\nchanges; however, residual/recurrent tumor cannot be excluded by imaging,\nparticularly in the setting of abnormal urine cytology.\n2. Unchanged prominent external iliac nodes, none meeting strict\ncross-sectional criteria for lymphadenopathy.\n3. No synchronous urothelial tumor of the upper collecting system is\nidentified." }, { "input": "Lower Thorax: Limited evaluation of the lung bases are clear. There is\nrightward mediastinal shift with the heart in right hemithorax due to patients\nknown hypoplastic right lung. No pleural effusion.\n\nLiver: The liver is homogeneous in signal intensity without suspicious mass. \nNo imaging features suggestive of cirrhosis. There is mild signal drop on out\nof phase imaging consistent with mild hepatic steatosis (fat fraction 8.6%). \nNo ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary dilatation. The common bile\nduct smoothly tapers to level of the ampulla without obstructing stone or\nperiampullary mass. Gallbladder is unremarkable. No gallstones.\n\nPancreas: Pancreas is otherwise homogeneous in signal intensity. No\npancreatic duct dilatation or peripancreatic fat stranding. There is a 0.5 x\n0.5 cm T2 hyperintense lesion within the pancreatic body, corresponding to\nabnormality noted on cardiac MR from ___. (04:20). No\nadditional pancreatic lesions are seen.\n\nSpleen: The spleen is normal in size without suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: A 0.5 x 0.7 x 0.6 cm T2 hyperintense, T1 hypointense lesion in the\nleft upper pole corresponds to the abnormality noted on Cardiac MR and is most\nconsistent with a simple renal cyst (3:8). An additional 0.2 cm T2\nhyperintense cystic lesion in the right lower pole is noted (04:32), also\nlikely a simple cyst. Bilateral kidneys are otherwise homogeneous in signal\nintensity without suspicious mass.\n\nGastrointestinal Tract: Status post Nissen fundoplication with associated\npostsurgical changes. Stomach, visualized small large bowel are otherwise\nunremarkable. No obstruction.\n\nLymph Nodes: Retroperitoneal and mesenteric lymph nodes are nonenlarged.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissues are unremarkable.", "output": "1. 0.5 cm pancreatic cystic lesion, likely side branch IPMN (intraductal\npapillary mucinous neoplasm).Normal main pancreatic duct. Follow-up MRCP in ___\nyear is suggested to confirm expected stability.\n2. 0.7 and 0.2 cm bilateral simple renal cysts. No suspicious renal mass.\n3. Mild hepatic steatosis.\n\nRECOMMENDATION(S): Recommend follow-up MRCP without contrast in ___ year to\nassess for interval change in the pancreatic cystic lesion." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver:. The liver demonstrates a lobulated contour with nodularity. There is\na 1.6 x 1.9 cm. T2 intermediate intensity lesion in hepatic segment VIII\nwhich demonstrates peripheral nodular enhancement with some fill-in, although\nslightly atypical, is most consistent with a hemangioma (series 16, image 20).\nThere is an additional subcentimeter intermediate intensity lesion in hepatic\nsegment V/VIII, possibly an additional hemangioma. There is a subcentimeter\ncyst in segment II (series 10, image 24).\n\nA questionable area of arterial enhancement and washout is demonstrated\nimmediately posterior to the left hepatic pain in segment 2 of the liver at\nits posterosuperior aspect (series 19, image 10, series 14, image 27). This\nmeasures 11 mm in diameter. Evaluation of this region is somewhat limited by\npulsation artifact from the aorta in addition to misregistration of pre and\npostcontrast images.\n\nAn intrinsically T1 hyperintense exophytic lesion is seen along the posterior\naspect of segment 3 (series 10, image 52). Again evaluation is limited by\nmisregistration of pre versus postcontrast images however this appears to\nintrinsically be T1 hyperintense but also enhance postcontrast. This measures\n7 mm in diameter and there is no evidence of washout.\n\nThe liver is markedly heterogeneous in enhancement on arterial phase imaging\nwith more normal enhancement on delayed phase imaging.\n\nThere is no significant drop of signal on out of phase imaging to suggest\nhepatic steatosis. There is moderate volume ascites. The portal vein is\npatent. There is a recanalized paraumbilical vein. Note is made of\nintra-abdominal, primarily perisplenic varices. There are paraesophageal\nvarices.\n\nBiliary: The gallbladder is notable for wall edema, which can be seen in the\nsetting of liver disease. There is no intra or extrahepatic biliary duct\ndilation.\n\nPancreas: The pancreas is normal in signal intensity. There is no pancreatic\nduct dilation. There is no focal pancreatic lesion.\n\nSpleen: Spleen is top-normal in size measuring 12.2 cm.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys enhance homogeneously and are symmetric in size.\n\nGastrointestinal Tract: Small and large bowel are unremarkable.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: Arterial vasculature is patent. Hepatic arterial anatomy is\nconventional. There is no aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesions. \nThere is no soft tissue abnormality.", "output": "1. Lobulated nodular liver contour, compatible with underlying cirrhosis. \nLesion seen on ultrasound is consistent with a hemangioma.\n2. Equivocal 1.1 cm lesion posterior to the left hepatic vein in segment 2\ndoes not meet OPTN criteria for HCC. Recommend attention on follow-up exam.\n3. Segment 3 posterior exophytic T1 hyperintense lesion with arterial\nenhancement does not demonstrate washout or meet OPTN criteria for HCC.\n4. Markedly heterogeneous hepatic arterial enhancement with progressive\nnormalization, likely perfusional in the setting of underlying liver\ndysfunction.\n5. Sequela of portal hypertension including intra-abdominal and paraesophageal\nvarices and moderate volume ascites.\n6. Gallbladder wall edema likely secondary to underlying liver disease.\n\nRECOMMENDATION(S): MRI surveillance." }, { "input": "Lower Thorax: Limited evaluation of the lung bases is notable for mild right\nbasilar atelectasis. There is no pleural effusion.\n\nLiver: The liver is normal in morphology. There is slight drop in signal on\nin phase imaging, suggestive of iron deposition. There are no concerning\nfocal hepatic lesions within the limitations of a noncontrast study. There is\na small amount of perihepatic and perisplenic free fluid.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is mildly distended, and contains numerous small stones,\nsimilar to prior, as well as concentrated bile.\n\nPancreas: There is slight decrease in size of a cystic lesion in the body of\nthe pancreas measuring 9.1 x 5.2 cm, previously 9.7 x 5.8 cm, with internal\ndebris demonstrating susceptibility artifact, consistent with hemorrhagic\nmaterial. The T2 hyperintense, T1 mildly hypointense collection between the\npancreatic body and stomach is decreased in size, measuring 5.3 x 3.8 cm,\npreviously 6.1 x 5.0 cm (15:18). The previously seen less organized\ncollection along the pancreatic tail is decreased in size, with the dominant\nportion measuring 5.6 x 2.3 cm the, previously 9.4 x 6.3 cm (15:18), with\npossible connection to the dominant pancreatic body collection. The\npancreatic parenchyma in the pancreatic head and uncinate process demonstrate\nnormal signal intensity, and the pancreatic tail demonstrates mild atrophy\nthough retains intrinsic T1 signal. There is no main pancreatic ductal\ndilatation in the pancreatic tail.\n\nSpleen: The spleen is enlarged, measuring 13.6 cm in axial dimension, without\nfocal lesions.\n\nAdrenal Glands: The right and left adrenal glands are normal in size and\nmorphology.\n\nKidneys: The kidneys are normal and symmetric in size. There are no\nconcerning renal lesions within limitations of a noncontrast study. There is\nno hydronephrosis.\n\nGastrointestinal Tract: Visualized small and large bowel loops are\nunremarkable. There is no obstruction. Transverse mesocolonic and omental\nfluid is new from prior (15:27).\n\nLymph Nodes: There is no upper retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Mass effect of the\ndominant pancreatic collection on the portal confluence is better demonstrated\non prior contrast enhanced MR.\n\n___ and Soft Tissue Structures: There are no suspicious osseous lesions.", "output": "1. Slight decrease in size of walled-off necrosis in the pancreatic body with\nhemorrhagic debris, now measuring 9.1 x 5.2 cm, and slight decrease in size of\nwalled-off necrosis between the pancreatic body and stomach, now measuring 5.3\nx 3.8 cm.\n2. Substantially decreased size of previously seen less organized fluid\ncollection, with dominant portion now measuring approximately 5.6 x 2.5 cm.\n3. Increased perihepatic, perisplenic and transverse mesocolonic/omental\nfluid, which may reflect rupture of a peripancreatic collection.\n4. Similar pancreatic duct disruption related to the dominant walled off\nnecrosis in the pancreatic body.\n5. Cholelithiasis." }, { "input": "NOTE: The postcontrast images are motion limited due to lack of breath\nholding.\n\nLower Thorax: There is minimal bibasilar linear atelectasis. A pleural based\nenhancing opacity measuring 1.5 cm in the left lower lobe (series 1101, image\n31) is likely atelectasis given the enhancement pattern. No pleural or\npericardial effusion.\n\nLiver: The liver demonstrates homogeneous signal intensity on T2 weighted\nimages. There is no drop in signal on the out of phase images to suggest\npresence of steatosis.\n The homogeneously echogenic lesion noted on 2 prior ultrasounds\ndemonstrates a uniform intermediate hyperintense signal on the T2 weighted\nimages with discontinuous peripheral nodular enhancement on the postcontrast\nimages compatible with a cavernous hemangioma. This lesion is located at the\njunction of segment VII; VI and the caudate lobe (series 5, image 16) and\nmeasures approximately 2.2 x 1.3 cm-with no change in size compared to ___ but minimally increased since ___.\nNo focal liver lesion with imaging characteristics suspicious for HCC.\n\nBiliary: The gallbladder is surgically absent. There is mild central\nintrahepatic biliary ductal dilation with the CHD measuring up to 7 mm in\ndiameter, tapering normally towards the ampulla. This is likely related to\nprior cholecystectomy. A 2 mm rounded T2 hypointense signal within the distal\nCBD (series 3, image 17 and series 5, image 29) may represent\ncholedocholithiasis.\n\nPancreas: The pancreatic parenchyma is normal in signal intensity and\nenhancement without main duct dilation. No focal pancreatic masses\nidentified.\n\nSpleen: No splenomegaly or focal splenic lesions.\n\nAdrenal Glands: There are no adrenal nodules.\n\nKidneys: No hydronephrosis or solid enhancing renal masses identified.\n\nGastrointestinal Tract: There is a small hiatus hernia. There is no bowel\nobstruction.\n\nLymph Nodes: There are no enlarged upper abdominal lymph nodes.\n\nVasculature: The visualized portions of the abdominal aorta and IVC; the main\nportal vein and its branches are patent. The hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: Multilevel degenerative disc disease is\nnoted in the lumbar region.", "output": "1. The echogenic lesion described on the ultrasound dated ___\ncorresponds to a cavernous hemangioma located at the junction of segment VI;\nVII and caudate lobe with no change in size compared to the ultrasound and\nminimal increase in size since ___.\n2. There are no suspicious liver lesions with imaging findings compatible with\nHCC.\n3. There is a rounded 2 mm T2 hypointense filling defect in the distal CBD\nthat may represent choledocholithiasis." }, { "input": "Lower Thorax: Bilateral linear lower lobe atelectasis. No pleural effusion.\n\nLiver: The liver is not dysmorphic and there is no hepatic steatosis. \nPost-contrast images are degraded by motion artifact. Again noted is a 2.3 cm\nhemangioma in the caudate lobe one measuring 3.2 cm at the junction of segment\nV/VIII. No new focal liver lesion identified.\n\nBiliary: Status post cholecystectomy. No intra or extra biliary duct\ndilatation.\n\nPancreas: The pancreas is normal in signal and bulk. No main duct dilatation.\nNo focal lesion.\n\nSpleen: The spleen is homogeneous and normal in size.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: Unremarkable. No hydronephrosis.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No abdominal adenopathy. No ascites.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No focal concerning lesion.", "output": "No new focal concerning liver lesion.\nTwo liver hemangiomas." }, { "input": "Lower Thorax: No large lung mass or pleural effusion is identified\n\nLiver: Mild liver parenchymal signal dropout on out of phase images compared\nto the inphase likely reflect mild hepatic steatosis.\n\nBiliary: Intra and extrahepatic bile ducts are not dilated. Gallbladder is\nunremarkable.\n\nPancreas: Pancreas demonstrates homogeneous enhancement throughout. \nPancreatic duct is not dilated.\n\nSpleen: Spleen is normal size.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: 4.1 x 3.2 cm T2 hyperintense lesion demonstrates no suspicious\nenhancement, compatible with a simple renal cyst. Multiple other\nsubcentimeter T2 hyperintense lesions in bilateral kidneys are also compatible\nwith renal cysts.\n0.5 cm hyperintensity in mid left kidney is likely a hemorrhagic cyst.\nThere is no hydronephrosis.\n\nGastrointestinal Tract: Stomach is unremarkable. Small and large bowel loops\nare normal caliber.\n\nLymph Nodes: There is no lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Portal venous system is\npatent.\n\nOsseous and Soft Tissue Structures: No suspicious bone or soft tissue lesion\nis identified.", "output": "1. 4.1 cm simple left renal cyst without suspicious features.\n2. Mild hepatic steatosis." }, { "input": "Lower Thorax: No evidence of pericardial effusion, pleural effusion,\nparenchymal abnormality or lymphadenopathy.\n\nLiver: The liver is of normal size and demonstrates normal signal intensity.\n\nBiliary: No evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is of normal size and signal.\n\nPancreas: The pancreas is of normal size and signal intensity. No evidence of\npancreatic ductal dilatation or peripancreatic abnormalities.\n\nSpleen: The spleen is of normal size and signal intensity.\n\nAdrenal Glands: The adrenal glands are mildly prominent in bulk but\ndemonstrate normal signal intensity without focal lesions.\n\nKidneys: The kidneys are of normal size and signal intensity bilaterally.\n\nGastrointestinal Tract: The small and large bowel loops are of normal caliber\nand configuration. No evidence of bowel obstruction. There is a D2 duodenal\ndiverticulum.\n\nLymph Nodes: No evidence of lymphadenopathy.\n\nVasculature: There are bilateral accessory renal arteries which are patent\nwithout significant stenosis. Vasculature is patent. No evidence of aortic\naneurysm.\n\nOsseous and Soft Tissue structures: There is S-shaped scoliosis of the\nthoracolumbar spine in addition to degenerative change. Midline ventral\nabdominal wall hernia is noted. This contains a portion of the transverse\ncolon. No evidence of secondary obstruction.", "output": "No evidence of renal artery stenosis or focal adrenal lesions." }, { "input": "Lower Thorax: There is a moderate sized right pleural effusion and associated\ncompressive atelectasis. There is minimal left basilar atelectasis. No left\npleural effusion is identified. The base of the heart is normal in size. \nThere is no pericardial effusion.\n\nLiver: The liver is enlarged with a nodular contour. This suggests underlying\ncirrhosis. There is patchy mild hepatic steatosis, with a fat fraction of\napproximately 5%, which explains the heterogeneous appearance of the\nparenchyma on the recent CT. Wedge-shaped areas of restricted diffusion and\nprogressive reticular enhancement are compatible with fibrosis. The exam is\nsomewhat limited by respiratory motion. In the right lobe, there is a 7 mm T2\nhyperintense lesion, which has some mild peripheral nodular enhancement that\nslightly fills in on the delayed phases. This is most compatible with a\nhemangioma. There are a few foci of arterial hyperenhancement. The largest\nis a round focus of enhancement that measures 11 mm in segment ___ (10, 43). \nGiven the limitations of the exam, is difficult to assess for washout, though\nnone is obviously present. Several other foci are present in the right lobe,\nmeasuring 7 mm (10, 52) and 5 mm (10, 51). These also do not definitely have\nwashout. There is no correlate on the T2 weighted images or\ndiffusion-weighted images. These likely represent transient hepatic intensity\ndifferences.\n\nAlong the inferior tip of the right hepatic lobe is a loculated fluid\ncollection measuring 35 x 20 x 24 mm (2, 25 and 7, 40). It has a mildly\nenhancing rim. This likely represents loculated ascites rather than an\nabscess, as are no significant inflammatory changes in the adjacent fat. \nThere is a small amount of non loculated perihepatic ascites.\n\nThere is a replaced right hepatic artery from the ___. The portal veins are\npatent. There is a recanalized paraumbilical vein, compatible with portal\nhypertension. Varices are noted in the anterior abdomen. The hepatic veins\nare patent.\n\nBiliary: There is no intrahepatic biliary duct dilation. The common bile duct\nmeasures 8 mm, which is at the upper limits of normal after\npostcholecystectomy changes. The gallbladder is surgically absent. There is\nno abnormality in the gallbladder fossa.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass. Incidentally noted is\npancreatic divisum.\n\nSpleen: The spleen is enlarged, measuring 14.8 cm. There are no focal splenic\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. In the lower pole of the left\nkidney, there is an 8 mm cyst. The low pole the right kidney, there is some\nscarring and cortical irregularity, likely from prior infection or injury.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal.\n\nLymph Nodes: There are a few prominent periportal lymph nodes, though none\nmeet size criteria for pathologic enlargement. There is no retroperitoneal or\nmesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is mild atherosclerotic plaque. Incidentally noted are two\nbilateral inferior vena cavas.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nModerate multilevel degenerative changes are noted throughout the spine. The\nknown vertebral body fractures seen in the dedicated thoracic spine MRI are\nbetter assessed on that exam.", "output": "1. Cirrhotic liver with fibrosis and patchy hepatic steatosis, which explains\nthe liver's heterogeneous appearance on the recent CT.\n2. No worrisome liver lesions.\n3. Patent hepatic vasculature.\n4. Evidence of portal hypertension with splenomegaly, a recanalized\nparaumbilical vein, and a small amount of ascites, including a loculated focus\nof ascites along the right lobe of the liver.\n5. Pancreatic divisum." }, { "input": "Lower Thorax: Visualized lung bases are clear. There is no pericardial or\npleural effusion.\n\nLiver: The liver is normal in size, morphology, and signal intensity. A T2\nhyperintense 1.2 x 1.5 cm lesion in segment 7 with peripheral nodular\nenhancement likely represents a hemangioma as seen on recent ultrasound\n(3:11). An additional 1.0 x 0.9 cm T2 hyperintense lesion just inferior to\nthis in segment 7 with peripheral nodular enhancement also likely represents a\nhemangioma (3:13). A similar lesion in peripheral segment 7 (03:13) measuring\n1.0 x 0.7 cm is also consistent with a hemangioma. A 0.7 x 0.9 cm T2\nhyperintense lesion in segment 4A which appears to fill in on delayed\npostcontrast images also likely represents a hemangioma (3:13). A\nsubcentimeter T2 hyperintense lesion without significant enhancement in\nsegment 6 likely represents a cyst or biliary hamartoma. An area of focal fat\nis noted adjacent to the falciform ligament (08:50) and appears to correspond\nto the lesion seen in the left lobe on ultrasound.. There is no significant\nhepatic steatosis.\n\nBiliary: The gallbladder is within normal limits. There is no intrahepatic or\nextrahepatic biliary dilation.\n\nPancreas: Pancreas is normal bulk and signal intensity. There is no evidence\nof focal lesions.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: Adrenal glands are normal in size and shape bilaterally.\n\nKidneys: Bilateral kidneys are normal and symmetric in size. There is no\nevidence of focal lesions. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach is unremarkable. Visualized portions of\nthe large small bowel are unremarkable.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There are no aggressive osseous lesions.\n\nPelvis: Limited views from localizer images demonstrate a partially visualized\n4.4 cm right adnexal cystic lesion (1:2) which appears similar in\nconfiguration, but slightly smaller in overall size compared to CT abdomen\nfrom ___ and was better characterized on pelvic ultrasound as likely\nrepresenting a hemorrhagic cyst.", "output": "Hyperechoic lesions in the right lobe of the liver seen on ultrasound\ncorrespond to hemangiomas, the largest of which measures 1.5 cm in segment 7. \nHyperechoic lesion seen in the left lobe of the liver on ultrasound\ncorresponds to an area of focal fat adjacent to the falciform ligament.\n\nSlightly smaller size of partially visualized 4.4 cm right adnexal cystic\nlesion better characterized as a hemorrhagic cyst on pelvic ultrasound from\n___." }, { "input": "Lower Thorax: The partially visualized lung bases are clear. No pleural or\npericardial effusion.\n\nLiver: The liver contour is smooth. There is mild diffuse hepatic steatosis. \nThere is a single punctate T2 hyperintensity (series 7, image 13), likely\nrepresenting a biliary hamartoma. No enhancing liver lesions. No evidence of\nportal vein thrombosis.\n\nBiliary: No intra extrahepatic biliary dilatation. The gallbladder is normal\nin appearance.\n\nPancreas: The pancreas is normal in size and enhances homogeneously. No focal\nlesions. No pancreatic ductal dilatation. No peripancreatic stranding.\n\nSpleen: Spleen is normal in size. No focal lesions.\n\nAdrenal Glands: Adrenals are normal in size and shape bilaterally.\n\nKidneys: Within the interpolar region of the left kidney, there is a 1.5 x 1.0\nx 1.1 cm (transverse x AP x CC) cyst with a single thin septation without\nmeasurable enhancement (series 17, image 69 and series 1501, image 34). Based\non this examination, this is a Bosniak II lesion. There is an additional\nsubcentimeter simple cyst within the lower pole of the right kidney (series 6,\nimage 21). No other enhancing lesions. Otherwise, the kidneys enhance\nsymmetrically. No evidence of hydronephrosis. There is a small amount of\nperinephric stranding bilaterally.\n\nGastrointestinal Tract: There is a moderate-sized hiatal hernia. Otherwise,\nthe stomach, and partially visualized small large bowel are within normal\nlimits.\n\nLymph Nodes: No visualized mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. 1.5 cm cyst with a single thin nonenhancing septation within the interpolar\nregion of the left kidney, which is a Bosniak II lesion and does not require\nany specific follow-up.\n2. Mild hepatic steatosis.\n3. Moderate-sized hiatal hernia." }, { "input": "Lower thorax: Lung bases are clear aside from mild atelectasis on the left. \nNo evidence of pleural or pericardial effusion. Cardiomegaly is noted.\n\nLiver: The liver enhances homogeneously. There is a 1 cm hemangioma in segment\n6 (04:19). There is no significant steatosis. No liver metastases are\nidentified.\n\nBiliary: The gallbladder is unremarkable. No biliary dilation.\n\nPancreas: The pancreatic parenchyma enhances homogeneously. The main duct is\nnormal caliber. There are a few tiny T2 hyperintensities in the pancreatic\nbody and tail that may communicate with the main duct (4:22, 23) measuring 3\nmm. These may be side-branch IPMNs.\n\nSpleen: Normal sizes and enhancement. A few small nonenhancing cystic lesions\nare noted in the parenchyma, the largest measuring 1.3 cm posteriorly and\ncontaining a thin septation. These are likely benign.\n\nAdrenal Glands: Bilateral adrenals are within normal limits.\n\nKidneys: There are a few small cortical cysts bilaterally. No worrisome renal\nlesions are demonstrated. There is no hydronephrosis.\n\nGastrointestinal Tract: There are mildly prominent, but not grossly dilated,\nfluid-filled small bowel loops throughout the lower abdomen and pelvis. There\nis a moderate colonic stool load. There is no ascites.\n\nPelvis: The bladder wall is diffusely thickened, likely from chronic outlet\nobstruction. The prostate is enlarged and was better evaluated on recent\nprior dedicated study.\n\nLymph Nodes: No enlarged lymph nodes are demonstrated.\n\nVasculature: No abdominal aortic aneurysm. No other significant findings.\n\nOsseous and Soft Tissue Structures: No aggressive bone lesions are\ndemonstrated. There appears to have been prior right inguinal hernia repair. \nThere is a small left inguinal hernia containing fat and fluid.", "output": "1. No evidence of metastatic disease in the abdomen or pelvis.\n2. Tiny pancreatic cystic lesions measuring up to 3-mm, likely side-branch\nIPMNs. See management recommendations below.\n\nRECOMMENDATION(S): For management of pancreatic cyst(s) up to 5 mm in\npatients ___ years of age or older, no follow-up is required.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Lower thorax: CT abdomen and pelvis ___. Outside MRI abdomen ___.\n\nLiver: The liver enhances normally without focal lesions.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal.\n\nPancreas: Normal without focal lesions or duct dilation.\n\nSpleen: Normal in size and signal intensity.\n\nAdrenal Glands: Normal.\n\nKidneys: Kidneys are normal without hydronephrosis or worrisome mass. There\nare few scattered T2 bright cortical foci compatible with simple cysts of the\nlargest 5 mm in the lower pole of the left kidney (07:27). The included\nportions of the ureters are normal in caliber.\n\nGastrointestinal Tract: The stomach and included loops of small and large\nbowel are normal in caliber without obstruction. There is probable transient\nsmall bowel intussusception in the left lower quadrant (13:10).\n\nPelvis: Urinary bladder, prostate and seminal vesicles are unremarkable. \nThere is no pelvic wall or inguinal lymphadenopathy and no pelvic free fluid. \nA utricle cyst is incidentally noted (10:17).\n\nLymph Nodes: Irregular shaped but circumscribed fluid collection in the mid\nretroperitoneum just below the renal arteries is centered in the aortocaval\nspace and anterior to the aorta measures 5.5 x 2.1 x 3.7 cm (TRV x AP x CC)\n(09:39). This is unchanged since CT of ___. At the inferior\naspect of the collection there is a 2.1 x 1.5 cm enhancing soft tissue\ncomponent (17:80), stable in size. On MR of ___ the collection\nmeasured 3.2 x 2.5 x 3.1 cm (TRV x AP x CC), overall larger today; the solid\ncomponent is unchanged\n\nVasculature: The abdominal aorta and iliac arteries are normal in caliber and\nwell opacified. The celiac axis, SMA and bilateral renal arteries are patent.\nThe portal vein, splenic and superior mesenteric veins are patent.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is normal.", "output": "Solid and cystic lesion in the mid retroperitoneum is stable since recent CT\nbut has grown since outside MR and is worrisome for metastatic disease. \nSurgical consultation is recommended.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr. ___\n___ on ___ at 15:44 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: The bases of the lungs are clear. There is no pleural effusion.\nThe base of the heart is normal in size. There is no pericardial effusion.\n\nLiver: The left lobe and the caudate lobe are enlarged. The contour of the\nliver is nodular. This is in keeping with the provided history of cirrhosis. \nThere is no significant hepatic steatosis. In the periphery of segment 8,\nthere is a 19 x 18 mm partially exophytic round lesion which is slightly\nhyperintense on the T2 weighted images, demonstrates restricted diffusion, is\narterially hyperenhancing, washing out, and has a pseudocapsule. This is\ncompatible with hepatocellular carcinoma, meeting OPTN-5a criteria. This is\nnew from the prior exam. No other lesions meet OPTN-5 criteria for HCC.\n\nIn segment ___, there is an unchanged 12 x 8 mm focus of arterial\nhyperenhancement (11, 37), which has no correlate on the T2 weighted images,\nwashout, or pseudocapsule. This is likely perfusional. Attention on followup\nexams is recommended.\n\nAdditionally, there are several punctate foci of arterial hyperenhancement in\nthe periphery of the liver which have no correlate on the T2 weighted images\nand no washout. These have the appearance of transient hepatic intensity\ndifferences (11; 14, 19, 22, 30, and 52).\n\nThe common hepatic artery arises from the SMA (11, 54). The portal and\nhepatic veins patent.\n\nBiliary: There is no intrahepatic biliary duct dilation. The common bile duct\nis slightly prominent, measuring 9 mm. It tapers smoothly to the ampulla\nwithout evidence of a mass or filling defect. The gallbladder is surgically\nabsent. The mild prominence of the common bile duct may be related to post\ncholecystectomy changes.\n\nPancreas: Noted is an annular pancreas. The pancreatic parenchyma is normal\nin signal and enhances homogeneously. There is no duct dilation or mass.\n\nSpleen: The spleen is normal in size, measuring 12.3 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are a few subcentimeter cysts.\nNo worrisome renal lesions are identified. There is no hydronephrosis or\nperinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. There is no significant atherosclerotic plaque. No large varices\nare identified.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nThe soft tissues are unremarkable.", "output": "1. New 19 mm lesion in segment 8, compatible with a hepatocellular carcinoma,\nmeeting OPTN-5a criteria.\n2. No other lesions meet OPTN-5 criteria for HCC. Several foci of arterial\nhyperenhancement are likely perfusional, as described above, though bear\nwatching on followup exams.\n3. Cirrhotic liver. Normal sized spleen. No ascites.\n4. Incidentally noted annular pancreas.\n5. The common hepatic artery arises from the SMA.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:46 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: This exam is not dedicated for imaging of the lungs. Within\nthis limitation, no obvious pulmonary mass is identified. No evidence of\npleural or pericardial effusion.\n\nLiver: The liver is enlarged and nodular, compatible with history of\ncirrhosis. Since the prior MRI, the patient has had interval resection of a\n2-cm HCC in segment 8. There is continued evolution of expected postsurgical\nchanges in the resection bed with interval decrease in the size of the\nresection bed and resolution the air-fluid level that was concerning for a\nsection on the most recent CT from ___. The T2-hyperintense,\nT1-hypointense, non-enhancing cavity within the resection bed is compatible\nwith coagulation necrosis (series 6, image 11; series 8, image 38; series\n___, image 36). Surrounding serpiginous T2-hyperintense, T1 hypointense\nfoci in the subcapsular region along the anterolateral resection bed with\nearly arterial enhancement that persists most likely represents inflammatory\nfibrosis (series ___, image 24 ; series 6, image 8). The early\nhyper-enhancing focus at the dome on the prior exam is not seen today, likely\na transient hepatic intensity difference. No new, concerning focal hepatic\nlesion. No ascites.\n\nThere is thickening and probable scarring of the right hemidiaphragm abutting\nthe area of wedge resection.\n\nBiliary: The gallbladder is surgically absent with surgical clips creating\nsusceptibility artifact in the gallbladder fossa. No intrahepatic or\nintrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. An incidental\nannular pancreas is noted (series 1001, image 91). No main pancreatic ductal\ndilatation, evidence of a focal pancreatic mass, or peripancreatic fat\nstranding.\n\nSpleen: The spleen is top-normal in size, measuring up to 13 cm, decreased\ncompared to the prior exam.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration. No\nevidence of a focal renal mass.\n\nKidneys: The kidneys are normal in size and symmetric. No concerning focal\nrenal lesion, perinephric abnormality, or hydronephrosis.\n\nGastrointestinal Tract: The exam is not dedicated for imaging of bowel;\nhowever, visualized loops of bowel in the abdomen appear within normal limits.\n\nLymph Nodes: Scattered lymph nodes are again measurable but appear slightly\ndecreased in the interim, the largest is a gastrohepatic node measuring up to\n9 mm (series ___, image 53).\n\nVasculature: The abdominal aorta is normal in caliber. The bilateral renal\narteries, SMA, and celiac axis are widely patent. The hepatic arterial supply\nappears conventional. The portal veins are patent.\n\nOsseous and Soft Tissue Structures: No osseous signal abnormality suspicious\nfor malignancy or infection. Gynecomastia is mild.", "output": "1. Serpiginous, enhancing tissue along the anterolateral segment VIII\nresection bed likely represents inflammation and fibrosis.\n\n2. No new or concerning focal hepatic lesion.\n\n3. Cirrhotic liver with splenomegaly. Patent portal vein." }, { "input": "Lower Thorax: There is minimal atelectasis at the lung bases. There is no\npericardial or pleural effusion. The heart size is normal.\n\nLiver: The hepatic parenchyma demonstrates normal signal intensity on T1 and\nT2 weighted sequences. There are multiple subcentimeter biliary hamartomas or\nsmall hepatic cysts, denoted by very high internal signal intensity on T2\nweighted sequences without appreciable internal contrast enhancement (series\n14, image 23, series 3, image 14, 11, 18, 24). Arising from segment ___ is a\n10 mm arterially enhancing lesion (series 10, image 31), which demonstrates\nsimilar signal intensity is to background hepatic parenchyma on delayed\nsequences and on precontrast series (series 12, image 31). This lesion\nindents the middle hepatic vein, also seen on the ultrasound examination from\n___. It is retrospectively seen on prior contrast-enhanced CT\nexaminations dating back to ___, demonstrating the same mild mass\neffect on the middle hepatic vein, without flow-limiting stenosis or thrombus.\nThe constellation of findings are most compatible with an FNH. There are no\nlesions demonstrating washout or pseudocapsule.\n\nBiliary: There is no intra or extrahepatic bile duct dilation. The\ngallbladder is normal. No ductal stones are detected.\n\nPancreas: The pancreas demonstrates normal signal intensity and bulk, without\nduct dilation or focal solid mass. There is a 2 mm cystic lesion of the along\nthe pancreatic head, likely a tiny side branch IPMN (series 3, image 34).\n\nSpleen: The spleen size is within normal limits. There are no focal splenic\nlesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. There is a 9 mm simple cyst arising from the upper pole of\nthe left kidney (series 3, image 23). No concerning renal lesion is detected.\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal lesion.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, renal arteries, and\nproximal ___ are patent and normal in caliber. There is an accessory left\nrenal artery (series 10, image 65). Conventional hepatic arterial anatomy is\ndemonstrated. The portal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: There are no osseous lesions concerning\nfor malignancy or infection.", "output": "1. 1.0 cm segment ___ hepatic lesion, corresponding to the hypoechoic lesion\nseen on recent ultrasound from ___, is unchanged in size since\n___, and demonstrates MR signal characteristics most compatible with\nan FNH. No concerning hepatic lesions detected.\n2. The hepatic parenchyma demonstrates normal signal intensity, without MR\nevidence of significant steatosis." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is normal.\n\nMultiple hepatic cysts and or biliary hamartomas are seen throughout the\nliver, denoted by very high internal signal intensity on T2 weighted\nsequences, low signal intensity on T1 weighted precontrast images, without\nappreciable internal contrast enhancement, the largest arising from segment\nVIII measuring 2.5 x 2.1 cm (series 6, image 31, 29, 27, 22, 16). No\nconcerning hepatic mass is detected. There is no intra or extrahepatic bile\nduct dilation. Aberrant intrahepatic bile duct anatomy is demonstrated, with\nthe right posterior duct draining into the left (series 8, image 4). The\ncystic duct demonstrates low medial insertion into the CHD (series 8 image 4).\n\nThe pancreas demonstrates normal signal intensity and bulk. Arising from the\npancreatic tail is a 16 x 11 mm (axial) cystic lesion, demonstrating high\ninternal signal intensity on T2 weighted sequences, low signal intensity on T1\nweighted precontrast images, without internal nodularity or enhancing focus,\nmeasuring up to 20 mm on coronal oblique sequences (series 6, image 13, series\n8, image 3). This lesion first appears on a CT examination from ___, and, allowing for differences in imaging technique, remains stable since\nthat exam. The main pancreatic duct remains normal in caliber.\n\nThe spleen, adrenal glands, stomach, and intra-abdominal loops of small and\nlarge bowel are normal. There is no mesenteric or retroperitoneal\nlymphadenopathy, and no ascites.\n\nThe abdominal aorta, celiac trunk, SMA, and renal arteries are patent and\nnormal in caliber. An accessory left hepatic artery is present (series 11,\nimage 66).\n\nMultiple subcentimeter renal cysts are denoted by a high internal signal\nintensity on T2 weighted sequences, low signal intensity on T1 weighted\nprecontrast images, without appreciable internal contrast enhancement (series\n3, image 35, 32, 25). The kidneys otherwise normal.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "20 mm cystic lesion arising from the pancreatic tail is minimally changed\nsince the CT examination from ___.\n\n6 month followup MRCP recommended to assess for stability, per departmental\nguidelines." }, { "input": "Lower Thorax: Visualized images of the lower thorax are unremarkable without\npleural or pericardial effusion.\n\nLiver: Again seen are multiple rounded T2 hyperintensities scattered\nthroughout the liver, the largest in segment VIII measuring up to 2.8 cm,\nconsistent with biliary hamartomas and/or hepatic cysts.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe right posterior duct drains into the left hepatic duct as seen previously.\nPatient is status post cholecystectomy. Again noted is a low medial insertion\nof a long cystic duct remnant.\n\nPancreas: Again seen is a multiloculated cystic lesion in the pancreatic tail\nwith multiple several thin septations measuring up to 2.0 x 1.4 x 1.5 cm,\npreviously 2.0 x 1.3 x 1.5 cm (3:31, 4:31. There is no definite communication\nwith the main pancreatic duct, which itself appears normal in caliber and\ncontour. No concerning pancreatic lesions identified.\n\nSpleen: Tiny T2 hyperintense lesion in the spleen, likely a splenic cyst, is\nunchanged. Otherwise, the spleen demonstrates normal size and signal\ncharacteristics.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and signal\nintensity without discrete lesion or nodularity.\n\nKidneys: The kidneys are normal size bilaterally. Multiple bilateral\nsubcentimeter T2 hyperintensities, consistent with simple renal cysts, are\nunchanged. Otherwise, the kidneys demonstrate normal signal intensity. No\nconcerning focal renal lesions identified. There is no hydronephrosis or\nproximal hydroureter.\n\nGastrointestinal Tract: The stomach and loops of small and large bowel are\nunremarkable without evidence of bowel wall thickening or obstruction.\n\nLymph Nodes: There are no prominent or pathologically enlarged mesenteric or\nretroperitoneal lymph nodes.\n\nVasculature: The abdominal aorta and its major branches demonstrate normal T2\nvascular flow voids without ectasia or aneurysm formation.\n\nOsseous and Soft Tissue Structures: No bone marrow signal abnormalities. No\nconcerning osseous lesion identified. No soft tissue abnormalities.", "output": "Stable appearance of a 2 cm pancreatic tail cystic lesion. Differential\ndiagnosis includes serous macrocystadenoma vs side-branch IPMN. Follow-up MRCP\nis recommended in ___ years, per departmental protocol.\n\nRECOMMENDATION(S): Follow-up MRCP is recommended in ___ years, per departmental\nprotocol." }, { "input": "Lower Thorax: Lung bases are clear.\n\nLiver: There is diffuse drop of signal of liver parenchyma on in phase\nimaging. There are no suspicious lesions. There is a punctate T2\nhyperintense lesion along the dome of the liver, likely a biliary hamartoma\n(series 3, image 22). The liver is not enlarged.\n\nBiliary: The gallbladder is unremarkable. There is no biliary duct dilation.\n\nPancreas: There is fatty atrophy of the pancreas without focal lesion.\n\nSpleen: The spleen is not enlarged. There is diffuse drop of signal in phase\nimaging.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: There are no suspicious renal lesions. There are bilateral renal\ncysts including a 7 mm hemorrhagic/proteinaceous cyst in the left upper pole.\n\nGastrointestinal Tract: There is colonic diverticulosis. Views of the small\nand large bowel are otherwise unremarkable.\n\nLymph Nodes: There is no enlarged lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. Hepatic arterial anatomy\nis conventional.\n\nOsseous and Soft Tissue Structures: There is no soft tissue abnormality. \nThere are no suspicious bony lesions. T2 hyperintense lesions in T12 and L2\nwithout associated enhancement are most likely benign.", "output": "Hemosiderosis involving the liver and spleen. No evidence of leukemic\ninvolvement of the liver." }, { "input": "There is an large mass residing within the C sweep of the duodenum,\ncorrelating with the finding on recent CT scan. This is ovoid in shape, with\n___ of 11.5 x 8.8 x 8.9 cm (AP x TR x CC). This has a thin, smooth T2\nhypointense rim with relatively homogeneous internal T1 hypo intensity,\nheterogeneous internal T2 signal with central T2 hyperintensity and peripheral\nintermediate signal. There is lack of enhancement within the central T2\nhyperintense portion consistent with necrosis and peripheral avid enhancement\nwith restricted diffusion consistent with viable tumor. Allowing for modality\ndifferences, there appears to be slight interval increase in size,\nparticularly within the anterior to posterior dimension which was previously a\nmaximum of 10.6 cm. This structure has superior mass effect on the pancreatic\nneck and head, a lateral mass effect on the second portion of the duodenum,\nposterior mass effect on the third portion of the duodenum and anterior mass\neffect on the transverse colon. Fat planes with each of these structures are\nobscured and while no macroscopic invasion is definitively identified,\nmicroscopic invasion is certainly not excluded. The superior mesenteric artery\nand vein are displaced towards the left but appear to be patent.\n\nThe exact origin of this mass is difficult to determine, but given lack of\nvisualization of the uncinate process of the pancreas, pancreatic origin is\nsuspected.\n\nThe pancreatic duct at the level of the head and neck is narrowed, with\nprominence of the upstream duct of the body and tail(3-4mm) with narrowing. \nThis is presumably on the basis of extrinsic compression and mass effect from\nthe mass described above.\n\nThere is an additional lesion within the tail of the pancreatic tail,\ncorrelating with the area of subtle hypermetabolism on the recent PET CT\n(6:55). There is a 7mm cyst centrally within this area of abnormality, with\nsurrounding T2 hyperintensity, restricted diffusion and subtly increased\nenhancement. The structure has diameter of 2.7cm, with slight bulging of the\npancreatic contour and loss of the normal acinar pattern.\n\nThe liver, biliary tree, spleen and adrenal glands are unremarkable. There\nare bilateral simple renal cysts. No lymphadenopathy or ascites is identified.\nOsseous structures are unremarkable. There is no mass within the visualized\nabdominal wall soft tissues.", "output": "11.5 cm enlarging solid, centrally necrotic mass apparently originating from\nthe uncinate process of the pancreas, as well as additional 2.7 cm mass within\nthe pancreatic tail. The leading differential diagnosis is multifocal\npancreatic neuroendocrine tumor. Pancreatic malignant nerve sheath tumor is\nalso in the differential but considered less likely. There is mass effect on\nthe pancreatic duct at within the neck and head with upstream ductal dilation.\nThe SMV is narrowed as it is displaced to the left, but otherwise no vascular\ninvolvement is identified." }, { "input": "Lower Thorax: The lung bases are grossly clear.There is no cardiomegaly.\n\nAscites: There is no ascites.\n\nLiver: There is no focal concerning liver lesion.\n\nGallbladder and Biliary System: The gallbladder appears mildly distended with\nno gallstones nor surrounding pericholecystic inflammatory change. The\nproximal common bile duct and common hepatic duct is mildly dilated to 8 mm (\n06:14 ) with smooth tapering towards the ampulla. There are no biliary stones.\n\nPancreas: The pancreas is normal in signal intensity.There is no evidence of\nfocal mass.There is classic pancreatic ductal anatomy without dilatation.\n\nSpleen: The spleen is not enlarged.There is no focal splenic lesion.\n\nKidneys and Adrenals: The kidneys are normal bilaterally with no focal\nlesion.The adrenal glands are normal bilaterally.\n\nBowel: There is a small juxtapapillary duodenal diverticulum arising from the\nsecond stage of the duodenum (06:17 ). The visualized bowel loops and\nmesentery are otherwise within normal limits.\n\nLymph Nodes: There is no significant mesenteric or retroperitoneal\nlymphadenopathy.\n\nVessels: The abdominal vasculature is normal and widely patent.\n\nBones: The osseous structures are unremarkable and there is no suspicious bone\nlesion.", "output": "1. No evidence of biliary stones nor periampullary mass.\n2. Small juxtapapillary duodenum diverticulum may represent the cause of the\nmild extrahepatic biliary dilatation." }, { "input": "Lower Thorax: No large pleural effusion.\n\nLiver: Normal size, contour, and signal intensity. No focal lesion.\n\nBiliary: The mid CBD measures up to 7 mm, similar to priors. No intrahepatic\nbile duct dilation. The gallbladder is normal without stones.\n\nPancreas: Normal size and signal intensity without ductal dilation or focal\nlesion.\n\nSpleen: Normal size and signal intensity without focal lesion.\n\nAdrenal Glands: Normal in size and shape bilaterally without focal lesion.\n\nKidneys: Normal size and nephrograms bilaterally. No hydronephrosis or focal\nlesion.\n\nGastrointestinal Tract: The stomach is unremarkable. Small duodenal\ndiverticulum is again seen. Imaged small and large bowel loops demonstrate\nnormal caliber and enhancement. There is colonic diverticulosis.\n\nLymph Nodes: No pathologically enlarged lymph nodes.\n\nVasculature: No abdominal aortic aneurysm. The portal vein, splenic vein, and\nSMV are patent.\n\nOsseous and Soft Tissue Structures: No aggressive bone lesion.", "output": "No focal liver lesion. No MR correlate to the ultrasound finding or\nexplanation for abdominal pain." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in contour and signal characteristics. Adjacent to\nthe falciform ligament in segment IV B, there is a 9 mm focus of T1 and T2\nintermediate intensity, which demonstrates signal dropout on in and out of\nphase imaging and hypoenhancement on postcontrast imaging, unchanged from\nprior MR and corresponding to the echogenic focus seen on prior ultrasound,\nconsistent with focal fat.\n\nBiliary: There is no intrahepatic biliary dilatation. The CBD is prominent,\nmeasuring 9 mm, unchanged. The gallbladder demonstrates mild wall thickening\ntoward the fundus with subtle increased enhancement, likely representing\nadenomyomatosis.\n\nPancreas: The pancreas is normal in morphology and signal intensity, without\nfocal lesions or pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size, without focal lesions.\n\nAdrenal Glands: Adrenal glands are normal in size and morphology.\n\nKidneys: The kidneys are normal and symmetric in size and signal\ncharacteristics, without focal lesions or hydronephrosis.\n\nGastrointestinal Tract: The stomach and visualized small large bowel are\nunremarkable, without evidence of obstruction.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta and its major branches are patent. The\nportal and hepatic venous vasculature is patent.\n\nOsseous and Soft Tissue Structures: There are no worrisome osseous lesions. \nThere is a tiny fat containing ventral hernia.", "output": "A 9 mm area of focal fat in segment IV B, adjacent to the falciform ligament,\ncorrelates with the echogenic focus seen on prior ultrasound. No concerning\nfocal hepatic lesions. No evidence of cirrhosis.\n\nMild fundal gallbladder adenomyomatosis." }, { "input": "Lower Thorax: Lung bases are clear. Heart size is normal.\n\nLiver: The liver is normal in morphology and signal intensity. No focal\nhepatic lesions are seen.\n\nBiliary: The gallbladder is surgically absent. Again seen is a prominent\ncystic duct stump versus small remnant gallbladder. There is a new filling\ndefect in the distal common bile duct measuring 1.0 cm (CC) (series 5, image\n27). There is no increasing biliary duct dilation. There are other areas of\nanti dependent hypointense signal within the biliary tree consistent with\npneumobilia, as seen previously.\n\nPancreas: The pancreas is normal in morphology and signal intensity. \nPreviously seen subcentimeter cystic lesion in the pancreatic tail is no\nlonger identified.\n\nSpleen: Spleen is normal in size and signal intensity. Note is made of a\nsmall accessory spleen.\n\nAdrenal Glands: The right and left adrenal glands are unremarkable.\n\nKidneys: Postsurgical changes are noted from left partial nephrectomy. There\nis a 2.8 x 2.6 cm simple cyst in the lower pole of the left kidney. Mild\nfullness of the left lower pole collecting system is unchanged. The right\nkidney is unremarkable.\n\nGastrointestinal Tract: There is no hiatal hernia. Views of the small and\nlarge bowel are unremarkable.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: Flow voids are preserved.\n\nOsseous and Soft Tissue Structures: There is no suspicious bony lesion. There\nis no superficial soft tissue abnormality.", "output": "1. Subcentimeter pancreatic cystic lesion in the body is no longer identified.\n2. 1.0 cm filling defect in the distal common bile duct, concerning for ductal\nstone. No associated biliary dilation.\n3. Post surgical changes from partial left nephrectomy.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 15:21 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nsignificance hepatic steatosis or iron deposition. The contours are smooth. \nIn segment 7, there is an 8 x 13 mm lobulated lesion hyperintense on the T2\nweighted images which demonstrates progressive enhancement suggestive of a\nhemangioma. In segment 8, there is a linear 14 x 25 mm region of arterial\nhyperenhancement without washout or a T2 correlate and most in keeping with\narteriovenous fistulization. No concerning solid or cystic lesions.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. There is cholelithiasis but no evidence of\ncholecystitis.\n\nPancreas: The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There is an 8 mm cyst in the left upper\npole. There are no concerning solid or cystic lesions. No hydronephrosis or\nhydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout. No\nmural thickening or abnormal enhancement.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. In the right hepatic lobe, the lesion seen on ultrasound corresponds to a\nhemangioma. No worrisome hepatic lesion.\n2. Small arteriovenous fistula in segment 8.\n3. Cholelithiasis but no evidence of acute cholecystitis." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, the bilateral lung bases\nare grossly clear. The heart is normal in size. There is no pleural or\npericardial effusion.\n\nLiver: The liver is enlarged and nodular in contour. There are diffuse\nbandlike areas of progressive enhancement, compatible with fibrosis. Findings\nare in keeping with pseudocirrhosis secondary to treatment for metastatic\nbreast cancer. No suspicious hepatic lesion is identified.\n\nHepatic arterial anatomy is conventional. The splenic artery arises\nseparately from the aorta, an anatomic variant. There is a small amount of\nperihepatic ascites. The portal veins are patent. The hepatic veins are\ndiminutive but patent.\n\nThere is a small amount of perihepatic ascites.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is normal in size in signal intensity. There is a\nnonspecific 0.9 x 0.6 cm nonenhancing T2 hyperintense lesion in the anterior\nspleen, which could represent a cyst or lymphangioma.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are symmetric in size. There is mass effect on the\nanterior upper pole of the right kidney from the adjacent liver. There is\nnormal corticomedullary differentiation. There is no focal renal lesion or\nhydronephrosis.\n\nGastrointestinal Tract: The stomach is within normal limits. Visualized upper\nabdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: There is a focus of T1 hypointensity and\nrestricted diffusion in the T12 vertebral body (series 10, image 16),\nnonspecific in for which differential considerations include benign etiologies\nor osseous metastasis. No other suspicious osseous lesions are identified. \nThe abdominal wall is within normal limits.", "output": "1. Enlarged, nodular liver with bandlike areas of fibrosis, in keeping with\npseudocirrhosis secondary to treatment for metastatic breast cancer. No\nsuspicious hepatic lesion.\n\n2. Nonspecific focus of T1 hypointensity and restricted diffusion in the T12\nvertebral body, for which differential considerations include benign\netiologies or osseous metastasis. Dedicated MRI of the lumbar spine with\ncontrast is recommended for further evaluation.\n\nRECOMMENDATION(S): MRI of the lumbar spine with contrast\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 09:19 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: There is a small left pleural effusion. There is no pericardial\neffusion.\n\nLiver: The liver is markedly nodular in contour, demonstrating numerous free\nair nodules, in keeping with known history of pseudocirrhosis from prior\nbreast cancer treatment. In comparison to the ___ examination,\nthere are new nodules scattered throughout the liver demonstrating a slightly\nincreased signal intensity on T2 weighted sequences, some demonstrating\nrim-like enhancement (series 13, image 36, 43), difficult to differentiate\nfrom continued worsening fibrosis but possibly reflecting new metastases. \nAgain seen are bandlike areas of progressive enhancement throughout the liver\nin a reticular pattern, in keeping with extensive confluent fibrosis.\n\nModerate ascites is new since ___.\n\nBiliary: There is no intra or extrahepatic bile duct dilation. The\ngallbladder demonstrates a edematous wall (series 4, image 33). No ductal\nstones are detected.\n\nPancreas: The pancreas demonstrates normal signal intensity and bulk, without\nduct dilation or focal mass.\n\nSpleen: The spleen is mildly enlarged, measuring 13.0 cm (series 3, image 30).\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size and enhance symmetrically, without\nhydronephrosis. No focal renal lesion is detected.\n\nGastrointestinal Tract: The stomach and intra-abdominal loops of small and\nlarge bowel are normal in caliber. There is no focal gastrointestinal lesion.\n\nLymph Nodes: Prominent porta hepatis lymph nodes are again demonstrated,\nunchanged from the prior examination. There is no retroperitoneal\nlymphadenopathy.\n\nVasculature: The abdominal aorta, celiac trunk, SMA, renal arteries, and\nproximal ___ are patent and normal in caliber. Conventional hepatic arterial\nanatomy is demonstrated. The portal hepatic veins remain patent, with the\nintrahepatic portions obscured by extensive fibrosis.\n\nOsseous and Soft Tissue Structures: Multiple ill-defined enhancing osseous\nlesions are seen throughout the vertebral bodies, the majority new since ___, highly concerning for metastases (series 13, image 17, 30, 41,\n54, 67, 76, 90, 101). These are not well-visualized on the T2 weighted\nsequences. No pathologic fracture is identified.", "output": "1. Numerous enhancing osseous metastases throughout the vertebral bodies are\nnew since ___, concerning for progression of metastatic breast\ncancer.\n2. Interval worsening of pseudocirrhosis of the liver, with additional\nenhancing lesions difficult to differentiate between new regenerative nodules\nversus new hepatic metastases.\n3. Moderate intra-abdominal ascites is new since ___.\n4. Small left pleural effusion." }, { "input": "Lower Thorax: There is subsegmental atelectasis in the left lung base. Right\nlung bases clear.\n\nLiver:\nThere is redemonstration of markedly nodular liver contour with numerous T2\nhypointense nodules consistent with pseudocirrhosis secondary to prior breast\ncancer treatment. Intervening mildly T2 hyperintense, T1 hypointense, rim\nenhancing areas throughout the hepatic parenchyma described on the prior MRI\nfrom ___ have overall decreased in size and now demonstrate more\nhomogeneous, progressive enhancement, compatible with treatment response and\nevolving confluent fibrosis.\n\nSuperimposed on these background changes in the liver, there are innumerable,\nmostly subcentimeter enhancing nodules scattered throughout the liver with\nassociated restricted diffusion. These appear more apparent than the prior,\nparticularly on DWI, but might have corresponding lesions on the prior. A few\nindex lesions are provided as follows:\n1. 11 mm nodule in segment VII (series 1301, image 40)\n2. 6 mm nodule in peripheral segment III (series 1301, image 82)\n3. 7.2 mm nodule in peripheral segment V (series 1301, image 112)\n\nThere is minimal ascites which has improved compared to the prior study.\n\nAdenopathy is seen at the celiac trunk has decreased since the prior study, on\naxial images measuring up to 3.6 x 1.9 cm (series 1302, image 66), previously\n5.1 x 2.1 cm similarly, a large precaval/portal caval lymph node has decreased\nin size, measuring 1.8 x 2.7 cm (series 1202, image 89), previously 2.0 x 3.1\ncm.).\n\nBiliary: The gallbladder is not distended. There is however gallbladder wall\nedema which is likely secondary to third spacing from underlying chronic liver\ndisease. There is mild dilatation of the segmental intrahepatic bile ducts\nwithin the left lobe comparable to the prior study.\n\nPancreas: The pancreas is normal in morphology and demonstrates normal\nintrinsic T1 signal intensity. There is no focal pancreatic lesion or main\nductal dilatation.\n\nSpleen: Mildly enlarged spleen measuring 13.5 cm in craniocaudal dimension. \nAn 8 mm T2 hyperintense, hypo lesion in the anterior spleen (series 4, image\n28) remains unchanged and likely represents a hemangioma or lymphangioma.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable. No hydronephrosis. 2 right-sided\nrenal arteries are noted.\n\nGastrointestinal Tract: The stomach and visualized small bowel and colon are\nunremarkable. No evidence of bowel obstruction.\n\nLymph Nodes: No enlarged retroperitoneal or mesenteric lymph nodes.\n\nVasculature: Normal caliber of the abdominal aorta. The major mesenteric\narteries are normal in caliber and patent. The splenic vein, SMV and portal\nvein are patent.\n\nOsseous and Soft Tissue Structures:\nMultiple enhancing bone lesions are again noted throughout the vertebral\nbodies in keeping with osseous metastases. Some lesions have increased in\nsize and some have decreased in the interval. Index lesions are as follows:\n1. 8 mm arterially enhancing nodule in T11 vertebral body (series 1301, image\n45), previously 3 mm\n2. 8.5 mm arterially enhancing nodule in L1 vertebral body (series 1301,\nimage 75), previously 5 mm\n3. 10 mm delayed enhancing nodule in the right L2 pedicle (series 1303, image\n95), previously 15 mm\n4. 6 mm anteriorly enhancing nodule within the left T10 transverse process is\nnew (series 1301, image 26).", "output": "1. Pseudocirrhosis of the liver secondary to prior breast cancer treatment,\nwith intervening areas of confluent fibrosis, largely evolved since the prior\nMRI from ___ in a manner consistent with treatment response.\n2. Innumerable, mostly subcentimeter enhancing nodules scattered throughout\nthe liver with associated restricted diffusion, likely representing\nmetastases, which appear more prominent than the prior, particularly on DWI. \nThis difference in conspicuity might be secondary to technical differences in\nscanning (current examination performed at a higher field strength than the\nprior). Advise attention to these lesions on follow-up studies to assess if\nthey represent new metastases or evolving metastases with differences in\nconspicuity related to a combination of technical imaging factors and\ntreatment response. Notably, adenopathy seen along the celiac trunk and\nanterior to the IVC has decreased in size since the prior.\n2. Variable change of numerous osseous metastases, as above.\n3. Minimal ascites, improved since the prior study." }, { "input": "Lower Thorax: Partially imaged lung bases are clear.\n\nLiver: A large, lobulated nonenhancing T2 hyperintense lesion and segment VI/7\nrepresents a large hepatic cyst. There are several additional nonenhancing\nsmall hepatic cysts in the left and right hepatic lobes which are\nsubcentimeter in size. The remaining liver is of normal size and demonstrates\nnormal signal intensity.\n\nBiliary: No evidence of intrahepatic or extrahepatic biliary dilatation. The\ngallbladder is of normal size and signal.\n\nPancreas: The pancreas is of normal bulk and signal intensity. No evidence of\npancreatic ductal dilatation or peripancreatic abnormalities.\n\nSpleen: The spleen is of normal size and signal intensity.\n\nAdrenal Glands: The adrenal glands are of normal bulk and signal intensity\nbilaterally.\n\nKidneys: The large 3.8 x 5.8 x 3.9 cm left angiomyolipoma arising from the\nmidpole of the left kidney demonstrates solid and fat containing components. \nPrior imaging is unavailable at this time and therefore correlate comparisons\ncannot be concluded. There are several bilateral nonenhancing T2 hyperintense\nsimple cortical and peripelvic renal cysts which do not demonstrate concerning\nfeatures on postcontrast imaging. Additionally, there are 2 left upper pole\nsubcentimeter cysts bilaterally which demonstrate inherent T1 hyperintensity\nconsistent with proteinaceous/hemorrhagic cyst (10:35, 43).\n\nGastrointestinal Tract: The small and large bowel loops are of normal caliber\nand configuration. No evidence of bowel obstruction.\n\nLymph Nodes: No evidence of mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Vasculature is patent. A seen on prior CTA chest from ___ there\nis a focal dissection of the proximal celiac artery with aneurysmal dilation\nmeasuring up to 1.5 cm (15:26). There is aneurysmal dilation of the proximal\nright common iliac artery measuring up to 2.1 cm in diameter (1201:75) and a\naneurysmal dilation of the distal left common iliac artery measuring up to 2.6\ncm in diameter (1201:47). No evidence of abdominal aortic aneurysm.\n\nOsseous and Soft Tissue structures: The osseous and soft tissue structures\nare within normal limits.", "output": "1. 3.8 x 5.8 cm left angiomyolipoma. Prior imaging was unavailable at this\ntime and therefore correlate comparisons cannot be concluded.\n2. Additional bilateral simple cysts and left hemorrhagic/proteinaceous cysts\nwithout concerning features.\n3. Large right hepatic lobe lobulated liver cyst. Additional smaller hepatic\ncysts and/or biliary hamartomas.\n4. 2.1 cm proximal right common iliac and 2.6 cm distal left common iliac\nartery aneurysms.\n5. Proximal celiac artery aneurysmal dilation measuring up to 1.5 cm with\nfocal dissection, stable since ___." }, { "input": "Lower Thorax: Linear atelectasis is seen at the left lung base. No pleural or\npericardial effusion. No hiatus hernia.\n\nLiver: There are multiple lobulated relatively circumscribed mildly T2\nhyperintense foci, all of which demonstrate restricted diffusion and, although\npostcontrast images are limited due to non breath hold technique, all appear\nto demonstrate progressive nodular discontinuous enhancement, characteristic\nof hepatic hemangiomas:\n\n-In segment II there is a 17 mm focus (05:11 and 22:10)\n-Peripherally in segment IV-A, there is a 26 x 19 mm focus (5:13 and 22:12)\n-More inferiorly in segment IV-8, there is a 16 x 12 mm focus (5:17 and 22:14)\n-Along the border of VI and VII, there is an 8 mm focus (5:20 and 22:16)\n-Slightly inferior to this in segment VI peripherally, there is a 10 mm focus\n(05:22 and 22:18)\n-Inferior to this also in segment VI, there is a similar-appearing 7-8 mm\nfocus (5:27 and 22:22)\nNo concerning focal liver lesions are seen elsewhere.\n\nBiliary: There is no intra- or extrahepatic biliary ductal dilation. The\ngallbladder is unremarkable.\n\nPancreas: Aside from mild fatty atrophy of the pancreatic head, the pancreas\ndemonstrates normal homogeneous signal intensity. There is no main pancreatic\nductal dilation.\n\nSpleen: There is no splenomegaly or focal splenic lesion.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration.\n\nKidneys: There are multiple bilateral renal cystic foci measuring up to 4.1 cm\nin the left lower pole; some of these demonstrate thin internal septa. No\nenhancing renal lesions are seen, although note that the inferior aspects of\nthe kidneys are not imaged on postcontrast sequences. The background renal\nparenchyma demonstrates normal signal intensity. No hydronephrosis or\nproximal hydroureter.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. Imaged\nloops of small bowel are within normal limits. There is a 5.6 cm segment of\nproximal transverse colon which is focally collapsed (4:6), however this was\nseen to be normal caliber on the recent CT of ___. Otherwise,\nthe imaged colon is unremarkable.\n\nLymph Nodes: As seen on the recent CT, there is a large lobulated T2\nhyperintense primarily left periaortic retroperitoneal mass which demonstrates\nheterogeneous enhancement, only partially visualized on this study, measuring\nup to 8.5 x 6.8 cm in aggregate on this study (06:40). Mass demonstrates\nmarked restricted diffusion (06:40). Closely adjacent lymph nodes in the\nmesenteric root are abnormally numerous and enlarged and also demonstrate\nmarked restricted diffusion, individually measuring up to 31 x 14 mm (05:40\nand 06:40). Abnormally restricting and enhancing soft tissue contiguous with\nthe superior aspect of the conglomerate retroperitoneal mass is seen to extend\nsuperiorly along the left paravertebral space to approximately the level of\nthe adrenal glands (06:34).\n\nVasculature: The imaged abdominal aorta is normal in caliber. Visible major\nproximal tributaries are grossly patent. IVC is normal in caliber and patent.\nPatent hepatic veins. Patent portal vein, SMV, and splenic vein.\n\nOsseous and Soft Tissue Structures: There is a mid thoracic vertebral body\nhemangioma (04:30). 14 mm T2 hyperintense focus in the inferior aspect of a\nmid to upper lumbar vertebral body may represent focal fat or an additional\nsmall intraosseous hemangioma (04:27). No suspicious foci of abnormal marrow\nsignal are seen.", "output": "1. Multiple hepatic hemangiomas measuring up to 26 mm, as above. No evidence\nof hepatic metastatic disease.\n2. Large primarily left periaortic retroperitoneal mass with closely adjacent\nbulky mesenteric root lymphadenopathy, partially imaged and more completely\nevaluated on recent CT abdomen and pelvis. Although nonspecific, MRI\nappearance is suggestive of lymphoma.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 2:26 pm, 10 minutes\nafter discovery of the findings." }, { "input": "There is re- demonstration of a peripheral segment II hepatic cyst measuring 9\nx 8 mm. There is no suspicious hepatic mass. There is a dependent gallstone\nwithin the contracted gallbladder. There is no evidence of cholecystitis. \nThere is no intrahepatic or extrahepatic biliary ductal dilatation.\n\nThere is re- demonstration of multiple cystic lesions throughout the pancreas.\nIn the pancreatic body, there is a multilobulated cystic lesion measuring 1.6\nx 0.9 x 2.1 cm (tranverse x anteroposterior x craniocaudal, 5:1), previously\n1.6 x 0.8 x 2.1 cm, not significantly changed. There is an unchanged 3 x 2 x 6\nmm (03:37) cystic lesion along the anterior aspect of the uncinate process. \nThere is an unchanged 3 mm pancreatic head cystic lesion (03:37). The\npancreatic duct is not dilated. Pancreas divisum is again visualized.\n\nDecrease in size of subcentimeter right upper pole renal cyst currently\nmeasuring 4 mm likely represents a collapsing cyst. There is no evidence of\nhydronephrosis. There is no suspicious renal lesion. The adrenal glands are\nwithin normal limits. Spleen is not enlarged.\n\nThere are bilateral accessory renal arteries. There are no enlarged upper\nabdominal lymph nodes.", "output": "1. Unchanged cystic lesions of the pancreatic head and pancreatic body likely\nrepresent side branch IPMN. The largest cystic lesion is in the pancreatic\nbody measuring 1.6 x 0.8 x 2.1 cm. Followup MRCP is recommended in ___ years to\nevaluate stability.\n2. Cholelithiasis without evidence of cholecystitis.\n3. Pancreas divisum." }, { "input": "Lower Thorax: No pleural effusion.\n\nLiver: The liver morphology is not cirrhotic. There is no focal lesion within\nthe limitation of absence of IV contrast.\n\nBiliary: No intra or extra biliary ductal dilatation. The gallbladder is\ncollapsed on few cholelithiasis. No sign of cholecystitis.\n\nPancreas: The pancreas demonstrate normal signal intensity. No main duct\ndilatation. Pancreas divisum.\nRedemonstration of a multilobulated cystic lesion measuring 2.1 x 1.6 cm in\nthe body of the pancreas (series 4, image 20), not significantly changed from\nprior of ___.\nAdditional punctate cysts are noted in the head and uncinate process of the\npancreas.\n\nSpleen: The spleen is homogeneous and measures 9.6 cm.\n\nAdrenal Glands: Unremarkable. No focal lesion.\n\nKidneys: No focal lesion. No hydronephrosis.\n\nGastrointestinal Tract: Uncomplicated sigmoid diverticulosis. No bowel\nobstruction.\n\nLymph Nodes: No abdominal lymphadenopathy. No ascites.\n\nVasculature: No abdominal aortic aneurysm. Limited evaluation of the vessels\nin the absence of IV contrast. Bilateral accessory renal arteries.\n\nOsseous and Soft Tissue Structures: No concerning bone lesions. Mild new\ncompression of L2.", "output": "1. 2.1 cm cyst within the body of the pancreas, likely a side branch IPMN\nremains unchanged since ___. Two additional tiny cysts, also likely side\nbranch IPMNs are noted in the head and uncinate process of the pancreas.\nPancreas divisum noted incidentally.\n2. Cholelithiasis.\n\nRECOMMENDATION(S): MRCP follow-up in ___ years." }, { "input": "Lower Thorax: Visualized lungs are clear. There is no pleural effusion.\n\nLiver: Normal morphology and signal intensity of the liver parenchyma. There\nis an 11 mm lesion in segment 7 (series 4, image 14) corresponding to\nhypodensity seen on the recent CT and not seen on prior CT from ___. No\nother suspicious focal liver lesion identified. 2 mm enhancing lesion in\nsegment 7 (series 1101, image 25) may represent a flash filling hemangioma or\nsmall FNH.\n\nBiliary: The gallbladder is surgically absent. The patient is status post\n___'s procedure. Unremarkable appearance of the choledochojejunostomy. \nThere is no intrahepatic biliary duct dilatation.\n\nPancreas: Postsurgical changes from ___'s procedure. \nPancreaticojejunostomy appears intact the. There is no evidence of local\ndisease recurrence. There is mild atrophy of the remanent pancreatic\nparenchyma. There is no pancreatic duct dilatation.\n\nSpleen: Spleen is normal in size and signal intensity.\n\nAdrenal Glands: Adrenal glands are unremarkable bilaterally.\n\nKidneys: The kidneys are normal in size and symmetric and demonstrate normal\ncorticomedullary differentiation. There is a 12 mm hemorrhagic cyst arising\nfrom the lateral interpolar left kidney. There is no hydronephrosis.\n\nGastrointestinal Tract: Visualized small and large bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Abdominal aorta is normal in caliber. Main mesenteric branch\nvessels are patent. Note is made and accessory left hepatic artery arising\nleft gastric. The portal vein, SMV and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesion.", "output": "1. 11 mm lesion in hepatic segment 7 most likely represents metastatic\ndisease.\n2. Stable postsurgical changes from prior Whipple's procedure." }, { "input": "Lower Thorax: There is no pleural effusion.\n\nLiver: Liver demonstrates a cirrhotic morphology. There is no focal hepatic\nlesion. There is drop of signal in the liver, spleen, bone marrow, and\nadrenal glands on in-phase-imaging, consistent with iron deposition. There is\nmoderate ascites.\n\nBiliary: There is cholelithiasis. There is no biliary duct dilation.\n\nPancreas: The pancreas is moderately atrophic. There is no pancreatic duct\ndilation.\n\nSpleen: Spleen is mildly enlarged measuring 12.4 cm with low signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are notable for iron\ndeposition, described above.\n\nKidneys: The bilateral kidneys are unremarkable with stable subcentimeter\ncortical cysts. There is no hydronephrosis.\n\nGastrointestinal Tract: There is haziness of the omentum without abnormal\nenhancement, nonspecific in the setting of ascites.\n\nLymph Nodes: There are no enlarged mesenteric or retroperitoneal lymph nodes.\n\nVasculature: There is no abdominal aortic aneurysm. There is mild\natherosclerosis. There is a replaced left hepatic artery arising from the\nleft gastric. The portal vein is patent. Note is made of mild gastric\nvarices and paraesophageal varices.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions.", "output": "1. Cirrhotic liver morphology with moderate ascites and abdominal varices. No\nsuspicious hepatic lesions.\n2. Haziness of the omentum, a nonspecific finding in the setting of ascites.\n3. Diffuse iron deposition in the liver, spleen, bone marrow, and adrenal\nglands." }, { "input": "Lower Thorax: The partially imaged lower thorax is unremarkable.\n\nLiver: The liver is slightly heterogeneous and extensively nodular contour. \nSmall T2 hyperintense lesions are consistent with cysts or biliary hamartomas.\nNo concerning hepatic lesions identified. Small volume ascites. Interval\nimprovement of in phase compared to out of phase signal loss consistent with\nmild iron deposition.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. \nCholelithiasis without gallbladder wall edema.\n\nPancreas: The pancreas is normal and homogeneous in signal intensity and\nenhancement. No focal lesions or pancreatic ductal dilation.\n\nSpleen: Top normal size and normal signal intensity, noting resolution of in\nphase compared to out of phase signal loss.\n\nAdrenal Glands: Significant in phase compared to out of phase signal loss\ncompatible with significant iron deposition. No focal lesions.\n\nKidneys: Multiple simple renal cysts. Kidneys are otherwise symmetric in size\nand nephrogram. No hydronephrosis.\n\nGastrointestinal Tract: Partially imaged loops of large and small bowel are\nunremarkable.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy. Mesenteric\nedema is decreased compared to the prior examination, a nonspecific finding\nsometimes related to ascites.\n\nVasculature: Incidental accessory or replaced left hepatic artery.\n\nOsseous and Soft Tissue Structures: Unremarkable.", "output": "1. Cirrhosis with small volume ascites. No focal lesions.\n2. Interval improvement of iron deposition, now most prominent in the adrenal\nglands.\n3. Cholelithiasis." }, { "input": "Of note, study is moderately degraded by patient motion, particular the\npostcontrast images, which required non breath hold technique to acquire.\n\nLower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in signal intensity and morphology. There is no\nsuspicious focal lesion within the confines of a non breath hold study.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is almost completely decompressed, limiting assessment.\n\nPancreas: A multiloculated cystic lesion with internal debris and septations\nthat appears to arise from the pancreas measures up to 12.6 x 9.0 x 14.6 cm\n(9:32, 4:17). Evaluation for an enhancing component is limited by patient\nmotion and non breath hold technique, though no masslike enhancement is seen\nwithin the lesion. There is a relatively thin enhancing capsule and thin\nenhancing septa.. Numerous collateral vessels are splayed around this lesion,\nsuggesting compromise of splenic venous drainage.\n\nSpleen: There is mild splenomegaly with the spleen measuring up to 14 cm\n(05:15).\n\nAdrenal Glands: The previously seen left adrenal gland lesion is\nre-demonstrated with substantial signal drop on the out of phase imaging when\ncompared with the in phase imaging consistent with intravoxel fat and a benign\nadrenal adenoma (12:35, 12:36). There is no right adrenal lesion.\n\nKidneys: A simple left renal cyst is noted. There is no suspicious lesion or\nhydronephrosis.\n\nGastrointestinal Tract: Unremarkable.\n\nLymph Nodes: No suspicious lymphadenopathy, although motion degradation limits\nassessment.\n\nVasculature: The aorta is normal in caliber. Major arteries appear patent but\nnot well assessed on this non breath hold study. There are numerous venous\ncollaterals in about the large cystic lesion suggesting compromised flow\nthrough the main splenic vein with likely flow through collateral vessels\nincluding the gastroepiploic vein. No definite thrombus.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion.", "output": "1. Moderately limited assessment secondary to motion with non breath hold\ncontrast enhanced images providing limited assessment.\n2. Dominant complex encapsulated multicystic lesion that appears to arise from\nthe pancreatic tail measures up to 14.6 cm, most likely representing a\nmucinous cystic neoplasm. Sampling is recommended if resection is not\nplanned.\n3. Left adrenal gland nodule has imaging findings consistent with a benign\nadrenal adenoma.\n4. Mild splenomegaly.\n\nRECOMMENDATION(S): Sampling of the large probable pancreatic mucinous cystic\nneoplasm is recommended if resection is not planned." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver:\n\nThere are multiple suspicious hepatic lesions which demonstrate whole vague T2\nhyperintensity, slightly more than liver, continuous peripheral enhancement,\nand capsular retraction:\n\nSegment 7 lesion measuring 1.3 cm (06:10).\nSegment 6 lesion measuring 1.9 cm (06:20).\nSegment 6 lesion measuring 1.6 cm (06:24).\nSegment 2 lesion measuring 1.1 cm (06:14).\n\nThere are other scattered well-defined small T2 hyperintense lesions a without\nenhancement, consistent with hepatic cysts/biliary hamartomas. There is also\na 1.9 cm hepatic dome lesion with T2 hyperintensity and discontinuous\nperipheral enhancement, consistent with a benign hemangioma.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: Tiny T2 hyperintense pancreatic tail lesions, largest measuring 4 mm\n(06:24), likely representing side-branch IPMNs.\n\nSpleen: The spleen is upper limits normal in size. Splenic parenchyma is\nunremarkable.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: There are bilateral parapelvic cysts. The kidneys are normal in size\nand signal characteristics. The corticomedullary differentiation is\nwell-maintained with normal excretion of contrast on the delayed phase images.\nThere are no solid lesions. No hydronephrosis or hydroureter.\n\nGastrointestinal Tract: Gastric banding device noted. The GI tract is of\nnormal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: Focal T2 hyperintense lesion in the lower\nthoracic region vertebral body likely represents hemangioma.\n\nThe known omental caking is partially visualized on this exam. Early\nscalloping of the right liver edge likely representing metastatic implants.\n\nThere is trace perihepatic and perisplenic free fluid.", "output": "1. At least 4 liver lesions as detailed above consistent with metastatic\ndisease.\n2. Further metastatic disease in the abdomen with partially visualized\nomental caking and early implants along the right liver edge.\n3. 4 mm pancreatic tail side-branch IPMN." }, { "input": "Lower thorax: Within the limits of evaluation by MRI, the bilateral lung bases\nare grossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is no\nevidence of hepatic steatosis. There is a 1.4 x 1.1 cm T2 hyperintense lesion\nin segment VII (series 5, image 12), which demonstrates progressive nodular\nenhancement, compatible with a hemangioma. There are small cysts or biliary\nhamartomas in segment II and at the border of segments ___. There is no\nevidence of metastatic disease in the liver.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: There is mild diffuse atrophy of the pancreas. There is no focal\npancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are normal in size and\nshape.\n\nKidneys: The kidneys are symmetric in size. There is focal cortical scarring\nin the interpolar region of the left kidney. There are multiple peripelvic\ncysts in both kidneys. There are also a few scattered <5 mm T1 hyperintense\nfoci in both kidneys, compatible with hemorrhagic cysts. Multiple bilateral\nnonobstructing renal calculi are better delineated on prior CTs. There is no\nhydronephrosis.\n\nPeritoneum: There is nodularity and enhancement of the omentum, most\npronounced in the left hemiabdomen, unchanged compared to the prior CT of the\nabdomen/pelvis from ___ when accounting for differences in\nmodality, compatible with omental metastases.\n\nGastrointestinal Tract: A gastric band is in appropriate position with port\nin the left paramidline anterior abdominal wall. There is no bowel\nobstruction. The colon is grossly unremarkable, noting limited sensitivity of\nMRI for detecting colonic lesions.\n\nPelvis: The uterus is surgically absent. There is no adnexal mass. The\nbladder is within normal limits. There is no free fluid in the pelvis.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified.", "output": "1. Nodularity and enhancement of the omentum, most pronounced in the left\nhemiabdomen, unchanged compared to the prior CT of the abdomen/pelvis from ___ when accounting for differences in modality, compatible with\nomental metastases.\n\n2. Small cysts versus biliary hamartomas in the left hepatic lobe, and a\nsegment VIII hemangioma. No evidence of metastatic disease in the liver." }, { "input": "Lower thorax: Within the limits of evaluation by MRI, the bilateral lung bases\nare grossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is no\nevidence of hepatic steatosis. Stable 1.4 cm segment 7 hemangioma. There are\nsmall cysts or biliary hamartomas in segment II and at the border of segments\n___. There is no evidence of metastatic disease in the liver.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: There is mild diffuse atrophy of the pancreas. There is no main\nductal dilatation. There are stable scattered subcentimeter T2 hyperintense\nnonenhancing foci within the pancreatic parenchyma, most likely representing\nside-branch IPMNs.\n\nSpleen: The spleen is mildly enlarged at 13.2 cm, increased from the prior\nstudy at which time it measured 11.3 cm.\n\nAdrenal Glands: The right and left adrenal glands are normal in size and\nshape.\n\nKidneys: The kidneys are symmetric in size. There is focal cortical scarring\nin the interpolar region of the left kidney. There are multiple peripelvic\ncysts in both kidneys. There are also a few scattered <5 mm T1 hyperintense\nfoci in both kidneys, compatible with hemorrhagic cysts. Multiple bilateral\nnonobstructing renal calculi are better delineated on prior CTs. There is no\nhydronephrosis.\n\nPeritoneum: Peritoneal enhancement, omental nodularity, and free fluid in the\nabdomen and pelvis has increased compared to the prior MRI from ___,\ncompatible with worsening metastatic disease (3:22, 1803:112, 03:13, 03:11,\n3:6).\n\nGastrointestinal Tract: A gastric band is in appropriate position with port\nin the left paramidline anterior abdominal wall. There is no bowel\nobstruction. The colon is grossly unremarkable, noting limited sensitivity of\nMRI for detecting colonic lesions.\n\nPelvis: The uterus is surgically absent. There is no adnexal mass. The\nbladder is within normal limits.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified.", "output": "1. Interval increase of omental nodularity and omental and peritoneal\nenhancement as well as ascites, concerning for metastatic progression.\n2. New mild splenomegaly." }, { "input": "Lower thorax: Lower thorax demonstrates no pleural effusions.\n\nLiver: The liver is unremarkable aside for stable cysts and hemangioma. There\nis no steatosis. There is replaced right hepatic artery arising from the SMA.\nThe portal vein is patent.\n\nBiliary: The gallbladder is unremarkable. No intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: Stable pancreatic cystic lesions measuring up to 3 mm compatible\nwith side-branch intraductal papillary mucinous neoplasms. No main ductal\ndilatation.\n\nSpleen: Borderline enlarged, as on prior.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The kidneys are unremarkable except for multiple stable peripelvic\ncysts and hemorrhagic cysts.\n\nGastrointestinal Tract: Patient status post gastric banding, which is in\nappropriate position. There is no bowel obstruction. Compared to ___, there is increased ascites but the omental implants are stable. For\ninstance, in the left omentum, there is similar confluence of the implants. \nIn the pelvis, these are not significantly changed.\n\nPelvis: The uterus is surgically absent.\n\nLymph Nodes: There is no abdominopelvic lymphadenopathy.\n\nVasculature: The abdominal aorta and its branches are patent with normal\ncaliber.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "No significant change in carcinomatosis, however the amount of ascites is\nincreased. Since disease is mostly peritoneal carcinomatosis, follow-up of\nfindings can be better assessed with CT abdomen and pelvis with contrast." }, { "input": "Lower thorax: Visualized lung bases are clear. There are small bilateral\npleural effusions. There is no pericardial effusion. Please refer to\nconcurrent CT chest report for report description of intrathoracic findings.\n\nLiver: Liver is normal in size and signal intensity. A 1.4 cm mildly T2\nhyperintense lesion with continuous peripheral enhancement in segment 6 is\nconcerning for metastasis and is only faintly seen on prior exam, but present\non exam from ___ (05:22). A 1.5 cm lesion in segment 7 described as\na hemangioma on multiple prior exams no longer appears T2 hyperintense and is\nslightly smaller in size compared to prior (1301:26) raising concern that it\nalso represents a metastatic lesion. An additional mildly T2 hyperintense 11\nmm lesion in segment 2 is not well appreciated on postcontrast images and is\nalso only possibly faintly seen on most recent prior, but present on exam from\n___ and is also concerning for metastatic lesion (05:10). Several T2\nhyperintense lesions are consistent with simple cysts or biliary hamartomas\nand grossly stable from prior. There is no significant fatty steatosis.\n\nBiliary: The gallbladder is unremarkable. There is no intrahepatic or\nextrahepatic biliary dilation.\n\nPancreas: There is stable appearance of 3 mm cystic lesions in the body of the\npancreas, likely side branch IPMNs.\n\nSpleen: Spleen is borderline enlarged measuring up to 13 cm. There are\nsplenic varices noted.\n\nAdrenal Glands: Bilateral adrenal glands are normal in size and shape.\n\nKidneys: Kidneys are normal symmetric size. There are multiple bilateral\nparapelvic cysts which appear grossly stable.\n\nGastrointestinal Tract: There has been a significant increase in volume of\nintra-abdominal ascites. A gastric band device is seen in stable position\naround the stomach. Visualized small and large bowel are otherwise\nunremarkable. There is no evidence of obstruction.\n\n There is similar appearance of omental nodularity in the left hemi abdomen\nbetter appreciated on prior CTs. There is also diffuse peritoneal enhancement\nand scalloping along the right liver edge without large measurable nodules.\n\nPelvis: The uterus is surgically absent. There is no adnexal abnormality.\n\nLymph Nodes: There is no retroperitoneal mesenteric lymphadenopathy. There is\nno pelvic lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There are no aggressive osseous lesions.", "output": "1. Multiple hepatic metastases are more prominent compared to prior exam, but\npresent on exam from ___.\n2. Increased intra-abdominal ascites with stable appearance of omental and\nperitoneal disease.\n3. Stable cystic lesions in the pancreas, likely side branch IPMNs.\n4. Stable borderline splenomegaly." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. Several T2 hyperintense lesions are noted in the\nliver, measuring up to 24 mm. These are most compatible with cysts. No\nworrisome liver lesions are identified on this noncontrast exam.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is normal. No stones are identified.\n\nPancreas: The pancreatic parenchyma is normal in signal. There is no duct\ndilation or mass.\n\nSpleen: The spleen is normal in size, measuring 10.3 cm. There are no focal\nlesions.\n\nAdrenal Glands: Again, arising from the lateral limb of the left adrenal\ngland, there is a 10 x 8 mm lesion which is isointense to the gland on the T1\nweighted images and hypointense to the gland on the T2 weighted images (7 B,\n18). No obvious drop in signal is noted on the out of phase images to suggest\nthe presence of intravoxel fat. It is unchanged in size and appearance from\nthe prior exam. No new adrenal lesions are identified. The right adrenal\ngland is normal.\n\nKidneys: The kidneys are normal in size. Multiple subcentimeter unchanged\nsimple and hemorrhagic cysts are noted. There is no hydronephrosis or\nperinephric abnormality.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. Evaluation the vasculature is limited on this noncontrast exam.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMinimal multilevel degenerative changes are noted in the spine. The soft\ntissues are unremarkable.", "output": "No change in the size or appearance of the 10 mm left adrenal lesion. This\nsuggests benignity, though the lesion remains indeterminate on MRI. \nStatistically, it is likely an adenoma." }, { "input": "Lower Thorax: Multiple confluent pulmonary opacities are again noted better\ncharacterized on recent chest CT. Trace of right pleural effusion.\n\nLiver: Normal hepatic morphology. No concerning liver lesion.\n\nBiliary: Uncomplicated cholelithiasis. No intra or extra biliary duct\ndilatation.\n\nPancreas: Normal T1 signal hyperintensity. No focal concerning lesion. No\nmain duct dilatation.\n\nSpleen: The spleen is normal in size and morphology. No focal lesion.\n\nAdrenal Glands: Unremarkable.\n\nKidneys: The kidneys are unremarkable besides a tiny left renal cortical cyst.\nNo hydronephrosis.\n\nGastrointestinal Tract: Tiny hiatal hernia. No bowel obstruction.\n\nLymph Nodes: No abdominal lymphadenopathy. Trace of new ascites in the\nabdomen.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No concerning bone lesions. Uncomplicated\nsmall fat containing umbilical hernia. There is a focal area of edema in the\nmedial aspect of the right psoas (series 9, image 77).", "output": "1. Uncomplicated cholelithiasis. No intrahepatic or extrahepatic bile duct\ndilatation. No concerning hepatic lesions.\n2. Multifocal airspace opacification better characterized on recent chest CT.\n3. Focal area of myositis in the right psoas." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology. There is drop in signal on\nout of phase imaging compared with in phase imaging along the falciform\nligament, correlating with the echogenic lesion seen on ultrasound, and\ncompatible with focal fat deposition (6:11). No suspicious focal liver lesion\nidentified.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallbladder is\nnormal without stones or wall thickening.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber. There is\npancreatic divisum.\n\nSpleen: The spleen is not enlarged. There is a small accessory spleen.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis. There is a 1 cm right renal cyst.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Focal fat deposition along the falciform ligament, correlating with the\nechogenic lesion seen on prior ultrasound. No concerning hepatic lesions.\n2. Pancreatic divisum." }, { "input": "12 mm T2 bright lesion in the peripheral right lobe of the liver demonstrates\nthe enhancement characteristics of a hepatic hemangioma and appears to\ncorrespond to the lesion described on prior CT. (___). Several other T2\nhyperintensities throughout the liver measure up to 17 mm and represent either\ncysts or biliary hamartomas (4:12). The hepatic and portal veins are patent.\nHepatic arterial anatomy is conventional. There are numerous simple cysts in\nthe kidneys. There is no hydronephrosis.\n\nThe gallbladder, pancreas, spleen, and adrenals are normal. The stomach and\nvisualized bowel are normal. There is no portacaval mesenteric, or\nretroperitoneal lymphadenopathy. There is no ascites. Bone marrow signal is\nnormal.", "output": "1. The indeterminate lesion described on prior CT corresponds to a hepatic\nhemangioma. Numerous other focal liver lesions represent cysts and biliary\nhamartomas, none with worrisome features.\n2. Numerous renal simple cysts, none with worrisome features." }, { "input": "Lower Thorax: There is no gross abnormality of the visualized lung bases. Of\nnote, the small ground-glass opacity in the left apex described on chest CT\ndated ___ should be re-assessed with a follow-up CT of the chest, as\nMRI is not the appropriate modality for evaluation of the lung parenchyma. \nThe heart is normal in size. There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is no\nevidence of hepatic steatosis. No focal lesions identified, within the limits\nof this noncontrast study.\n\nBiliary: The gallbladder is within normal limits. There is no intra or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is within normal limits. There is no pancreatic ductal\ndilatation.\n\nSpleen: The spleen is within normal limits.\n\nAdrenal Glands: There is thickening and nodularity of the medial and of the\nleft adrenal gland with signal loss on the out of phase images, compatible\nwith nodular hyperplasia, probably unchanged since the ___ MRI of the\nabdomen. The right adrenal gland is within normal limits.\n\nKidneys: The left kidney is markedly atrophic. The right kidney is normal in\nsize. There is a small amount of perinephric fluid on the right. There is no\nhydronephrosis.\n\nGastrointestinal Tract: No dilated bowel loops are seen within the upper\nabdomen.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The upper abdominal aorta and mesenteric vessels are within\nnormal caliber.\n\nOsseous and Soft Tissue Structures: The bone marrow is normal in signal. The\nabdominal wall is within normal limits.", "output": "Nodular hyperplasia of the medial of the the left adrenal gland, probably\nunchanged since ___.\n\nRECOMMENDATION(S): The small ground-glass opacity in the left apex described\non chest CT dated ___ should be re-assessed with a follow-up CT of the\nchest, as MRI is not the appropriate modality for evaluation of the lung\nparenchyma." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: Multiple T2 hyperintense lesions scattered throughout the liver\npreviously characterized as cysts or biliary hamartomas are not significantly\nchanged in size compared to prior. The dominant cystic lesion measures 10.1 x\n9.6 cm (04:14) and is unchanged from prior. Of note there is an unchanged 5.6\nx 4.3 cm multiseptated cystic lesion within segment 6 (04:30).\n\nBiliary: There is no intra or extrahepatic biliary duct dilatation.\n\nPancreas: Multiple cystic lesions throughout the pancreas are redemonstrated,\nshowing communication with the main pancreatic duct suggestive of side-branch\nIPMNs. There has been further collapse of a 4 mm cyst (03:26) that previously\nmeasured 1.7 cm in the pancreatic head. A 1.0 cm cyst about the pancreatic\nhead has also decreased in size compared to prior when it measured 1.3 cm.\nHowever there has been mild interval increase in size in a cyst that shows\npseudoseptations about the pancreatic head (03:26) measuring 2.1 x 1.5 cm,\nthat previously measured 1.6 x 1.6 cm. Otherwise the remainder of the\nside-branch IPMNs are overall stable, including a 1.1 cm cyst in the\npancreatic body (03:26).\n\nSpleen: The spleen is normal in size with no focal splenic lesion.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: The kidneys are normal in size with unchanged bilateral peripelvic\ncysts. There is no hydronephrosis.\n\nGastrointestinal Tract: There is a new small to moderate hiatal hernia\n\nLymph Nodes: There is no enlarged upper abdominal or retroperitoneal lymph\nnode\n\nOsseous and Soft Tissue Structures: Degenerative changes are again noted\nthroughout the lumbar spine.", "output": "Multiple cystic pancreatic lesions in keeping with side-branch IPMNs , the\ndominant of which showing pseudoseptations within the pancreatic head showing\nmild interval increase in size compared to prior. Previously aspirated cyst\nwithin the pancreatic head has further decreased in size. Otherwise the\nremainder of the side branch IPMNs are overall stable.\n\nRECOMMENDATION(S): Continued yearly follow up MRCP is recommended to assess\nstability." }, { "input": "Lower Thorax: Limited evaluation notable for small right fat containing\nBochdalek hernia.\n\nLiver: 0.7 x 0.7 cm segment 7 mildly T2 hyperintense lesion which demonstrates\nperipheral discontinuous nodular enhancement that progressively fills in,\nconsistent with a hemangioma and corresponds to abnormality noted on CT from\n___. (07:17). A 8.7 x 6.4 x 7.8 cm mesenteric cyst, is in close\napproximation with the liver and stomach (07:20). No nodular enhancement. No\nadditional worrisome lesions. No hepatic steatosis. No ascites.\n\nBiliary: No biliary duct dilatation. Cholelithiasis.\n\nPancreas: Unremarkable. No pancreatic duct dilatation.\n\nSpleen: Unremarkable.\n\nAdrenal Glands: Unremarkable\n\nKidneys: Unremarkable. No hydronephrosis.\n\nGastrointestinal Tract: Small hiatal hernia. No ascites or bowel\nobstruction.\n\nLymph Nodes: No retroperitoneal or mesenteric lymph node enlargement.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, and bilateral\nrenal arteries are patent. Hepatic anatomy is conventional. Hepatic veins,\nmain portal vein, SMV, and splenic vein are patent.\n\nOsseous and Soft Tissue Structures: Known right breast mass is partially seen.\nNo aggressive osseous lesions.", "output": "1. 0.7 cm segment right hepatic hemangioma, corresponding to abnormality\nnoted on CT from ___. No metastatic disease in the abdomen.\n\n2. Redemonstration of 8.7 cm exophytic hepatic, enteric duplication or\nmesenteric cyst." }, { "input": "Lower Thorax: Lung bases are clear.\n\nLiver: Normal morphology and signal intensity of the liver parenchyma. No\nfocal liver lesion seen.\n\nBiliary: The gallbladder is unremarkable. No intra or extrahepatic bile duct\ndilatation.\n\nPancreas: Normal morphology and signal intensity of the pancreas.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: Adrenal glands are unremarkable bilaterally.\n\nKidneys:\nPatient is status post embolization of a right renal angiomyolipoma which\narises from the lateral interpolar cortex and measures 10 x 6.6 x 11.8 cm (AP\nx TR x CC). There is mild inferior and medial displacement of the right\nkidney but there is no significant mass effect on the renal cortex. The mass\ndemonstrates large areas of signal dropout on the out of phase sequence\nconsistent with microscopic fat. There are scattered areas of T1\nhyperintensity within the mass on T1 fat-sat consistent with hemorrhage. \nThere is a single enhancing vessel and few enhancing septations within the\nanterior aspect of the lesion. Mild enhancement is also noted in the\nperiphery of the tumor. However, the majority of the mass does not enhance on\npost contrast sequences. No additional nodules or masses identified.\n\nThe left kidney is unremarkable. There is no solid mass in the left kidney.\n\nGastrointestinal Tract: The stomach and visualized bowel are unremarkable.\n\nLymph Nodes: No enlarged retroperitoneal or mesenteric lymph nodes.\n\nVasculature: The aorta is normal in size. There are bilateral single renal\narteries.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "Expected post embolization changes within the large right angiomyolipoma as\ndescribed. In particular, the majority of the tumor does not demonstrate\npost-contrast enhancement with only minimal residual enhancing septations\nnoted within the anterior aspect of the tumor. A single, likely capsular\nvessel is seen extending into the angiomyolipoma." }, { "input": "The study is mildly limited by patient motion.\n\nLower thorax: The visualized lung bases appear unremarkable. No pleural\neffusion or pericardial effusion.\n\nLiver: The liver is smooth in contour. There is no significant hepatic\nsteatosis. There is no suspicious hepatic lesion.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. \nGallbladder appears unremarkable.\n\nPancreas: The pancreatic parenchyma appears homogeneous and unremarkable. No\npancreatic ductal dilatation or peripancreatic stranding.\n\nSpleen: The spleen is normal in size. There is no focal splenic lesion.\n\nAdrenal Glands: Bilateral adrenal glands appear unremarkable.\n\nKidneys: Bilateral kidneys are symmetric in nephrogram and size. There is no\nhydronephrosis. There is a subcentimeter T1 hyperintense nonenhancing cyst in\nthe left upper pole, likely proteinaceous or hemorrhagic. Bilateral\nsubcentimeter T2 hyperintense nonenhancing foci are suggestive of renal cysts.\n\nGastrointestinal Tract: Patient is status post small-bowel resection in the\nright mid abdomen.\n\nPelvis: Bladder and distal ureters appear unremarkable. The prostate appears\nenlarged. No free fluid is noted in the pelvis.\n\nLymph Nodes: There is no inguinal lymphadenopathy. No pelvic sidewall\nlymphadenopathy. There is no retroperitoneal or mesenteric lymphadenopathy. \nProminent mesenteric lymph nodes measuring up to 7 mm are noted.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is a small fat containing right\ninguinal hernia.", "output": "There is no evidence of recurrent or metastatic disease." }, { "input": "Lower Thorax: Included lung fields are grossly clear. There is no large\npleural or pericardial effusion. Bilateral pleural effusions are new.\n\nLiver: Diffuse dropped signal of the liver on out of phase segments compatible\nwith fatty deposition. Again there multiple arterially enhancing lesions in\nthe liver with associated restricted diffusion. Although precise comparison to\nthe prior study is difficult in the setting of significant artifact overall\nthere is little change.\n\n-Conglomerate of enhancing masses together measuring 3.2 x 2.1 cm in segment 7\n-1 cm, 0.4 cm, and 0.4 cm masses in segment 2 (8:35 and 34 respectively)\n-8 mm focus in segment 5 (08:40).\nBiliary: There is a CBD stent in place. Stones are seen in a nondistended\ngallbladder without wall thickening. There is pneumobilia with mild dilation\nof intrahepatic bile ducts predominantly in the left lobe grossly similar to\nCT of ___.\n\nPancreas: There is ill-defined mass with restricted diffusion in the\npancreatic head. Given artifact precise measurement is not possible. However\nCT on the diffusion sequences the mass measures approximately 5.1 x 3.6 cm\n(08:42). This is grossly unchanged. There is also confluent soft tissue\nrounded biliary stent, however it is unclear if this reflects normal pancreas\nor tumor (14:22).\n\nSpleen: The spleen measures 12.6 x 8.5 cm, stable. There are no focal\nlesions.\n\nAdrenal Glands: Poorly seen but grossly normal.\n\nKidneys: No hydronephrosis or mass in the partially imaged portions.\n\nGastrointestinal Tract: There is small hiatal hernia. Included loops of\nsmall and large bowel are normal in caliber.\n\nLymph Nodes: There is a conglomerate of retroperitoneal lymphadenopathy in the\nupper abdomen inseparable from the pancreatic mass similar to prior.\n\nVasculature: The abdominal aorta is normal in caliber. The upper abdominal\nvasculature is not well evaluated give non-breathhold technique. The portal\nvein is difficult to evaluate but is likely occluded.\n\nThere is new moderate ascites.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is normal.", "output": "1. Very limited study due to non-breathhold technique. Although evaluation is\nsuboptimal neuroendocrine tumor in the pancreas and metastatic lesions in the\nliver are grossly stable.\n2. The portal vein is difficult to evaluate but likely chronically occluded.\n3. There is new moderate ascites and small bilateral pleural effusions.\n4. Splenomegaly.\n5. Cholelithiasis." }, { "input": "The study is degraded by motion artifact.\n\nLower Thorax: No pleural pericardial effusion.\n\nLiver: No focal suspicious hepatic lesions. A couple of small hepatic\ncysts/biliary hamartomas. No steatosis.\n\nBiliary: No intra extrahepatic bile duct dilatation\n\nPancreas: No focal pancreatic lesions.\n\nSpleen: No focal splenic lesion\n\nAdrenal Glands: Unremarkable\n\nKidneys: Simple appearing renal cortical cysts bilateral ranging up to 13 mm\npresent in the lower pole of the left kidney.\n\nGastrointestinal Tract: There is a well-circumscribed nonenhancing fat\ncontaining submucosal lesion measuring 23 x 38 mm in the gastric antrum most\nlikely representing a submucosal lipoma.\n\nLymph Nodes: No lymphadenopathy\n\nVasculature: Major vessels are patent\n\nOsseous and Soft Tissue Structures: No suspicious lesions", "output": "There is a well-circumscribed nonenhancing fat containing submucosal lesion in\nthe gastric antrum representing a submucosal lipoma." }, { "input": "Lower Thorax: Trace left pleural effusion. No pericardial effusion.\n\nEvaluation of the visualized abdomen is suboptimal due to motion.\n\nLiver: The liver has a nodular contour consistent history of cirrhosis. There\nis trace perihepatic ascites there are multiple enhancing lesions within the\nliver, predominantly involving the right lobe. Representative lesions\ninclude:\n\n1. Segment VI measuring 1.8 cm with arterial enhancement, washout, and pseudo\ncapsule, diagnostic of hepatocellular carcinoma (series 10, image 55; series\n12, image 46).\n2. Segment VII measuring 2.3 cm with arterial enhancement and T2\nhyperintensity, but no evidence of washout or pseudo capsule (series 10, image\n40; series 8, image 13).\n3. Segment I measuring 2.0 cm with arterial enhancement and T2 hyperintensity,\nbut no evidence of washout or pseudo capsule (series 10, image 49; series 8,\nimage 16).\n4. Segment VI measuring 1.4 cm with arterial enhancement and T2\nhyperintensity, but no evidence of washout or pseudo capsule (series 10, image\n61; series 8, image 19).\n5. Segment VI measuring 0.9 cm with arterial enhancement and T2\nhyperintensity, but no evidence of washout or pseudo capsule (series 10, image\n61; series 8, image 19).\nBiliary: There is no intra or extrahepatic biliary ductal dilatation\n\nPancreas: The pancreas is normal in size and morphology. No pancreatic ductal\ndilatation.\n\nSpleen: Splenomegaly measuring 14.4 cm.\n\nAdrenal Glands: The adrenal glands are normal in size and contour.\n\nKidneys: The kidneys are symmetric and normal contour. There are a few\nscattered subcentimeter T2 hyperintense lesions which are too small to\ncharacterize.\n\nGastrointestinal Tract: Limited evaluation of the gastrointestinal tract is\nunremarkable.\n\nLymph Nodes: There is no lymphadenopathy in the visualized abdomen.\n\nVasculature: There are large upper abdominal portosystemic collaterals\nincluding a large splenorenal shunt.\n\nOsseous and Soft Tissue Structures: The visualized soft tissues and osseous\nstructures are unremarkable.", "output": "1. OPTN 5A lesion in segment VI measuring 1.7 cm diagnostic of hepatocellular\ncarcinoma.\n2. Multiple additional lesions demonstrate features suspicious for\nhepatocellular carcinoma, but do not meet OPTN criteria for hepatocellular\ncarcinoma. Close follow-up advised.\n3. Cirrhosis with evidence of portal hypertension including splenomegaly and\nupper abdominal portosystemic collaterals." }, { "input": "Lower Thorax: There is bilateral gynecomastia. Minimal dependent atelectasis\nnoted at the lung bases, along with trace bilateral pleural effusions.\n\nLiver: The liver demonstrates a nodular contour and a cirrhotic morphology. \nThere has been interval chemoembolization to the right lobe. Lack of an\nadequate arterial enhanced phase limits evaluation for any residual or new\nhepatic disease. On the delayed portal venous phase, there are multiple\nscattered nonenhancing hypointense foci, that were also present previously\nwith no significant interval change.\nThe hepatic veins are patent.\nThe portal vein appears attenuated but remains patent.\n\nBiliary: No intra or extrahepatic biliary ductal dilation. The gallbladder is\ndistended and demonstrates presence of multiple tiny calculi in the dependent\nportion with no pericholecystic inflammation.\n\nPancreas: The background pancreatic parenchyma demonstrates normal signal\nintensity and enhancement on all pulse sequences. Again visualized are\nscattered T2 hyperintense, nonenhancing cystic lesions throughout the\npancreatic parenchyma with the largest in the midbody measuring 8 mm in size,\nunchanged compared to the prior exam. The main pancreatic duct is not\ndilated.\n\nSpleen: The spleen is enlarged, measuring 16.6 cm in the anteroposterior axis.\nThere are no focal splenic lesions.\n\nAdrenal Glands: There are no adrenal nodules\n\nKidneys: No hydronephrosis or solid enhancing renal masses noted. Stable 4 mm\nsimple cortical cyst noted in the interpolar region of the left kidney.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: No enlarged upper abdominal lymph nodes identified.\n\nVasculature: A large splenorenal shunt is again identified. The hepatic veins\nare patent. The portal vein and its branches are attenuated but patent. A\nlarge splenorenal shunt is again visualized.\n\nOsseous and Soft Tissue Structures: Normal marrow signal. No soft tissue\nabnormalities noted.\n\nTrace ascites in the perihepatic space.", "output": "1. Unchanged cirrhotic morphology of the liver, status post chemoembolization\nin ___. Lack of an adequate arterial enhanced phase on this study\nlimits evaluation for residual or new hepatic disease.\n2. Numerous incidental findings include splenomegaly with a large splenorenal\nshunt, trace perihepatic ascites, patent portal vein and its branches,\nbilateral trace pleural effusions with bibasilar atelectasis, gynecomastia." }, { "input": "Lower thorax: Trace left pleural effusion.\n\nLiver: The liver demonstrates nodular contour and cirrhotic morphology. No\nhepatic lesion, meeting OPTN 5 criteria.\nStatus post TACE to the right lobe.\nAgain seen are scattered, nonenhancing hypointense foci on the delayed portal\nvenous phase, faintly seen on T2 weighted sequences, likely corresponding to\npost treatment changes. These lesions are grossly unchanged compared to\nprior, as follows:\n\n-0.9 cm lesion in hepatic segment VII (1102:33)\n-1.7 cm lesion in hepatic segment VII (1102:37)\n-1.1 cm lesion in hepatic segment VI (1102:47)\n\nThe hepatic vasculature appears patent. Small volume ascites, minimally\nincreased compared prior\n\nBiliary: There is no intra or extrahepatic biliary dilatation. Gallstones\nwithout radiographic findings to suggest cholecystitis.\n\nPancreas: Normal pancreatic signal characteristics. Again seen are scattered\nT2 hyperintense, nonenhancing cystic lesions throughout the pancreatic body,\nthe largest measuring 7 mm (5:23), largely unchanged compared to prior. The\nmain pancreatic duct is normal in caliber.\n\nSpleen: The spleen is enlarged, measuring 17 cm in the AP axis. There is a\nsimple cyst in the upper aspect of the spleen (5:16) without focal concerning\nlesions.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis. Again seen is a T2 hyperintense, nonenhancing 4 mm\ncortical cyst in the interpolar region of the left kidney (3:37).\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Again seen there is a large splenorenal shunt. Abdominal aorta\nis normal in caliber and major branch vessels are patent. The portal vein,\nsplenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Cirrhotic liver morphology, status post TACE in ___. No hepatic\nlesion, meeting OPTN 5 criteria.\n2. Portal venous hypertension manifested by splenomegaly, large splenorenal\nshunt and small volume ascites, slightly increased since prior exam.\n3. Trace left pleural effusion." }, { "input": "LOWER CHEST: There are trace right and small left pleural effusions with\nadjacent atelectasis.\n\nABDOMEN:\n\nLIVER: The liver is nodular consistent with cirrhosis. A 1.4 cm nonenhancing\nfocus with mild T2 signal hyperintensity corresponds to a treated lesion in\nsegment VII, decreased in size since the prior examination, previously 1.7 cm\n(series 7, image 168). Allowing for differences in measurement technique, a\nsimilar nonenhancing focus at the margin of segments VI and VII is unchanged\nand corresponds to another treated lesion (series 7, image 177). No\nassociated enhancing nodularity to suggest recurrence. There is small volume\nabdominal ascites. There are numerous T2 hypointense, hypoenhancing siderotic\nnodules with blooming on longer echo time sequences.No OPTN 5 lesions. The\nportal veins are attenuated, but patent. The hepatic veins are patent. \nHepatic arterial anatomy is conventional.\n\nBILIARY: There is no intrahepatic or extrahepatic biliary dilatation. There\nis cholelithiasis without wall thickening or surrounding inflammation.\n\nPANCREAS: The pancreas is normal in signal intensity. Assessment of\npre-existing cystic pancreatic lesions is limited by motion artifact. The\nlargest visible lesion on the current examination measures up to 7 mm in the\npancreatic body (series 3, image 16). No main pancreatic duct dilatation. No\nevidence of peripancreatic inflammation.\n\nSPLEEN: The spleen is enlarged and measures 15.6 cm, previously 17 cm. Tiny\nsubcentimeter cyst in the anterior aspect of the superior spleen, unchanged. \nNo focal concerning lesions.\n\nADRENALS: The adrenal glands are normal in size and shape.\n\nURINARY: The kidneys are normal in size and nephrogram. No concerning\nlesions. No hydronephrosis.\n\nGASTROINTESTINAL: The stomach is unremarkable. Partially imaged loops of\nlarge and small bowel are unremarkable.\n\nLYMPH NODES: No abdominal lymphadenopathy.\n\nVASCULAR: No abdominal aortic aneurysm. There are extensive upper abdominal\nportosystemic collaterals, including a large splenorenal shunt.\n\nBONES: No concerning osseous lesion.\n\nSOFT TISSUES: There is mild body wall edema. Gynecomastia is redemonstrated.", "output": "1. Decreased size of treated lesions in the right hepatic lobe. No evidence\nof residual or recurrent disease. No OPTN 5 lesions.\n2. Cirrhosis with sequela of portal hypertension including small volume\nascites, splenomegaly, and upper abdominal portosystemic collaterals,\nincluding a large splenorenal shunt.\n3. Patent hepatic vasculature.\n4. Suboptimal assessment of cystic pancreatic lesions measuring up to 7 mm\nbecause of motion artifact, likely side branch intraductal papillary mucinous\nneoplasms. Recommend continued attention on follow-up imaging.\n\nRECOMMENDATION(S): Suboptimal assessment of cystic pancreatic lesions\nmeasuring up to 7 mm, likely side branch intraductal papillary mucinous\nneoplasms. Recommend continued attention on follow-up imaging." }, { "input": "Motion artifact degrades image quality, particularly on the post gadolinium\nsequences.\n\nLower Thorax: Visualized lower thorax is grossly unremarkable. Gynecomastia\nnoted.\n\nLiver: The liver demonstrates a nodular contour with hypertrophy of the\nleft/caudate lobes with relative atrophy of the right hepatic lobe in keeping\nwith morphologic changes of cirrhosis. Multiple siderotic nodules are noted\nin the liver.\n\nRedemonstration of a 1.8 cm faint T2 hyperintense focus involving segment VII\n(series 5, image 11), representing a previously treated lesion, similar in\nsize compared to ___. Redemonstration of multiple areas of\nhypoenhancement in segments VIII and VII corresponding to post treatment\nchange (series 7, images 159-163). No new areas of arterial enhancement or\nwashout. No OPTN 5 lesions.\n\nThere is a patent TIPS in situ extending from the right portal vein to the\nleft hepatic vein.\n\nSmall volume ascites noted in the upper abdomen.\n\nBiliary: No intra- or extrahepatic biliary dilation. There is cholelithiasis\nwithout cholecystitis.\n\nPancreas: Pancreas is atrophic without ductal dilation. There is decreased T1\nsignal intensity of the pancreatic parenchyma, likely the sequela of prior\npancreatitis.\n\nSpleen: The spleen is enlarged measuring up to 16.4 cm. Stable 0.5 cm simple\ncyst involving the spleen anteriorly.\n\nAdrenal Glands: Adrenal glands are thin without nodularity.\n\nKidneys: The kidneys show symmetric enhancement without concerning lesion. \nThere is no hydronephrosis or hydroureter. 0.5 cm simple cyst involving the\nmidpole of the left kidney.\n\nGastrointestinal Tract: Stomach is grossly unremarkable. Visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal adenopathy.\n\nVasculature: Visualized abdominal vasculature is grossly unremarkable. \nConventional arterial supply of the liver. Large splenorenal shunt noted. \nPerisplenic varices noted.\n\nOsseous and Soft Tissue Structures: There are no gross abnormalities.", "output": "1. Liver cirrhosis with evidence of portal hypertension evidenced by\nsplenomegaly, perisplenic varices, and a large splenorenal shunt. Patent TIPS\nin situ.\n2. Post treatment changes in the right hepatic lobe. No OPTN 5 lesions.\n3. Cholelithiasis." }, { "input": "Lower Thorax: Small bilateral pleural effusions, left greater than right. \nMild cardiomegaly.\n\nLiver: As before nodular hepatic morphology is in keeping with cirrhosis. \nInnumerable siderotic nodules are present.\n\nAgain seen is a 1.7 x 1.3 cm T2 intermediate intensity in segment 7 (series 5,\nimage 14), likely representing a previously treated lesion, similar in size\ncompared to the ___ examination. There is no associated arterial\nenhancement or washout. A focus arterial hyperenhancement in segment 6\n(series 7, image 69) is without definite delayed phase correlate, likely\nreflecting a transient hepatic intensity difference. Close attention on\nfollow-up imaging is recommended. No other new lesions are present meeting\nOPTN 5 criteria for hepatocellular carcinoma.\n\nAs before, a patent TIPS is present in situ.\n\nSmall volume upper abdominal ascites.\n\nBiliary: No intrahepatic or extrahepatic bile duct dilatation. Cholelithiasis\nwithout evidence of cholecystitis.\n\nPancreas: The pancreas is largely atrophic without evidence of main pancreatic\nductal dilatation.\n\nSpleen: The spleen is enlarged up to 14.5 cm. There is a 0.5 cm simple cyst\nin the anterior pole of the spleen (series 5, image 16).\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: The kidneys are symmetric in size and signal intensity. No\nsuspicious renal lesions are identified. No hydronephrosis. A subcentimeter\nsimple cyst is again seen in the left interpolar kidney (series 3, image 26).\n\nGastrointestinal Tract: The stomach is unremarkable. Visualized small and\nlarge bowel loops are unremarkable. No evidence of bowel obstruction.\n\nLymph Nodes: No enlarged abdominal lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Status post splenic artery\nembolization. Persistent large upper abdominal varices are again present.\n\n\nOsseous and Soft Tissue Structures: Bilateral gynecomastia. No suspicious\nosseous or soft tissue abnormalities are present.", "output": "1. Cirrhotic liver morphology with stable appearance of a treated lesion in\nsegment 7.\n2. Focal arterial hyperenhancement in segment 6 is felt to be in keeping with\na transient hepatic intensity difference although attention on follow-up\nimaging is recommended. No suspicious liver lesions are present meeting OPTN\ncriteria for hepatocellular carcinoma.\n3. Patent TIPS.\n4. Status post splenic artery embolization.\n5. Splenomegaly, small volume ascites, persistent large upper abdominal\nvarices.\n6. Cholelithiasis." }, { "input": "MRI OF THE ABDOMEN WITH AND WITHOUT IV CONTRAST:\n\nIncluded views of the lung bases are clear. There is no pericardial or pleural\neffusion. The heart size is top-normal.\n\nThe liver contour is markedly nodular, in keeping with known history of\ncirrhosis. Hepatic parenchyma demonstrates heterogeneous signal intensity on\nT2 weighted sequences (series 4, image 23), with diffuse reticular contrast\nenhancement on delayed sequences, denoting confluent fibrosis (series 13,\nimage 47). Multiple ill-defined subcentimeter foci of arterial\nhyperenhancement do not have T2 or delayed phased correlates, representing\ntransient hepatic intensity differences (series 10 image 50, 60). No\nconcerning hepatic mass is detected.\n\nThere is no intra or extrahepatic bile duct dilation. Multiple gallstones\nreside within an otherwise normal gallbladder (series 4, image 16). There are\nno ductal stones.\n\nThe pancreas demonstrates normal signal intensity and bulk. The main\npancreatic duct is normal in caliber.\n\nThe spleen is mildly enlarged, measuring 16.3 cm (series 3, image 25). A\nlarge recannalized paraumbilical vein is unchanged since the CT examination\nfrom ___, denoting chronic portal hypertension (series 12, image\n33).\n\nThe adrenal glands, kidneys, stomach, and intra-abdominal loops of small and\nlarge bowel are normal. There is no mesenteric or retroperitoneal\nlymphadenopathy, and no ascites.\n\nConventional hepatic arterial anatomy is demonstrated. The portal and hepatic\nveins remain patent.\n\nThere are no bony lesions concerning for malignancy or infection.", "output": "1. Cirrhotic liver with confluent fibrosis. No lesions meeting OPTN criteria\nfor HCC.\n2. Mild splenomegaly and a massively dilated recanalized paraumbilical vein,\ndenoting chronic portal hypertension.\n3. Cholelithiasis." }, { "input": "Lower Thorax: Lower lung bases and pleural spaces are clear.\n\nLiver: The patient is status post chemoembolization x 3 of multiple hepatic\nlesions.\nThe dominant lesion, a segment V/VI mass which is partly exophytic along the\ninferior aspect of the right hepatic lobe, measures 8.2 x 9.4 cm, previously\n8.8 x 10.0 cm in a similar plane, slightly decreased in size overall. A large\nproportion of this mass shows intrinsic hyperintensity on precontrast T1WI\nwithout enhancement consistent with post treatment necrosis.\nAlong the inferomedial margin of this lesion, a crescentic region demonstrates\npersistent nodular arterial phase hyperenhancement and washout, measuring\napproximately 8.0 x 4.8 cm (series 11, image 96), equivocally increased in\nsize from the comparison CT scan of the abdomen and pelvis performed ___, in keeping with residual HCC. Adjacent to the inferior edge of this\nlesion are at least 3 nodular foci of arterial hyperenhancement measuring 2-3\nmm in diameter, two of which are located within the omental fat (series 9,\nimage 101) and a single lesion seen along the peritoneal lining (series 9\nimage 103). Small size limits assessment although close attention on\nfollow-up imaging is recommended as local metastatic disease cannot be\nexcluded.\n\n- Within segment 4B there is a new 2.0 x 1.5 cm arterially hyper enhancing\nlesion which demonstrates washout and a pseudo capsule, in keeping with HCC,\nmeeting OPTN 5B criteria.\n\n- Within segment 4B there is an additional new focus of arterial hyper\nenhancement demonstrating washout (series 9, image 52) measuring up to 6 mm,\nsuspicious for ___.\n\n- Within segment 2, there is a new 5 mm focus of arterial hyper enhancement\nwith washout (series 9, image 41), along with a 4 mm focus of arterial hyper\nenhancement with washout (series 9, image 53) suspicious for ___.\n\n- within segment 2 superiorly there is a 9 mm focus of arterial hyper\nenhancement with no definite washout on the delayed images (series 9, image\n35). Close attention on follow-up imaging is recommended.\n\n- Centrally within segment 8, the large lesion recently treated with\nchemoembolization (series 7, image 44) demonstrates residual hepatocellular\ncarcinoma along its margins. Along the superomedial aspect of the necrotic\nlesion there is a 2.1 x 1.0 cm focus of arterial hyper enhancement with\nwashout. Further inferiorly there is an additional focus of arterial hyper\nenhancement with washout measuring 2.4 x 1.9 cm (series 9, image 50),\nrepresenting residual HCC.\n\n- Within segment 2, there is another focus of arterial hyper enhancement\ndemonstrating washout (series 9, image 50), measuring up to 10 mm in size,\nwhich has slightly decreased in size from the comparison study where it\nmeasured up to 16 mm (series 4, image 14).\n\n- On the prior CT from ___, an arterial enhancing lesion was seen\nwithin the dome of the liver, which has since been treated with chemo\nembolization, now representing an area of necrosis with no evidence of\nresidual tumor.\n\n- within segment 3 there are two adjacent areas of arterial hyper enhancement\nwhich do not demonstrate washout on the delayed images, nor are they present\non the pre contrast images (series 9, image 56), measuring up to 14 mm in\nsize, and most likely representing transient hepatic attenuation differences.\n\nMultiple additional necrotic treated lesions are seen within the right lobe,\nand a single area in the left lobe (series 9, image 42), representing sites of\npreviously treated HCC.\n\nThe main portal vein, as well as right and left main portal veins are patent. \nWithin the left lobe of the liver there are a few branching areas of non\nenhancement (series 9, image 44), seen on multiple prior studies, likely\nreflecting a combination of thrombosis within small portal vein branches, and\nbile lakes.\n\nNo ascites.\n\nBiliary: No intra or extrahepatic ductal dilatation. Gallbladder is\nunremarkable.\n\nPancreas: Pancreas enhances homogeneously with no focal mass lesion. No\nperipancreatic stranding or ductal dilatation.\n\nSpleen: The spleen is nonenlarged with no focal mass lesion.\n\nAdrenal Glands: 1.7 x 1.6 cm left adrenal adenoma is again identified. An\nadditional 6 mm adenoma is seen arising from the right adrenal gland.\n\nKidneys: No dilatation of the renal collecting system. No renal mass lesion.\n\nGastrointestinal Tract: Visualized loops of small large bowel are within\nnormal limits. Incompletely visualized and only seen on the coronal images is\na suspected stool filled diverticulum arising from the ascending colon.\n\nLymph Nodes: No significant retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: No aneurysmal dilatation of the abdominal aorta.\n\nOsseous and Soft Tissue Structures: No acute or aggressive osseous lesions are\ndemonstrated.", "output": "Multifocal hepatocellular carcinoma status post chemoembolization. There has\nbeen a mixed response to treatment.\n\n- Residual disease is again seen along the periphery of the large, previously\ntreated, necrotic mass within segment ___.\n\n- Residual HCC is also noted along the margins of the recently treated lesion\nwithin segment 8 centrally.\n\n- New focus of HCC is seen within segment 4B, meeting OPTN 5b criteria.\n\n- multiple small foci of arterial hyper enhancement with washout are seen\nwithin segment 4B and segment 2, as described above, suspicious for\nhepatocellular carcinoma but not meeting OPTN criteria.\n\n- treated hepatocellular carcinoma at the dome of the liver." }, { "input": "Lower Thorax: Within the limitations of MRI, the lung bases are clear. There\nis no pleural effusion. The base of the heart is normal in size. There is no\npericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is no hepatic steatosis. Within the limitations\nof this noncontrast exam, no focal liver lesions are identified.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The common\nbile duct measures 3 mm. It tapers smoothly to the ampulla. There is no\nevidence of choledocholithiasis or a mass. The gallbladder is not distended. \nThere are innumerable gallstones, filling the body of the pancreas and\nextending into the pancreatic neck. That being said, the gallbladder is not\ndistended. There is no wall thickening or surrounding pericholecystic fluid. \nThere is no MRI evidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma is normal in signal. There is no duct\ndilation or mass. There is no evidence of active or chronic pancreatitis.\n\nSpleen: The spleen is normal in size, measuring 10.9 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are no worrisome renal\nlesions, hydronephrosis, or perinephric abnormalities. A 4 mm cyst is noted\nin the left kidney.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm. Evaluation of the vasculature is somewhat limited on this\nnoncontrast exam.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nA 15 mm T2 hyperintense lesion in T12 is most compatible with a hemangioma. \nThe soft tissues are unremarkable.", "output": "1. Cholelithiasis without evidence of cholecystitis.\n2. Normal appearance of the biliary tree and pancreas. No evidence of\ncholedocholithiasis, biliary duct dilation, or pancreatitis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion. There is signal\nchanges at the left lung base which may represent atelectasis but are\nnonspecific on MR imaging.\n\nLiver: The liver appears homogeneous in signal intensity. There is no loss of\nsignal on T1 out of phase imaging to indicate hepatic steatosis.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder contains sludge but has no wall thickening.\n\nPancreas: The pancreas appears homogeneous in signal intensity. There is no\npancreatic ductal dilatation.\n\nSpleen: The spleen appears homogeneous in signal intensity and is not\nenlarged.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size. There is no hydronephrosis. In\nthe upper pole of the left kidney there is a 1.8 cm cyst. For multiple small\ncysts measuring less than 1 cm in the right kidney.\n\nGastrointestinal Tract: The visualized portions of the gastrointestinal tract\nare within normal limits.\n\nLymph Nodes: There is no pathologic lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. The\nvisualized subcutaneous soft tissues are unremarkable.", "output": "No suspicious mass lesion or pathologic lymphadenopathy in the abdomen." }, { "input": "Lower thorax: No pleural effusion. No atelectasis.\n\nLiver: Unremarkable hepatic contours. Patent hepatic vasculature. No\nsuspicious hepatic masses.\n\nBiliary: No biliary ductal dilatation. Unremarkable gallbladder.\n\nPancreas: Unremarkable pancreatic contours. No pancreatic ductal dilatation.\n\nSpleen: No splenomegaly.\n\nAdrenal Glands: Unremarkable.\n\nKidneys:\nThe right kidney is normal in appearance with no hydronephrosis.\n\nThe left kidney demonstrates an inferior pole mixed cystic and solid mass\nmeasuring 9 x 9.8 x 12.4 cm. This is peripherally hyperenhancing. Large\ncystic components more inferiorly demonstrate hemorrhage. The mass invades\nthe Gerota's fascia more anteriorly with loss of clear fat plane between the\nrenal mass and the splenic flexure. Otherwise common adjacent solid are not\ninvolved. The tumor extends into the left renal vein however, does not go\nbeyond midline and does not involve the IVC. There are multiple suspicious\nsubcentimeter lymph nodes in the left periaortic region.\n\nGastrointestinal Tract: No bowel obstruction.\n\nPelvis: Normal sized uterus. No adnexal masses. There is engorgement of the\nleft pelvic veins and left gonadal veins secondary to the outflow obstruction\nfrom the left renal vein thrombus.\n\nLymph Nodes: Sub cm left periaortic prominent lymph nodes are suspicious for\nmetastatic disease given prominence and proximity to the main mass.\n\nVasculature: Normal caliber abdominal aorta. Intra-abdominal branches are\npatent. There are 2 left renal arterial branches arising next to each other\nfrom the aorta; a short shared trunk cannot be entirely excluded (series 1501\nimage 80). There is a single right renal artery. IVC is patent. Tumor\nthrombus does not extend into the IVC.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Left inferior pole renal mass measuring up to 12.4 cm, with suspected\ninvasion into Gerota's fascia anteriorly with possible early serosal invasion\nat the splenic flexure.\n2. Tumor thrombus within the left renal vein but not extending past midline. \nThe IVC remains clear.\n3. Prominent left periaortic lymph nodes are suspicious for tumor involvement.\n4. Two left renal arteries, possibly sharing a short common trunk at the\ntakeoff (series 1501 image 80)." }, { "input": "Lower Thorax: Mild atelectasis is noted at the right lung base.\n\nLiver: Multiple nonenhancing lesions are identified in liver segment II and\nIII, in keeping with treated tumor status post TACE (1103:45, 64, 71). 0.6 cm\nnodular enhancement is identified at the inferior margin of otherwise\nnonenhancing 2.2 cm lesion in segment II (1101:48). 0.8 cm focus of arterial\nenhancement is identified in segment VII without washout (1101:29), unchanged.\nPreviously described focus of enhancement in the caudate lobe is not\nvisualized on current exam.\n\nBiliary: Mild central intrahepatic bile duct dilation is unchanged. Common\nbile duct is mildly dilated to 9 mm, similar to prior.\n\nPancreas: 1.0 cm cystic lesion is identified at the pancreatic body (04:17),\nstable and likely represents a side-branch IPMN. Millimetric cystic lesions\nat the pancreatic head and tail are also stable (04:21, 17). Pancreas divisum\nis noted. There is no main ductal dilatation. Pancreas demonstrates\nhomogeneous enhancement throughout.\n\nSpleen: Enlarged spleen measures 15 cm in month.\n\nAdrenal Glands: Right adrenal gland is not well visualized. A 1.5 cm adenoma\nin the left adrenal gland is stable.\n\nKidneys: Multiple cysts are identified in bilateral kidneys measuring up to\n1.4 cm. There is a small amount layering hemorrhage within a 1.1 cm cyst in\nthe interpolar region of the left kidney (9:83). There is no hydronephrosis.\n\nGastrointestinal Tract: Stomach is unremarkable. Small and large bowel loops\nare normal caliber.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy is identified.\n\nVasculature: Bland thrombus in the portal confluence is not significantly\nchanged. Small eccentric thrombus in the SMV is similar to before. Replaced\ncommon hepatic artery arises from the SMA. Large varices are noted in the\npara-aortic region. 1.9 cm splenic artery aneurysm is unchanged. The common\nhepatic artery is replaced to the SMA.\n\nOsseous and Soft Tissue Structures: No concerning bone lesion is identified. \nVentral hernia contains nonobstructed small bowel loops.", "output": "1. 0.6 cm nodular enhancement is identified at the inferior margin of\notherwise nonenhancing lesion in segment II. Attention is advised on\nfollow-up.\n2. Other treated lesions in the left hepatic lobe are free of any residual\nenhancement.\n3. Cystic lesions measuring 1.0 cm or less in the pancreas are stable and\nlikely side-branch IPMNs.\n4. Thrombus in the portal vein confluence and SMV are unchanged.\n5. Liver cirrhosis with splenomegaly and portosystemic varices.\n6. 1.9 cm splenic artery aneurysm is unchanged." }, { "input": "Lower Thorax: Subsegmental atelectases is seen at the lung bases.\n\nLiver: The liver redemonstrates cirrhotic morphology with multiple treatment\ncavities and lesions as follows (series ___:\n\n- Treatment cavity in segment II with similar linear enhancement in its\ninferior aspect measuring 1.6 x 1.4 cm, previously 2.1 x 1.6 cm (image 30).\n\n- Treatment cavity in segment ___ measuring 0.6 cm without finding of\nrecurrence tumor (image 31).\n\n- Treatment cavity in segment IVb 1.8 X 1.8 CM, stable without findings of\nrecurrent tumor (image 54).\n\n- There are two indeterminate lesions, one measuring 0.8 cm on series 1001,\nimage 22 in segment 7 and one measuring 1.1 cm on 1002 image 53 on segment 4B \nwith washout, however no pseudo capsule, suspicious for HCC although not\nmeeting OPTN criteria (series 1102, image 24 and image 52).\n\nBiliary: Again seen is moderate biliary ductal dilatation up to the hilum,\nseen on multiple prior examinations. Cholecystectomy changes are again noted.\n\nPancreas: The pancreas again redemonstrates a few cystic lesions, measuring up\nto 8 mm, either sequela of pancreatitis or side-branch intraductal papillary\nmucinous neoplasms, amenable to reassessment on routine exams. No main ductal\ndilatation demonstrated.\n\nSpleen: There are multiple cirrhotic nodules in the moderately and large\nspleen, evidence of portal hypertension.\n\nAdrenal Glands: The thickening of the left adrenal hands in stable dating back\nto the CT of ___. The right adrenal gland appears unremarkable.\n\nKidneys: The kidneys demonstrate bilateral small cysts, some of which are\nhemorrhagic. No hydronephrosis.\n\nGastrointestinal Tract: There is no intestinal obstruction or ascites in the\nupper abdomen.\n\nLymph Nodes: A few prominent periportal and peripancreatic lymph nodes\nmeasuring up to 1.1 cm are stable and possibly reactive.\n\nVasculature: No significant change in main portal vein/distal SMV thrombus. \nThe intrahepatic portal veins are diminutive centrally and the posterior\nbranch of the right portal vein is ectatic, as on prior. No change in 1.9 cm\ndistal splenic artery aneurysm.\n\nOsseous and Soft Tissue Structures: No worrisome osseous lesions are seen.", "output": "1.Cirrhotic liver morphology with two indeterminate lesions suspicious,\nalthough not meeting OPTN criteria for HCC.\n\n2. The treatment cavity in segment II demonstrates linear enhancement\ninferiorly, amenable to reassessment on routine follow-ups. Additional\ncavities without findings of recurrent disease.\n\n3. No change in pancreatic cystic lesions, portal venous thrombus and splenic\nartery aneurysm.\n\n\n\nRECOMMENDATION(S):" }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is shrunken and nodular consistent with a cirrhotic\nmorphology. Treatment cavities are seen in hepatic segment ___ and ___. \nSurrounding the treatment cavity in segment ___ there are two new 7 mm foci of\nnodular arterial enhancement suspicious for local recurrence (19; 37, 43).\n- A 0.8 cm enhancing lesion in hepatic segment ___ demonstrates washout and\npseudocapsule (19; 46/21:46).\n- A 0.8 cm enhancing lesion in hepatic segment VIII demonstrates washout and\npseudocapsule (19; ___.\n- A 0.5 cm enhancing lesion in segment VII (19:29) demonstrates washout\nwithout pseudocapsule.\n- A 1.2 x 0.9 cm enhancing lesion in hepatic segment VII demonstrates only\nminimal enhancement along the lateral peripheral margin and this area\ndemonstrates washout without pseudocapsule (19; 24).\n-scattered focal areas of arterial enhancement are seen which do not have\ncorrelates on other sequences, likely transient hepatic intensity differences\n(19; 46, 55).\nThere is trace perihepatic ascites.\n\nBiliary: The gallbladder is surgically absent. There is moderate central\nintrahepatic biliary ducts and prominence of the CBD similar to prior.\n\nPancreas: Normal in signal intensity. There is evidence of pancreatic\ndivisum and a santorinicele, similar to prior. Scattered T2 hyperintense\nlesions are seen throughout the pancreas measuring up to 1 cm in the\npancreatic body, previously measuring 0.5 cm (3; 22). A 0.9 cm cystic lesion\nin the pancreatic tail was not well visualized on the prior (3; 26).\n\nSpleen: The spleen is enlarged measuring 15.9 cm without focal lesion.\n\nAdrenal Glands: Left adrenal gland is mildly uniformly thickened without a\ndiscrete nodule. No right adrenal nodules..\n\nKidneys: There is no hydronephrosis. Bilateral renal cysts are seen.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: Subcentimeter short axis retroperitoneal lymph nodes and porta\nhepaticus lymph nodes are unchanged compared to the prior exam.\n\nVasculature: There is an accessory right hepatic artery which arises from the\nSMA. Stable 1.9 cm splenic artery aneurysm. There is moderate atherosclerotic\ndisease of the abdominal aorta. There are large upper abdominal varices. The\nintrahepatic portal veins remain diminutive, similar to prior the main portal\nvein and distal SMV thrombus is not as well visualized on this study.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. A\nlobulated ventral abdominal wall hernia containing loops of bowel and free\nfluid is noted with a neck measuring 4.7 cm.", "output": "1. Cirrhotic liver morphology with several subcentimeter hepatic lesions,\ndescribed in detail above, which do not meet size criteria for OPTN lesions\nbut are suspicious for ___, including new nodular foci of enhancement adjacent\nto the segment ___ treatment cavity. Recommend short-term interval follow-up.\n2. Interval increase in size of the dominant pancreatic cystic lesion, now\nmeasuring 1 cm, recommend attention on follow-up." }, { "input": "Lower Thorax: Allowing for differences in modality, enhancing lesions in the\nleft lower lobe measuring 7 mm (1301:27) and right lower lobe measuring 5 mm\n(1301:11) appear grossly similar to the dedicated CT chest of ___\nand are concerning for metastatic foci.\n\nLiver: The patient is status post right partial hepatectomy and TACE. The\nremaining liver is shrunken and nodular, consistent with cirrhosis. Treatment\ncavities are again seen in hepatic segments II, III, and ___.\n\n- A 1.7 x 1.6 cm region of coagulation necrosis within the hepatic segment ___\ntreatment cavity is again seen. However, there is a crescentic, somewhat\nill-defined region of T2 hyperintensity (06:13) and high B-value diffusion\nrestriction (07:24) abutting the treatment cavity which measures approximately\n1.8 x 1.3 cm (1303:44), and is highly suspicious for tumor but does not\nexhibit correlative enhancement.\n- A 1.0 cm hyperenhancing lesion in hepatic segment II has slightly increased\nin size, previously 0.8 cm, and does not exhibit washout or pseudocapsule\n(1301:53).\n- A 0.9 cm hyperenhancing lesion in hepatic segment II is essentially\nunchanged, previously 0.8 cm, and does not exhibit washout or pseudocapsule\n(1301:31).\n- A 0.6 cm hyperenhancing lesion in hepatic segment VII is unchanged,\npreviously 0.5 cm, and demonstrates washout without definite pseudocapsule\n(1301:32 and 1303:32).\n- Allowing for differences in technique, a 1.3 x 1.0 cm hyperenhancing lesion\nin hepatic segment VII is unchanged in size, but does not exhibit washout or\npseudocapsule (1301:28 and 1304:28).\n\nScattered focal areas of arterial enhancement, including a prominent 0.6 cm\nlesion in hepatic segment VII, which do not have correlates on delayed or\nother sequences, likely represent transient hepatic intensity differences.\n\nThere is small volume perihepatic ascites, increased from prior.\n\nBiliary: The gallbladder is surgically absent. There is moderate central\nintrahepatic biliary ductal dilatation and prominence of the CBD, similar to\nprior.\n\nPancreas: Normal in signal intensity. There is evidence of pancreatic\ndivisum, similar to prior. Scattered T2 hyperintense lesions are again seen\nthroughout the pancreas, measuring up to 1.0 cm in the pancreatic body (6:26),\nunchanged since the prior study but increased since the study of ___\nwhen it measured 0.5 cm.\n\nSpleen: The spleen is moderately enlarged but stable with note of multiple\nsiderotic nodules.\n\nAdrenal Glands: Mild uniform thickening of the left adrenal gland without\ndiscrete nodule is re-demonstrated. The right adrenal gland is normal\n\nKidneys: Bilateral renal cysts are unchanged. No hydronephrosis.\n\nGastrointestinal Tract: Thickening of the stomach wall is suggestive of\nportal gastropathy. No evidence of obstruction in the visualized bowel.\n\nLymph Nodes: Subcentimeter porta hepatis and retroperitoneal nodes are\nunchanged compared to prior.\n\nVasculature: Known variant right replaced hepatic artery arising from the\nsuperior mesenteric artery. There is a stable 1.9 cm neck artery aneurysm. \nMultiple abdominal varices appear grossly similar. The intrahepatic portal\nveins remain diminutive, similar to prior. There is expansion of the portal\nvenous confluence with a heterogeneously enhancing mass measuring 2.8 x 2.4 cm\n(1303:89), not well seen on the prior study, concerning for tumor thrombus. \nThe splenic vein and partially visualized superior mesenteric vein appear\npatent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. A lobulated\nventral abdominal wall hernia containing loops of nonobstructed bowel and\ntrace free fluid has increased in size with its neck measuring 5.9 cm (06:15),\npreviously 4.7 cm.", "output": "1. In the absence of prior interval treatment, crescentic T2 and\ndiffusion-weighted signal abnormality about the focus of coagulation necrosis\nin the segment ___ treatment cavity is highly concerning despite not meeting\nOPTN criteria.\n2. Multiple other hyperenhancing lesions, as described above, do not meet OPTN\ncriteria but are suspicious for ___ nonetheless.\n3. Expansion of the portal venous confluence with a heterogeneously enhancing\nmass is concerning for tumor thrombus. The visualized splenic and superior\nmesenteric veins appear grossly patent.\n4. Enhancing subcentimeter pulmonary nodules in the right lower lobe and left\nlower lobe, better characterized on the same day dedicated chest CT, are\nconcerning for metastasis.\n5. Cirrhosis with portal hypertensive sequelae, including stable splenomegaly,\nportal gastropathy, and interval increase in small perihepatic ascites.\n6. Stable pancreatic cystic lesions measuring up to 1 cm may represent side\nbranch IPMNs. Attention on follow-up recommended.\n7. Stable splenic artery aneurysm.\n8. Moderate central intrahepatic biliary ductal dilatation with prominence of\nthe common bile duct may suggest ampullary stenosis." }, { "input": "Lower Thorax: Right basal bronchiectasis, atelectasis and inflammatory change,\nsimilar to prior CT allowing for difference in technique.\n\nLiver: Postsurgical changes with partial right hepatectomy. There is a lesion\nin segment 3 of the liver which demonstrates arterial phase hyper enhancement,\nand washout on portal venous and subsequent post-contrast phases in addition\nto a pseudocapsule compatible with hepatocellular carcinoma. This currently\nmeasures 2.3 cm maximal diameter, previously 2.1 cm. There are several tiny\narterial phase foci of hyper enhancement, notably at the right hepatic dome,\nmeasuring 6 mm, several tiny foci of enhancement in a perihilar distribution\n(series ___, image 40), and anteriorly in segment 3, measuring 7 mm\n(series 1101, image 58). The smaller lesions do not meet OPTN criteria for\nHCC. They do not demonstrate definite associated washout. No pseudocapsule\nis identified.\n\nBiliary: Minimal dilation of the common bile duct measuring 8 mm. Mild\nprominence of the central biliary tree also. These changes are similar to\nprevious study. Gallbladder appears unchanged.\n\nPancreas: There is pancreas divisum. There is mild dilation of the main\npancreatic duct including the dorsal draining duct measuring 5 mm (series 7,\nimage 31). There are several small cystic foci in the pancreas the largest of\nwhich is located anteriorly in the pancreatic body and measures 1 cm (series\n7, image 22). No internal enhancement post-contrast or nodularity within the\nlesion.\n\nSpleen: Enlarged, measuring 15.3 cm. Gamma Gandy bodies are present. No\nother focal splenic lesion.\n\nAdrenal Glands: There is a left adrenal adenoma, measuring 17 x 8 mm, stable..\nRight adrenal gland appears normal.\n\nKidneys: There are small bilateral renal cysts. No concerning renal lesion.\n\nGastrointestinal Tract: There is a ventral abdominal hernia containing small\nbowel nonobstructive loops.\n\nLymph Nodes: There is mild retroperitoneal lymphadenopathy, with periaortic\nlymph nodes measuring up to 11 mm in short axis diameter (series 1103, image\n105). There is a lymph node in the porta hepatis also, enlarged, measuring\n1.1cm in short axis.\n\nVasculature: There is nonocclusive thrombus in the main portal vein arising at\nthe confluence with the splenic vein and SMV. There appears to be chronic\nthrombosis of the right portal vein with cavernous transformation. \nRetroperitoneal collateral vessels are demonstrated. Small low signal linear\nfocus within the inferior vena cava at site of apparent portosystemic\ncollateral shunt noted (series 1103, image 120). Paraesophageal and gastric\nvarices noted.\n\nOsseous and Soft Tissue Structures: No evidence of bony metastatic disease.", "output": "-Postsurgical changes in the liver. Segment 3 2.3 cm HCC, slightly increased\nfrom previous CT.\n-Stable mild bile duct dilation.\n-Pancreas divisum with mild duct dilation.\n-Pancreatic cystic lesion likely IPMN the anterior pancreatic body.\n-Nonocclusive main portal vein thrombus. Likely chronic right portal vein\nthrombus with cavernous transformation.\n-Changes of portal hypertension including splenomegaly, gastric varices,\npara-esophageal varices, retroperitoneal collaterals.\n-Small focal area of linear low signal intensity is demonstrated within the\ninferior vena cava at its junction with a retroperitoneal collateral vessel. \nThis likely reflects flow-void rather than thrombus." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is nodular in contour, compatible with cirrhosis. The\npatient is status post right hepatectomy. Since the prior MRI of the liver\nfrom ___, there has been interval TACE of a segment III\nhepatocellular carcinoma. The treated lesion measures 1.9 x 1.8 cm (series\n10, image 48), and demonstrates intrinsic T1 hyperintensity and no definite\ninternal enhancement. There is a 1.1 x 1.1 cm T1 hyperintense nodule more\nanteriorly in segment III (series 8, image 46), decreased in size from prior\nand previously 1.7 x 1.5 cm, likely reflecting treatment effect on a\nregenerative or dysplastic nodule.\n\nThere is a 0.9 x 0.6 cm arterially hyperenhancing lesion in the hepatic dome\n(series 10, image 15) with persistent enhancement on the portal venous phase,\nno evidence of washout or a pseudocapsule, minimally increased in size from\nprior, previously 0.7 x 0.6 cm, not meeting OPTN 5 criteria for hepatocellular\ncarcinoma. However, attention on follow-up is warranted.\n\nOther punctate foci of arterial hyperenhancement in segment II remain\nunchanged and do not meet OPTN 5 criteria for hepatocellular carcinoma.\n\nThere is nonocclusive thrombus within the portal confluence and main portal\nvein, unchanged. There are retroperitoneal collateral vessels. There are\nsmall esophageal and perigastric varices. The common hepatic artery is\nreplaced to the SMA.\n\nBiliary: The gallbladder remains unchanged in configuration. There is\nmoderate central intrahepatic and extrahepatic biliary ductal dilatation, with\nthe common bile duct measuring up to 1.0 cm, slightly increased from prior,\npreviously 8 mm.\n\nPancreas: There is mild diffuse atrophy of the pancreas. Note is made of\npancreas divisum. There is mild dilatation of the main pancreatic duct and\nduct of Santorini, unchanged. Again seen are multiple small cystic foci in\nthe pancreas, the largest measuring 0.9 x 0.8 cm in the pancreatic body\n(series 2, image 16), likely representing side-branch IPMNs, unchanged.\n\nSpleen: The spleen is enlarged, measuring 14.6 cm in length, and demonstrates\nnumerous Gamma Gandy bodies.\n\nAdrenal Glands: The right adrenal gland is normal in appearance. A 1.7 x 0.7\ncm left adrenal adenoma remains stable.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. There are multiple small bilateral renal\ncysts. There is no hydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: Prominent periportal lymph nodes are likely reactive to\nunderlying liver disease.\n\nVasculature: There is no abdominal aortic aneurysm. The celiac artery, SMA,\nand bilateral renal arteries are patent.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nThere are two tandem ventral hernias with wide necks, containing bowel loops.", "output": "1. Cirrhosis of the liver with postsurgical changes of right hepatectomy.\nInterval TACE of a segment III hepatocellular carcinoma since the prior MRI of\nthe liver from ___, with no definite internal enhancement within the\n1.9 x 1.8 cm treated lesion. No other lesions meeting OPTN 5 criteria for\nhepatocellular carcinoma.\n\n2. Nonocclusive thrombus within the portal confluence and main portal vein,\nunchanged.\n\n3. Pancreas divisum with mild dilatation of the main pancreatic duct and duct\nof Santorini, unchanged.\n\n4. Stable 1.7 x 0.7 cm left adrenal adenoma.\n\n5. Moderate central intrahepatic and extrahepatic biliary ductal dilatation,\nwith the common bile duct measuring up to 1.0 cm, slightly increased from\nprior, previously 8 mm." }, { "input": "Lower Thorax: Visualized lungs are clear. There is no pleural effusion.\n\nLiver:\nRedemonstration of morphologic changes of cirrhosis. Patient is status post\nright hepatectomy. Note is again made of a previously treated lesion in\nsegment III now measuring 1.6 x 1.6 cm with no associated residual enhancement\nto suggest residual or recurrent disease. This has decreased in size compared\nto the prior study where it measured 1.9 x 1.8 cm. The previously noted T1\nhyperintense nodule more anteriorly in segment III is less clearly visualized\non today's study. There are no new arterially enhancing lesions in the liver.\n\nNon occlusive thrombus within the portal confluence and main vein has\nprogressed in the interval now seen extending into the SMV and right and left\nportal vein branches. Note is again made of dilated portosystemic collaterals\nincluding mesenteric-renal and spine renal veins in keeping with sequela of\nportal hypertension.\n\nBiliary: Moderate dilatation of central intrahepatic bile ducts and\nextrahepatic ducts are similar to the prior study. CBD measures up to 1 cm.\n\nPancreas: There is mild diffuse atrophy in the pancreas. Note is again made\nof pancreatic divisum. There is persistent dilatation the main pancreatic and\nduct of Santorini. Multiple small cystic lesions are again noted in the\npancreas, the largest measuring 9 mm in the pancreatic body, stable compared\nto the prior study. 7 mm cyst at the uncinate process the larger, previously\nmeasuring 5 mm.\n\nSpleen: The spleen is enlarged measuring 16 cm in craniocaudal length.\n\nAdrenal Glands: Limited renal glands unremarkable. Nodular thickening of the\nleft adrenal gland measuring 1.8 x 1 cm is unchanged and once again\ndemonstrate signal dropout on the T1 out of phase sequence in keeping with an\nadenoma.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. Multiple small bilateral renal cysts are\nagain noted, including a 7 mm hemorrhagic cyst in the lateral interpolar\ncortex of the right kidney. There is no hydronephrosis.\n\nGastrointestinal Tract: Visualized small large bowel loops are in caliber.\n\nLymph Nodes: No significantly enlarged retroperitoneal or mesenteric lymph\nnodes.\n\nVasculature: Normal caliber of the abdominal aorta and main mesenteric branch\nvessels.\n\nOsseous and Soft Tissue Structures: Suspicious osseous lesion. Note is again\nmade of a wide necked ventral wall hernia containing loops of bowel. There is\na persistent 4 x 2.3 x 3.6 cm fluid collection within the right upper\nposterolateral abdomen adjacent to the liver which may be related to prior\nsurgery.", "output": "1. Cirrhotic liver morphology with postsurgical changes of right hepatectomy. \nPreviously treated HCC in segment III is smaller compared to the prior MRI\nwith no residual enhancement to suggest residual or recurrent disease. No new\nliver lesions meeting OPTN criteria for HCC.\n2. Interval progression of nonocclusive thrombus within the portal confluence\nnow extending into the SMV and right and left portal vein branches.\n3. Pancreatic divisum with mild dilatation of the main pancreatic duct and\nduct of Santorini is unchanged. Cystic pancreatic lesions are again noted\nmeasuring up to 9 mm which most likely represent side branch IPMNs. \nReassessment on follow-up is recommended.\n4. Moderate central intrahepatic and extrahepatic biliary duct dilatation is\nunchanged." }, { "input": "Lower thorax: Partially imaged lung bases are clear.\n\nLiver: Liver demonstrates heterogenous parenchymal signal with nodular\ncontours consistent with cirrhosis. Patient is status post right hepatectomy.\nThere is no significant hepatic steatosis.\n\nStable appearance of the previously treated lesion in segment 3 measuring 1.6\ncm without evidence of residual or recurrent enhancement.\n\nThere are at least 5 new arterially hyper enhancing lesions in the superior\naspect of segments 2 and 4 showing washout and pseudocapsule (series 1401,\nimage 27) measuring approximately 1.3, 1.3, 0.7, 0.7 and 0.7 cm each. 2 of\nthese lesions meet the OPTN 5A criteria for HCC.\n\nA small 9 mm arterially hyper enhancing lesion is seen superiorly in the dome\nof the liver (series 1401, image 15) does not demonstrate washout on the\nportal venous, this is likely related to transient hepatic intensity defect.\n\nThere is a 1.3 cm heterogenously enhancing lesion within segment 3 showing\narterial hyperenhancement (series 1401, image 50), without evidence of\nwashout, this is suspicious in appearance and should be followed up on\nsubsequent imaging.\n\nAgain seen is the partially occlusive thrombus within the proximal portal vein\nextending into the portosplenic confluence as well as the proximal SMV with\ninterval decrease in the thrombus burden. Multiple portosystemic and\nmesenteric collateral vessels are again seen in keeping with portal\nhypertension. There is a small amount of ascites.\n\nBiliary: The gallbladder is normally distended without evidence of wall\nthickening. No intra or extrahepatic biliary dilatation.\n\nPancreas: Pancreas shows mild atrophic changes with evidence of pancreas\ndivisum. Stable mild dilation of the main pancreatic duct as well as the duct\nof Santorini. Stable T2 hyperintense nonenhancing cystic lesion in the\npancreatic head/body measuring 9 mm, likely a side branch IPMN.\n\nSpleen: The spleen remains enlarged measuring 17 cm in craniocaudal length. \nNumerous T1 and T2 hypointense nonenhancing foci seen scattered throughout the\nsplenic parenchyma in keeping with Gamma Gandy bodies.\n\nAdrenal Glands: The right adrenal is within normal limits. Stable adenoma in\nthe left adrenal gland.\n\nKidneys: Both kidneys are normal in size and show homogeneous enhancement. \nFew T2 hyperintense nonenhancing lesions in bilateral cortices in keeping with\nsimple cysts, some of these show intermediate T2 signal indicating hemorrhagic\ncysts. No suspicious renal mass identified. There is no hydronephrosis.\n\nGastrointestinal Tract: The stomach and visualized bowel loops are normal in\ncaliber. There is colonic wall edema and mild mesenteric edema likely due to\nthe portal colopathy.\n\nLymph Nodes: Multiple mildly enlarged periportal lymph nodes are again seen,\nlikely related to cirrhosis..\n\nVasculature: No evidence of abdominal aortic aneurysm. The gastroduodenal\nartery comes off directly from the celiac axis. There is replaced proper\nhepatic artery. There is a 1.7 cm aneurysm of the splenic artery.\n\nOsseous and Soft Tissue Structures: No abnormal marrow signal. Again seen is\nthe large ventral hernia, partially imaged containing bowel loops and a small\namount of ascites.", "output": "1. Background of hepatic cirrhosis. 2 new OPTN 5A lesions in segments 4 and\n2. Multiple new subcentimeter lesions in these segments showing arterial\nenhancement and washout are in keeping with small ___'s but do not meet OPTN\nsize criteria. Heterogenously enhancing lesion in segment 3 does not\ndemonstrate washout but should be followed up on subsequent imaging. Interval\ndecrease in the portal venous and SMV thrombus burden with persistent main\nportal vein and SMV moderate narrowing.\n2. Stable splenomegaly with portal hypertension. Mild ascites.\n3. Stable 9 mm cystic pancreatic lesion, likely a sidebranch IPMN." }, { "input": "Lower Thorax: The lung bases are clear.\n\nLiver: The liver demonstrates cirrhotic morphology with hypertrophy of the\nleft and caudate lobe. Patient is status post TACE of the segment III HCC\nwithout evidence of new or residual enhancement around the treatment cavity\n(series 14, image 47). 2 of the previously seen arterially hyperenhancing\nlesions measuring 2.7 cm and 1.5 cm with washout and pseudo capsule in segment\nII have increased in size (series 14, image 30) compared to ___. \n3 additional subcentimeter arterially hyperenhancing lesions with washout in\nbetween the dominant segment 2 lesions have also increased in size compared to\n___. A 1.5 cm arterially hyperenhancing lesion in segment III\nwithout definite washout (series 14, image 43) has increased in size and\nremains suspicious for HCC.\n\nA 0.8 cm arterially hyperenhancing focus in the hepatic dome (series 14, image\n18) does not demonstrate washout. 0.8 cm arterial hyperenhancing focus in the\ncaudate lobe (series 14, image 36) does not demonstrate washout, new compared\nto ___. These could represent transient hepatic intensity\ndifferences.\n\nThere is small amount of perihepatic free fluid.\n\nBiliary: The patient is status post cholecystectomy. No biliary ductal\ndilatation.\n\nPancreas: The pancreas is mildly atrophic with normal signal intensity without\nductal dilatation. There are multiple subcentimeter cystic lesions in the\npancreatic body, tail, and uncinate process, most likely representing\nside-branch IPMNs. Incidentally noted is pancreas divisum.\n\nSpleen: The spleen measures 16.9 cm in AP dimension with multiple gamma Gandy\nbodies. There is small amount of perisplenic free fluid.\n\nAdrenal Glands: There is a 1.6 x 0.9 cm nodule in the left adrenal gland with\ndrop of signal in out of phase images consistent with adenoma, unchanged. The\nright adrenal gland is unremarkable.\n\nKidneys: The kidneys are normal and symmetric in size without suspicious focal\nlesions. Scattered simple cysts are seen throughout the right kidney\nmeasuring up to 1.2 cm. No hydronephrosis in either kidney. No perinephric\nabnormalities.\n\nGastrointestinal Tract: The stomach is distended. The visualized small and\nlarge bowel in the abdomen demonstrate no obstruction.\n\nLymph Nodes: Enlarged periportal lymph nodes are grossly unchanged, likely\nrelated to cirrhosis. Mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta and its branches are patent with normal\ncaliber. There is replaced proper hepatic artery arising from the SMA. \nRe-demonstrated is nonocclusive portal vein thrombus in the portal confluence\nwithout significant interval changes. The previously seen SMV thrombus is\npartially visualized but improved. There are multiple perisplenic varices. \nThere is a 1.6 cm splenic artery aneurysm, unchanged.\n\nOsseous and Soft Tissue Structures: Partially imaged is a ventral abdominal\nhernia containing nonobstructed small bowel loop. No suspicious osseous or\nsoft tissue lesions.", "output": "1. Multifocal HCC with interval increase in size of 5 previously-seen segment\nII lesions, consistent with disease progression. There is one OPTN 5A and and\none 5B lesion. The other lesions do not meet OPTN-5 criteria but are highly\nsuspicious for HCC.\n2. 1.5 cm arterially hyperenhancing lesion in segment III without washout\nhas also increased in size, not meeting OPTN-5 criteria, but remainng\nsuspicious for HCC.\n3. No new OPTN-5 lesions.\n4. Cirrhotic liver with findings of portal hypertension including small\nvolume ascites, splenomegaly, and portosystemic collaterals.\n5. Unchanged nonocclusive portal vein thrombus in the portal confluence. \nPartially visualized but improved nonocclusive thrombus in the SMV.\n6. Multiple unchanged subcentimeter cystic lesions throughout the pancreas\nmost likely representing side-branch IPMNs.\n7. Unchanged 1.6 cm splenic artery aneurysm.\n8. Large ventral hernia containing a nonobstructed small bowel loop." }, { "input": "Lower Thorax: The visualized lung bases are grossly unremarkable.\n\nLiver: The liver is relatively homogeneous in signal intensity noting a\nbackground of hepatic steatosis and pericholecystic fatty sparing. Multiple\nscattered punctate T1 hypointense, T2 hyperintense lesions reflect tiny cysts\nor biliary hamartomas. No suspicious hepatic lesions.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilatation. The\ngallbladder is normal\n\nPancreas: The pancreas is normal and homogeneous in signal intensity. No\npancreatic ductal dilatation or focal lesions.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right adrenal gland is normal in size and shape. 2.0 x 1.7\ncm nodule in the left adrenal gland demonstrates out of phase loss of signal\nreflecting macroscopic fat content.\n\nKidneys: The right and left kidneys are normal and symmetric size shape,\naccounting for differences in orientation. A lobulated 1.6 x 1.5 cm T2\nhyperintense lesion arising from the interpolar left kidney the demonstrates a\nthin septation (17:42), but without evidence of mural nodularity or enhancing\ncomponents in keeping with a Bosniak 2 renal cyst. No suspicious renal\nlesions.\n\nGastrointestinal Tract: A 2 x 1 cm T2 hyperintense lesion adjacent to the\ngastroesophageal junction on the left is incompletely imaged, but possibly a\nsmall hiatal hernia or distal esophageal diverticulum (02:15). The visualized\nstomach 7 loops of large small bowel are grossly unremarkable.\n\nLymph Nodes: Scattered mesenteric lymph nodes are not pathologically enlarged\nby size criteria. No visualized lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. Hepatic and renal arterial anatomy\nis conventional.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions.", "output": "1. 2.0 cm left adrenal adenoma.\n2. 1.6 cm Bosniak 2 left renal cyst.\n3. Incompletely imaged, probable small hiatal hernia or distal esophageal\ndiverticulum.\n4. Hepatic steatosis, with numerous sub cm biliary hamartomas versus cysts." }, { "input": "MR ABDOMEN:\nThe visualized portions of the liver, spleen, pancreas, bilateral adrenal\nglands are normal. There are gallstones in the gallbladder. Incidental note\nis made of a juxta papillary duodenal diverticulum. The abdominal aorta is of\nnormal caliber throughout. The main portal vein is patent. There is no\nascites. No enlarged mesenteric or retroperitoneal lymph nodes are seen.\n\nThe kidneys demonstrate normal corticomedullary architecture. There is a 10 mm\nwell-circumscribed T2 hyperintense cyst in the right kidney (series 7, image\n18). There are subcentimeter right renal peripelvic cysts (series 3, image 10\nand image 15).\n\nThere is a 5 mm lesion in the lower pole of the right kidney (series 17, image\n46) which may show signal loss on out of phase imaging compatible with fat.\nThere is no definite T2 correlate for this lesion.\n\nThe urothelial lining in the renal pelves and ureters is without thickening or\nabnormal enhancement. The ureters are normal in caliber. The bladder is\nwithin normal limits without focal wall thickening.\n\nMR PELVIS:\nThe bladder is unremarkable. There is no free fluid or lymphadenopathy.\n\nThe bone marrow signal is normal.", "output": "1. The echogenic lesion seen on the prior ultrasound has no T2 correlate and\nquestionable signal loss on out of phase sequences which could represent fat.\nThis lesion may represent an angiomyolipoma. However, a ___ year followup is\nrecommended for further evaluation.\n2. Cholelithiasis.\n3. Juxta papillary duodenal diverticulum.\n\nCOMPARISON: None." }, { "input": "Motion artifact degrades image quality. Allowing for this:\n\nLower Thorax: Visualized lower thorax is grossly unremarkable.\n\nLiver: The liver demonstrates normal signal intensity. No evidence of hepatic\nsteatosis. There is no focal hepatic lesion. There is no peribiliary\nenhancement to suggest cholangitis.\n\nBiliary: There is mild intrahepatic duct dilatation, similar compared to CT\n___. The CBD is mildly dilated, measuring up to 8 mm in maximal\ndimension, and tapers normally to the ampulla. Findings are within expected\nlimits post cholecystectomy. No filling defects are seen within the biliary\ntree. The gallbladder is surgically absent.\n\nPancreas: The pancreas is normal in contour and signal intensity. There are\nno focal lesions or ductal dilatation.\n\nSpleen: The spleen is normal in size and signal intensity. A splenule is\nnoted near the pancreatic tail, as seen on prior CT.\n\nAdrenal Glands: Adrenal glands are thin without nodularity.\n\nKidneys: The bilateral kidneys are normal in size and demonstrate symmetric\nnephrograms. There are no focal lesions. There is no hydronephrosis.\n\nGastrointestinal Tract: Stomach is grossly unremarkable. Visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal adenopathy.\n\nVasculature: The abdominal aorta is normal in caliber, and major branch\nvessels are patent. Portal veins, splenic vein and SMV are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. Soft\ntissue structures of the abdominal wall are unremarkable.", "output": "Mild intrahepatic and extrahepatic duct dilatation, similar compared to CT\nfrom ___, within expected limits post cholecystectomy. No obstructive cause\nidentified." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver is normal in size and morphology. Signal intensity is within\nnormal limits with no evidence of hepatic steatosis.\nThere are innumerable arterially hyperenhancing liver lesions consistent with\nmetastases some of which are stable since prior CT of ___ and CT of ___. Other lesions are new since prior CT examination of ___. For example a stable lesion since ___ seen in segment 8 extending into\nthe right hemidiaphragm measures 6.2 x 4 cm (series 14, image 29).\nReference new lesion since ___ at the hepatic dome demonstrates\narterial enhancement and washout characteristics measuring 3.0 x 2.8 cm\n(series 10, image 23). Additional new lesion measuring 1.2 cm in hepatic\nsegment 7 (series 10, image 47). Other new arterially hyperenhancing lesions\nscattered throughout both lobes of the liver are predominantly subcentimeter\nin size. A 1.8 cm segment 5 lesion adjacent to the gallbladder fossa is also\nstable (series 10, image 88) however unlike other lesions above, this lesion\ndoes not demonstrate arterial hyperenhancement.\n\nAn enhancing peritoneal nodule in the right-side of the abdomen measuring 1.1\ncm is unchanged when compared with the ___ study (series 10, image\n120)\n\nBiliary: There is no intra or extrahepatic biliary dilatation. \nCholelithiasis.\n\nPancreas: The pancreas is markedly atrophic. No focal pancreatic lesions are\nseen. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: There is a left percutaneous nephroureterostomy, with its distal tip\nin the mid ureter. There is also a right-sided nephrostomy percutaneous\nnephrostomy in-situ. Kidneys enhance and excrete symmetrically without\nsuspicious lesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. Interval development of innumerable new arterially hyperenhancing liver\nlesions in both lobes of the liver when comparison is made with the ___ study. The largest of these new lesions is a 1.5 cm segment 5 lesion. \nThese lesions are stable in comparison to the CT of 7 days prior on ___.\n2. Stable peritoneal nodule.\n3. Cholelithiasis." }, { "input": "Lower thorax: No significant pleural or pericardial effusion. Cardiomegaly\nnoted. There is linear atelectasis in the right lower lobe. Previously seen\nenhancing nodule in the epiphrenic fat measuring 1.8 x 0.9 cm has decreased in\nsize and now measures 0.4 x 0.7 mm (image 37, series 22).\n\nLiver: Again seen is a subcapsular implant posterior to the right lobe of the\nliver (image 41, series 19). This measures 2.7 cm AP x 5.0 cm transverse,\nunchanged from the prior examination, using similar measurements. Adjacent\n1.4 cm subcapsular implant (image 27, series 22) is unchanged. Small\nsubcapsular implants along the inferior right lobe of the liver are unchanged\nin size and number (image 86, 82, 78, 71 ; series 19).\n\nA 1.3 cm segment 2 hemangioma again noted. 7 mm flash filling hemangioma at\nthe dome is unchanged. 1 cm segment 7 hemangioma is unchanged.\n\nBiliary: No intra ors extrahepatic biliary ductal dilatation. Stones are\nnoted in the gallbladder, without wall thickening or pericholecystic fluid.\n\nPancreas: The pancreas is atrophic, without ductal dilatation or suspicious\npancreatic lesions.\n\nSpleen: Normal spleen. No masses. Accessory spleen noted.\n\nAdrenal Glands: Normal adrenals. No masses.\n\nKidneys: No suspicious renal lesions. There is mild moderate right-sided\nhydronephrosis, new when compared to the prior examination.\n\nGastrointestinal Tract: Postsurgical changes are seen status post right\ncolectomy. 12 x 6 mm nodule adjacent to the right section size is unchanged.\n\nPelvis: The right ureter is mildly dilated, narrowed as it passes with the\npatient's known pelvic masses. The right pelvic mass is slightly more bulky,\nand increased in size, measuring 3.5 cm AP by 3.4 cm transverse, previously\nmeasuring 3.3 cm AP by 3.3 cm transverse, using similar measurements. The\nleft pelvic mass is also increased in size, with the largest component\nmeasuring 2.8 x 2.1 cm, previously 2.7 x 1.5 cm, with a superior component\n(series 10, image 70) which currently measures 1.7 x 1.9 cm, previously 1.4 x\n1.7 cm. There is a spiculated focus of low T2 signal intensity in the right\nlower quadrant mesentery, unchanged from the prior examination.\n\nLymph Nodes: The patient's left pelvic nodal conglomerate measures 2.8 cm AP\nby 2.1 cm transverse, previously measuring 2.7 cm AP by 1.8 cm transverse. 9\nmm right external iliac node is unchanged (image 80, series 10). 7 mm nodule\nadjacent to the bladder is unchanged (image 81, series 10). 1 cm aortocaval\nnode is unchanged (image 26, series 10).\n\nVasculature: The abdominal aorta is non aneurysmal.\n\nOsseous structures and soft tissues: Bilateral fat containing inguinal\nhernias noted. Are notable soft tissue abnormality.", "output": "1. New right-sided hydroureteronephrosis, with transition point in the right\nureter as it passes the patient's known right pelvic mass. The bilateral\npelvic masses have mildly increased in size compared to prior.\n2. Interval decrease in size in a nodule / lymph node in the epiphrenic fat.\n3. No significant interval change in size in the patient's liver metastases\nand perihepatic / subcapsular liver implants." }, { "input": "Lower Thorax: No pleural or pericardial effusion.\n\nLiver: The liver appears homogeneous in signal intensity. There is no\nevidence of signal loss on T1 out of phase images to indicate hepatic\nsteatosis. There is no suspicious focal hepatic lesion.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe patient is status post cholecystectomy.\n\nPancreas: The patient is status post partial pancreatectomy with\npancreaticojejunostomy. The remaining portion of the pancreas appears normal\nand homogeneous in signal intensity. There is no pancreatic ductal\ndilatation.\n\nSpleen: The patient is status post splenectomy.\n\nAdrenal Glands: The adrenal glands are symmetric in size and normal in signal\nintensity.\n\nKidneys: The kidneys are symmetric in size and enhance symmetrically after\ncontrast administration. There is no hydronephrosis.\n\nGastrointestinal Tract: Patient is status post pancreaticojejunostomy. There\nis a stable focal area of small bowel dilatation at the site of anastomosis\nwhich appears unchanged compared to prior CT. Otherwise, the visualized\nportions of the gastrointestinal tract appears within normal limits.\n\nLymph Nodes: No pathologic lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nThere is focal enhancement at a costochondral junction on the right side\nanteriorly.", "output": "Status post distal pancreatectomy and pancreaticojejunostomy. No etiology for\nthe patient's abdominal pain and nausea is identified. No significant change\ncompared to the prior exams." }, { "input": "There is re- demonstration of a T2 hyperintense multiloculated cystic mass at\nthe junction of the right and left hepatic lobes measuring 4.8 x 3.3 x 3.8 cm,\npreviously 4.6 x 3.3 x 3.4 cm. There is an unchanged T1 hyperintense\ncomponent of this mass along the posterior aspect as well as unchanged septal\nenhancement.\n\nThere is an unchanged 3 mm hyper enhancing focus within segment 8 which\nretains contrast on delayed imaging matching blood pool likely representing\nsmall hemangioma. There is no suspicious hepatic enhancement.\n\nThere is an unchanged 1.4 cm gallstone within the gallbladder. There is no\nevidence of gallbladder wall thickening or pericholecystic fluid. There is no\nintrahepatic or extrahepatic biliary dilatation. The hepatic, portal,\nsplenic, and superior mesenteric veins are patent. The left gastric artery\narises from the aorta.\n\nThere is an unchanged 7 mm cystic structure medial to the common duct within\nthe pancreatic head likely representing side branch IPMN. The main pancreatic\nduct is not dilated. There is no evidence of pancreatic mass. Spleen is\nunremarkable.\n\nThere is symmetric renal enhancement and excretion of intravenous contrast.\nThere is no evidence of renal mass. There is no evidence of hydronephrosis.", "output": "1. Unchanged multilocular cystic lesion at the junction of the right and left\nhepatic lobes most consistent with a biliary cystadenoma.\n2. Unchanged 7 mm cystic lesion pancreatic head likely represents a side\nbranch IPMN." }, { "input": "The lung bases are grossly clear. There is no pleural or pericardial effusion.\n\nThe liver border is slightly nodular, in keeping with cirrhosis. There is\nsignal dropout on opposed phase ARC images, consistent with mild steatosis. In\nsegment IV a multilocular mass 4.9 x 3.5 x 5.2 cm in size is redemonstrated,\nwith multiple irregular enhancing ___ ___, 58). Some of the\nloculations have a high signal intensity on T1 WI, consistent with\nproteinaceous contents (10:48). The lesion is progressively increasing in\nsize: In ___ it was 3.8 x 3.5 x 4.6 cm, in ___ it was 3.6\nx 2.9 x 3.7 cm.\n\n4 mm persistently enhancing lesion in segment VIII is consistent with\nhemangioma (1201:27). There is a subcentimeter arterial hyper enhancing focus\nin the left lobe, without correlation on later phases or on T2 WI or DWI\n(1201: 46), consistent with transient intensity difference. There are no hyper\nenhancing and washing out lesions. There is conventional arterial hepatic\nanatomy. The portal and hepatic veins are patent.\n\nThere is cholelithiasis, without signs of acute cholecystitis. The intra and\nextrahepatic biliary ducts are normal in caliber.\n\nThe pancreas is normal in size and signal. Several cystic pancreatic lesions,\nmeasuring up to 7 mm, are unchanged, most likely side branch IPMNs (07:22) .\n\nThe spleen is normal in size.\nThere are small lower esophageal varices (1202:33).\n\nTiny cortical renal cysts are seen. Otherwise the kidneys and adrenals are\nnormal.\n\nThere is no free fluid in the abdomen.\nThere is no retroperitoneal or mesenteric lymphadenopathy.\nThe bone marrow signal is normal.", "output": "1. Progressive increase in size of previously seen multilocular cystic lesion\nin segment IV, with irregular ___, consistent with biliary cystadenoma.\nStable segment VIII hemangioma; additional focus of likely perfusion\nheterogeneity.\n2. Subtle liver contour nodularity, in keeping with cirrhosis. Small lower\nesophageal varices are signs of portal hypertension. No splenomegaly.\n3. Cholelithiasis\n4. Stable cystic pancreatic lesions, most likely side branch IPMN. Continued\nsurveillance at next scheduled MR or in one year is recommended." }, { "input": "Lower Thorax: Please see the chest CT obtained immediately prior to this exam\nfor complete thoracic details.\n\nLiver: The caudate lobe and left lobe are slightly enlarged. The contour of\nthe liver is undulating. This is in keeping with the history of cirrhosis. \nThere is no hepatic steatosis. Several areas of fibrosis are noted.\n\nAgain, in segment 4, there is a multilocular cystic mass measuring 50 x 40 x\n52 mm. When measured in similar planes, it previously measured 49 x 35 x 52\nmm. This is been slowly increasing in size over time. It measured\napproximately 30 mm in its longest dimension when first seen in ___. Again,\nsome of the components within the lesion have high signal on the T1 weighted\nimages, compatible with proteinaceous material. Some more discrete foci of\nhigh signal on the T1 weighted images likely represent the known\ncalcifications. The septae are enhancing, though there is no nodular\nenhancement or focal thickening. This is most compatible with a biliary\ncystadenoma.\n\nThere is an unchanged 4 mm enhancing focus in segment 8 which persists on the\ndelayed phases, and is most compatible with a hemangioma (1001, 35). \nAdditionally, there are multiple foci of arterial hyperenhancement without\nwashout or a correlate on the T2 weighted images (1001, 37, 40, 47, and 104). \nThese likely represent transient hepatic intensity differences.\n\nThe hepatic arterial anatomy is conventional. The portal and hepatic veins\nare patent.\n\nBiliary: There is no intra or extrahepatic biliary duct dilation. The\ngallbladder is not distended. There is at least one large gallstone measuring\n18 mm. There is no MRI evidence of cholecystitis.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or solid mass. Again, there are\nseveral pancreatic cystic lesions, measuring up to 8 mm (4, 13). Allowing for\nchanges in measurement, these are unchanged. They are most compatible with\nside branch IPMNs.\n\nSpleen: The spleen is normal in size, measuring 9.6 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. There are no worrisome renal\nlesions, hydronephrosis, or perinephric abnormalities.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: Some prominent periportal lymph nodes are noted, and likely\nreactive. There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of an\naneurysm or significant atherosclerotic plaque. Again noted are some small\nesophageal varices, as well as a varix connecting to the left gonadal vein,\nwhich demonstrates reflux.\n\nOsseous and Soft Tissue Structures: There are no concerning osseous lesions. \nMild multilevel degenerative changes are noted throughout the spine. There is\na 17 mm T2 hyperintense lesion in T12, which is most compatible with a\nhemangioma. The soft tissues are unremarkable.", "output": "1. Minimal increase in size in the multilocular cystic lesion in segment 4,\nmost compatible with a biliary cystadenoma, as described above. This lesion\ncontinues to slowly increase over time.\n2. Unchanged subcentimeter hepatic hemangioma. No new liver lesions.\n3. Cirrhotic liver and esophageal varices. No splenomegaly or ascites.\n4. Cholelithiasis.\n5. Unchanged subcentimeter pancreatic cystic lesions, which are most likely\nside branch IPMNs. Continued attention on followup exams is recommended." }, { "input": "Lower Thorax: 4 mm nodular subpleural focus is identified in the right lower\nlobe (1001:37).\n\nLiver: Since the prior MRI of ___ there has been resection of the\nsegment 4a complex cystic and solid liver lesion which had shown growth over\ntime, and was found to represent adenocarcinoma arising in a biliary\ncystadenoma at pathology after resection. Surrounding the resection bed,\nthere is hyperemia on early postcontrast images, particularly along the medial\naspect of the resection margin, without evidence of delayed hypo enhancement\nmost compatible with perfusion heterogeneity. A couple of foci of low signal\nintensity along the right lateral aspect of the resection margin show blooming\naffect on longer echo time in phase T1 weighted gradient echo images\ncompatible with surgical clips or other susceptibility producing postsurgical\nchange. Smaller similar appearing foci are seen along the medial aspect of\nthe resection cavity and anterior abdominal wall incision. No residual solid\nor cystic tumor is appreciated. A small hemangioma previously seen in hepatic\nsegment 8 is not clearly visualized and may have been included in the\nresection. In hepatic segment 7, a 6 mm focus of subcapsular hyper\nenhancement in the arterial phase (1001:31), is not appreciable on precontrast\nT1 weighted images and shows no washout, most likely reflecting perfusion\nheterogeneity. No new lesions are identified within the liver parenchyma. \nPortal vein is patent. Hepatic arterial anatomy is conventional.\n\nBiliary: The gallbladder is surgically absent. Minimal prominence of the\ncommon hepatic duct, measuring up to 7 mm, is seen but there is smooth\ntapering of the distal common bile duct at the ampulla and no evidence of\ncholedocholithiasis.\n\nPancreas: Pancreatic cystic lesions measuring up to 8 mm in diameter are\nunchanged (03:14). Pancreatic parenchyma is otherwise normal in signal\nintensity and enhancement. No pancreatic ductal dilation or new focal lesions\nidentified.\n\nSpleen: Normal in size and signal intensity, without focal lesions.\n\nAdrenal Glands: Normal in size and signal intensity, without focal lesions.\n\nKidneys: No hydronephrosis or focal renal lesions.\n\nGastrointestinal Tract: Large and small bowel loops are normal in caliber and\ncontour. The appendix is normal.\n\nLymph Nodes: There are no pathologically enlarged mesenteric or\nretroperitoneal lymph nodes.\n\nVasculature: Abdominal aorta is normal in caliber and branch vessels are\ngrossly patent. Note is made of a separate origin of the left gastric artery\narising directly from the aorta adjacent to the celiac trunk. Single\nbilateral renal arteries are widely patent. Slight prominence of the left\ngonadal vein is noted.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are\nidentified.", "output": "1. Interval resection of a segment 4a liver lesion representing\nadenocarcinoma within a biliary cystadenoma, with no evidence of residual or\nrecurrent disease. 6 mm focus of enhancement in hepatic segment 7 is most\nconsistent with focal perfusion heterogeneity.\n2. 4 mm nonspecific focus of subpleural atelectasis or nodularity at the\nright lung base. This could be further evaluated with chest CT if clinically\nindicated.\n3. Stable pancreatic cystic lesions amenable to continued surveillance with\nMRI in ___ years." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, the lung bases are\ngrossly clear. There is no pleural effusion.\n\nLiver: Again seen are postsurgical changes of resection of a biliary\ncystadenocarcinoma in segment ___, with susceptibility artifact along the\nmargins of the resection bed. There is arterial hyperenhancement adjacent to\nthe medial resection margin, decreased in extent compared to the prior study\nfrom ___, representing perfusion heterogeneity. There is no\ndeveloping cystic or solid mass to suggest recurrent tumor. A punctate focus\nof subcapsular arterial enhancement in segment 7 (series 15, image 35) without\nwashout appears smaller compared to the prior study, likely secondary to\ndifferences in timing on the arterial phase, and is most compatible with a\nperfusion anomaly. There is no evidence of hepatic steatosis.\n\nHepatic arterial anatomy is conventional. The portal and hepatic veins are\npatent.\n\nBiliary: The gallbladder surgically absent. There is mild dilatation of the\nextrahepatic duct, measuring up to 8 mm (previously 7 mm), with a smooth\ndistal tapering and no evidence of choledocholithiasis.\n\nPancreas: Multiple pancreatic cystic lesions, measuring up to 7 mm in the\npancreatic head (series 6, image 17), remain stable and likely represent side\nbranch IPMNs. The pancreatic parenchyma is normal in signal. There is no\nmain pancreatic duct dilatation.\n\nSpleen: The spleen is within normal limits.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: There are a few tiny cortical cysts in the left kidney. There is no\nsolid mass or hydronephrosis.\n\nGastrointestinal Tract: Visualized upper abdominal bowel loops are normal in\ncaliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta and major mesenteric branch vessels are\nnormal ___ caliber and patent. Note is made of a separate origin of the left\ngastric artery arising directly from the aorta adjacent to the celiac trunk.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions are seen. \nThere are incisional changes of the midline to right anterior abdominal wall.", "output": "1. Post resection of a segment IV biliary cystadenocarcinoma without MR\nevidence of residual or recurrent tumor.\n2. Stable pancreatic cystic lesions measuring up to 7 mm are likely side\nbranch IPMN. These can be followed on subsequent hepatic surveillance\nimaging." }, { "input": "Lower Thorax: There is mild left basilar atelectasis. Within the limitations\nof MRI, the lung bases are otherwise clear. There is no pleural effusion. \nThe base of the heart is normal in size. There is no pericardial effusion.\n\nLiver: The liver is normal in shape and contour. There are no morphologic\nfeatures of cirrhosis. There is no background hepatic steatosis. In the dome\nof the liver, there is a 4 mm T2 hyperintense nonenhancing focus, compatible\nwith a cyst or biliary hematoma. No worrisome liver lesions are identified. \nNote, the entire liver is not included in the field of view. The portal veins\nare patent.\n\nBiliary: The gallbladder is surgically absent. There is no intrahepatic\nbiliary duct dilation. The common bile duct measures 7 mm, which is slightly\nprominent for a patient of this age. This likely represents\npost-cholecystectomy changes. There is no choledocholithiasis or evidence of\na mass.\n\nPancreas: The pancreatic parenchyma is normal in signal and enhances\nhomogeneously. There is no duct dilation or mass. Incidentally noted is\npancreatic divisum.\n\nSpleen: The spleen is normal in size, measuring 9.6 cm. There are no focal\nlesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal.\n\nKidneys: The kidneys are normal in size. The lower pole of the left kidney,\nthere is a 38 x 33 x 34 mm cystic lesion. Within the lesion, there is an\nirregular 19 mm enhancing nodule. There is evidence of fat within the nodule \nThe internal contents of the cystic lesion are slightly hyperintense on the\nprecontrast T1 weighted images suggesting they are slightly hemorrhagic. This\nlesion is concerning for a clear cell renal cell carcinoma given the presence\nof fat in the enhancing nodule. It corresponds to the abnormality seen on the\nrecent renal ultrasound.\n\nIn the right kidney, there is a 77 mm simple cyst and a 37 mm simple cyst. No\nother renal lesions are identified. There is no hydronephrosis or perinephric\nabnormality. There is a small accessory right renal artery supplying the\nupper pole (100, 32). There is a single left renal artery. The renal vein\nanatomy is conventional. There is no evidence of a thrombus.\n\nGastrointestinal Tract: The stomach and small bowel are normal in course and\ncaliber. There is no evidence of obstruction. The imaged portions of the\nlarge bowel are normal. There is no ascites.\n\nLymph Nodes: There is no periportal, retroperitoneal, or mesenteric\nlymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence an\naneurysm. There is no significant atherosclerotic plaque.\n\nOsseous and Soft Tissue Structures: The bones are better assessed on the\nrecent PET-CT. There are no concerning osseous lesions in the imaged portions\nof the spine. The known left eleventh rib and lesion is not included in the\nfield of view. The soft tissues are unremarkable.", "output": "Partially hemorrhagic cystic lesion in the lower pole of the left kidney with\nan enhancing nodule is concerning for a renal cell carcinoma. Given the\npresence of fat within the nodule, it most likely represents a clear cell\nsubtype." }, { "input": "Lower Thorax: The visualized lung bases and lower mediastinum are grossly\nunremarkable. No pleural or pericardial effusion.\n\nLiver: There is a background of mild hepatic steatosis. The liver contour is\nsmooth. A T2 hyperintense lesion in the dome of the liver is unchanged and\nreflects a cyst or biliary hamartoma (6:7). An additional punctate T2\nhyperintense lesion in segment VII is unchanged and also reflects a cyst or\nbiliary hamartoma (06:10).\n\nBiliary: Persistent common bile duct dilation status-post cholecystectomy up\nto 10 mm. No abnormal intrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal signal intensity throughout. No pancreatic\nductal dilatation or focal lesion.\n\nSpleen: The spleen is normal in size and shape without focal lesion. There is\na tiny accessory spleen (10:10).\n\nAdrenal Glands: The right and left adrenal glands are normal size and shape.\n\nKidneys: The right and left kidneys are normal and symmetric in size and\nshape. A 3.7 x 3.1 x 3.2 cm complex T1 hyperintense, T2 hyperintense cystic\nlesion arising from the lower pole of the left kidney is essentially unchanged\nin size. The previously identified internal enhancing nodular component\nmeasures 2.3 cm and is unchanged in size given differences in measurement\ntechnique. A 5.2 x 6.5 cm simple cyst arising from the interpolar right\nkidney is unchanged. A 2.4 x 2.5 cm simple cyst arising from the lower pole\nthe right kidney is also unchanged. No new lesion or hydronephrosis.\n\nGastrointestinal Tract: The stomach and visualized loops of large small bowel\nare grossly unremarkable.\n\nLymph Nodes: No visualized retroperitoneal, mesenteric, or porta hepatic\nlymphadenopathy.\n\nVasculature: No gross abnormality, but not well evaluated given lack of\nintravenous contrast.\n\nPelvis: Limited evaluation of the pelvis on localizer sequences reveal an\nenlarged, fibroid uterus.\n\nOsseous and Soft Tissue Structures: The known anterior left seventh rib lesion\ndemonstrates T2 signal hyperintensity and T1 signal hypo intensity. A T2\nhyperintense lesion in the L1 vertebral body is grossly unchanged and likely\nrepresents a vertebral body hemangioma (06:32).", "output": "1. 3.7 cm mixed cystic and solid left lower pole renal mass, concerning for\nclear cell carcinoma, is unchanged since ___.\n2. Unchanged anterior left seventh rib lesion.\n3. Mild hepatic steatosis." }, { "input": "Limited study due to noncontrast technique.\n\nLower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The contours are smooth. There is\natrophy of the left hepatic lobe and hypertrophy of the caudate. No\nconcerning solid or cystic lesions.\n\nBiliary: Patient is status post cholecystectomy and hepaticojejunostomy. Mild\nleft and central intrahepatic duct dilation is unchanged compared to the prior\nexam. No bile duct stones are identified.\n\nPancreas: The pancreas is atrophic but normal in signal characteristics. A 3\nmm cystic lesion in the head (04:35) is unchanged compared to the prior exam. \nStatistically, this lesion is most in keeping with a side-branch IPMN. No\nnodularity or duct dilation.\n\nSpleen: There is splenosis in the left upper quadrant.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: There is mild fullness of the right collecting system. This finding\nis unchanged compared to the prior exam. The kidneys are otherwise normal in\nsize and signal characteristics. No concerning solid or cystic lesions. An 8\nmm cyst arising from the lower pole of the right kidney is unchanged.\n\nGastrointestinal Tract: A short segment jejuno-jejunal intussusception in the\nleft upper quadrant is noted. No evidence of a lead mass or obstruction. The\nGI tract is of normal caliber throughout. No mural thickening or abnormal\nenhancement.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Within the limitations of a noncontrast study, the visualized\nabdominal aorta and proximal mesenteric vessels appear patent without any\nsignificant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: An 11 x 34 mm left paraspinal\nintramuscular lipoma is unchanged. The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. Moderate dilation of the central and left intrahepatic bile ducts with\natrophy of the left hepatic lobe in keeping with chronic cholangitis is\nunchanged compared to the prior exam. No intrahepatic bile duct stones are\nidentified. No choledocholithiasis. The hepaticojejunostomy appears within\nnormal limits.\n2. Stable 3 mm pancreatic cyst statistically most likely represents a\nside-branch IPMN. No concerning features. Follow-up MRCP in ___ years is\nrecommended.\n3. Transient jejuno-jejunal intussusception." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: There is unchanged atrophy of the left hepatic lobe and hypertrophy of\nthe caudate lobe. The previously seen micro abscesses have resolved, although\nevaluation is limited without the use of IV contrast. There is no suspicious\nfocal liver lesion on limited noncontrast sequences.\n\nBiliary: Patient is status post cholecystectomy and hepaticojejunostomy. \nModerate irregular central and right intrahepatic biliary ductal dilatation is\nsimilar to the prior study with moderate left pneumobilia, also unchanged.\n\nPancreas: The pancreas is normal in signal intensity and morphology. A 6 mm\nT2 hyperintensity near the pancreatic head is unchanged from the prior study\nwhen measured in similar planes, statistically a side branch IPMN (06:30). \nThere is no pancreatic ductal dilatation.\n\nSpleen: Spondylosis of the left upper quadrant is noted.\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: Bilateral kidneys are normal without suspicious focal lesion or\nhydronephrosis. Subcentimeter simple cysts are noted.\n\nGastrointestinal Tract: No focal abnormality.\n\nLymph Nodes: No lymphadenopathy by imaging criteria.\n\nVasculature: No gross abnormality, better assessed on prior contrast enhanced\nstudies.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. A lipoma\nin the left paraspinal musculature is unchanged. No other focal abnormality.", "output": "1. Pancreatic cystic lesion measuring up to 6 mm is unchanged from prior\nstudies when measured in similar planes.\n2. Stable changes related to hepaticojejunostomy and cholecystectomy with\nsimilar pneumobilia and moderate central intrahepatic biliary ductal\ndilatation.\n3. Previously seen hepatic microabscess is no longer identified on limited\nnoncontrast images." }, { "input": "Lower Thorax: Imaged lower thorax is clear. There is no pleural or\npericardial effusion. Heart size is mildly enlarged.\n\nLiver: The liver is nodular in contour, compatible with cirrhosis. Mild\nhepatic steatosis is noted. Additionally, there is diffuse nodularity of the\ninternal architecture of the liver, likely representing regenerative nodules. \nIn segment II, there is a 9 mm arterially enhancing focus (13:32), with no\nintrinsic signal characteristics on T1 or T2 weighted images, which\ndemonstrates stable hyperenhancement compared to the surrounding liver on\ndelayed postcontrast phases. Scattered areas of progressive enhancement and\nsegments VII and VI indicate fibrosis.\n\nBiliary: There is no intra or extrahepatic biliary dilation. The gallbladder\nis present, with no stones.\n\nPancreas: The pancreas is normal in signal intensity. Pancreatic duct is\nnondilated and normal in morphology.\n\nSpleen: The spleen is mildly enlarged, measuring 13.4 cm in craniocaudal\ndimension.\n\nAdrenal Glands: The adrenal glands are morphologically normal bilaterally.\n\nKidneys: The kidneys are normal in size and signal intensity. Parapelvic and\ncortical cysts are noted bilaterally. There is no hydronephrosis or\nconcerning renal lesion.\n\nGastrointestinal Tract: The imaged gastrointestinal tract is normal in\ncaliber.\n\nLymph Nodes: Porta hepatis retroperitoneal lymphadenopathy is a function of\ncirrhotic physiology.\n\nVasculature: The abdominal aorta is normal in caliber. Hepatic arterial\nanatomy is conventional. Major aortic branches are patent. Small\nparaesophageal varices are noted.\n\nOsseous and Soft Tissue Structures: Bone marrow signal intensity is normal. \nT2 hyperintense focus in the right aspect of the L5 vertebral body (02:35), is\nlikely an intraosseous hemangioma.", "output": "1. Nonspecific 9 mm arterially enhancing focus in segment II of the liver,\nwithout suspicious features on T2 weighted imaging or dynamic post contrast\nimaging.\n2. Cirrhotic liver with mild splenomegaly. No ascites or large varices.\n\nRECOMMENDATION(S): There are no specific recommendations to follow the\nsegment II enhancing focus however continued surveillance of the liver is\nrecommended based on the patient's hepatic risk factors." }, { "input": "Lower thorax: The lung bases are clear. No pleural or pericardial effusions.\n\nLiver: The liver demonstrates normal signal intensity without suspicious focal\nlesions. Only arterial and delayed phases of the contrast enhanced sequences\nwere acquired for technical reasons.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilatation. The\ngallbladder appears unremarkable without evidence of stones.\n\nPancreas: Tiny cystic lesions are again seen in the head and tail of the\npancreas measuring up to 3 mm, not significantly changed compared to previous.\nThere is no pancreatic ductal dilatation.\n\nSpleen: The spleen is normal in size.\n\nAdrenal Glands: The patient is status post right adrenalectomy, with\nsusceptibility artifact from surgical clips. Again a foci of enhancement\nmeasuring approximately 5 mm is seen in the surgical bed (series 11:25), not\nsignificantly changed compared to the previous study from ___, and\nremains indeterminate. The left adrenal gland is unremarkable.\n\nKidneys: Bilateral kidneys are unremarkable without evidence of focal lesions\nor hydronephrosis.\n\nGastrointestinal Tract: The visualized large and small bowel are within\nnormal limits.\n\nLymph Nodes: There are no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Abdominal aorta and major vessels appear unremarkable.\n\nOsseous and Soft Tissue Structures: There are no suspicious bony lesions. The\npreviously seen abnormal enhancement within the spinous process of the L3\nvertebra has decreased compared to previous.", "output": "1. Stable 5 mm enhancing focus within the right adrenalectomy surgical bed.\n\n2. The enhancing focus within the L3 vertebrae has decreased in conspicuity\ncompared to previous.\n\n3. 3 mm cystic lesions within the head and tail of the pancreas remained\nstable and likely represent side duct IPMNs.\n\nRECOMMENDATION(S): The tiny cystic pancreatic lesions can be reassessed at\nthe same time as expected adrenal bed follow-up, or in ___ year if MR is not\notherwise planned." }, { "input": "Lower Thorax: The visualized lower thorax is grossly normal.\n\nLiver: The liver is normal in contour and signal intensity. No suspicious\nliver lesions are seen.\n\nBiliary: There is no evidence of intra or extrahepatic biliary dilation. No\nsegmental strictures, dilatation, or mural irregularities of the biliary duct.\nThe gallbladder is within normal limits, having a thin wall and no discrete\ngallstones.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nductal dilation. Multiple T2 hyperintense cystic lesions within the pancreas\nmeasuring up to 4 mm as seen on the prior study may represent side branch\nIPMNs.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: Patient is status post right adrenalectomy. An 8 mm focus of\nenhancement in the adrenalectomy bed (1602:49) is unchanged compared to the\nprior study. The left adrenal gland is unremarkable.\n\nKidneys: Bilateral kidneys demonstrate normal signal intensity. No suspicious\nrenal lesions are noted. No hydronephrosis. There is no perinephric\nabnormality.\n\nGI: The stomach and intra-abdominal loops of small and large bowel are within\nnormal limits.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber without evidence of\naneurysm or dilation. The major visualized branches of the aorta are patent.\n\nPelvis: Patient is status post hysterectomy. There is no pelvic fluid. There\nis no pelvic lymphadenopathy.\n\nBladder: The urinary bladder is adequately distended. There are no stones or\nmasses. The bladder wall is not thickened.\n\nOsseous and Soft Tissue Structures: Previously reported enhancement of the L3\nspinous process is not visualized on the current study. No bone marrow signal\nabnormalities detected. No suspicious osseous or soft tissue lesions\ndetected.", "output": "1. 8 mm focus of enhancement in the right adrenalectomy bed may represent a\nlymph node or residual adrenal tissue.\n2. Multiple pancreatic cystic lesions may represent side branch IPMNs. \nAttention on follow-up recommended." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in signal intensity and morphology. There is no\nsuspicious lesion. The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation.\nThe gallbladder is normal.\n\nPancreas: Normal in signal intensity without ductal dilatation. There is\nredemonstration of a T2 hyperintense cystic lesions, largest in the posterior\naspect of the distal body/tail of the pancreas measuring up to 4 mm, unchanged\nand compatible with side branch IPMNs (11:67). The previously noted cystic\nlesion in the head of the pancreas is not well visualized. There is no focal\nlesion.\n\nSpleen: Normal in size without focal lesion.\n\nAdrenal Glands: The patient is status post right adrenalectomy. A\npreviously-noted focus of enhancement in the adrenalectomy bed appears smaller\nand less distinct compared to the prior study dated ___ (202:65). The\nleft adrenal gland is unremarkable.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion.\n\nGastrointestinal Tract: Normal bowel caliber. No evidence of obstruction.\n\nLymph Nodes: No evidence of abdominal or pelvic lymphadenopathy\n\nPelvis: Patient is status post hysterectomy. There is no free fluid in the\npelvis.\n\nBladder: The urinary bladder is moderately well distended. There are no\nmasses. The bladder wall is not thickened.\n\nVasculature: There is a replaced right hepatic artery arising from the\nsuperior mesenteric artery.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. The\npreviously seen enhancement in the L3 spinous process on prior study from ___\nis not visualized on today's exam. No focal abnormality.", "output": "1. Focus of enhancement in the right adrenalectomy bed appears slightly\nsmaller and less distinct than prior study dated ___, likely\npostsurgical changes rather than residual/recurrent mass.\n2. Pancreatic cystic lesion in the distal body/tail measuring up to 4 mm,\nunchanged and compatible with a side branch IPMN. Attention on follow-up is\nrecommended.\n3. Previously seen focus of enhancement in the L3 spinous process is not\nvisualized." }, { "input": "There is diffuse dropout of signal on out of phase imaging, again consistent\nwith fatty deposition. There is focal sparing surrounding the gallbladder\n(3:45). There are still two subtle lesions in segments III and VI measuring\n13-14 mm with marginal T2 hypertintensity (14:18,35). They show arterial\nenhancement, but do not washout. They do not retain Eovist on delayed images\n(16:83, 90).\n\nThere is a 4.3 x 3.1 heterogeneous mass in the anterior aspect of the lower\npole of the left kidney that abuts the renal sinus (16:116). It demonstrates\nincreased T2 signal and hypervascularity. There is no evidence of intravoxel\nfat. It is more conspicuous on trace diffusion and post contrast images\ncompared to prior MR, but appears stable in size. There are no pathologically\nenlarged retroperitoneal lymph nodes by size criteria. There is no evidence of\nvascular invasion. Again noted is a 8 mm simple cyst in the upper pole of the\nright kidney. Bone marrow signal is normal.", "output": "1. 4.3 cm mass in the lower pole of left kidney, slightly more conspicuous\nthan on ___. Findings are most consistent with clear cell renal\ncell carcinoma. Urology consultation is recommended.\n2. Hepatic lesions in segments III and VI do not retain Eovist contrast and\ntherefore are unlikely to represent focal nodular hyperplasia (FNH). They are\nbenign appearing, but most likely represent hepatic adenomas.\n3. Hepatic steatosis.\n\nNOTIFICATION: Findings were discussed by Dr. ___ with Dr. ___\n___ (covering for Dr. ___ by phone at 2:29 p.m. on ___." }, { "input": "Lower Thorax: There are small bilateral, right greater than left, pleural\neffusions with adjacent atelectasis/consolidation.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are slightly nodular,\nthere is segmental atrophy of the left hepatic lobe consistent with cirrhosis.\nNo solid or cystic lesions. There is a small amount of ascites in the\npararenal spaces.\n\nBiliary: There is cholelithiasis. There is interval decompression of the\ngallbladder. The gallbladder measures approximately 42 x 98 mm. The\ngallbladder wall is markedly edematous measuring up to 12 mm. There is\npneumobilia in the common hepatic duct and and left hepatic ducts in keeping\nwith recent ERCP. A right lateral internal-external PTBD stent is present. \nThere has been markedly decompression of the intra and extrahepatic bile ducts\nsince the CT examination from ___. The gallbladder is also no\nlonger distended. The common bile duct measures up to 11 mm. The distal-most\n2.6 cm of the CBD is focally narrowed (series 5, image 17). Within the\nlimitations of a non-contrast study, no associated discrete mass is seen.\n\nPancreas: The pancreatic duct is massively dilated, measuring up to 28 mm,\nwith an abrupt transition point at the pancreatic head, where the CBD\nnarrowing begins (series 5, image 16). There is severe atrophy of the\npancreatic parenchyma. Previously-seen calcifications on the prior CT are not\nwell visualized with this technique. The constellation of findings are most\ncompatible with chronic pancreatitis. There are no solid masses.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid or cystic lesions. \nNo hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: The visualized abdominal aorta and proximal mesenteric vessels\nappear patent without any significant areas of narrowing or dilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.", "output": "1. Post internal-external biliary drain placement with marked decompression\nof the intra- and extrahepatic ducts and gallbladder since the CT examination\nfrom ___.\n2. The distal-most 2.6 cm of the CBD is focally narrowed, occurring at the\nsame level as a sharp transition point of the dilated pancreatic duct. No\nassociated discrete mass is seen, although the study is limited by lack of IV\ncontrast. The findings likely represent inflammatory stricture related to the\nrecent ERCP findings, however, continued imaging surveillance is recommended.\n3. Cholelithiasis and persistent gallbladder wall edema. Lack of intravenous\ncontrast limits assessment; however, the edema is likely related to recent\nobstruction seen on the ___ study.\n4. Severely dilated main and side-branch pancreatic duct dilatation is\nconsistent with chronic pancreatitis." }, { "input": "MR ABDOMEN: Again seen is a large cystic and solid mass within the right\nabdomen, centered in the retroperitoneum and measuring 21.2 x 16.3 x 23.3 cm\n(TV x AP x CC), previously 22.0 x 16.5 x 18.4 cm, unchanged allowing for\ndifferences in modality. Given the large size of the lesion and breath hold\nrelated temporal restrictions on coverage at MRI, the entire mass is not\ncovered in all planes, including the axial post-contrast images.\n\nThere is no bulk fat within the majority of the lesion. Bulk fat silhouetted\nby boundary artifact on out of phase T1I GRE images at the inferior aspect of\nthe tumor is felt to be due to engulfing of retroperitoneal fat. There is\nminimal intra voxel fat within the lesion with a few areas showing slight loss\nof signal on the out of phase images (8a:175, 8b:176). There is no evidence\nof internal hemorrhage. Areas of restricted diffusion and hyperintensity on\nT2WI within the mass are noted. After contrast administration, the solid\nportions of the mass enhance heterogeneously while portions of the mass do not\nenhance consistent with necrosis or cystic change.\n\nThe right adrenal gland is not seen separately and the mass may arise from the\nright adrenal gland or obliterate it. The fat plane is lost between the mass\nand the right kidney with some irregularity of the capsule-tumor interface for\nwhich right renal capsular invasion is suspected. The mass invades the right\nhepatic lobe. It also contacts the right psoas and right diaphragmatic crus\nwith loss of fat planes and invasion of these muscles cannot be excluded\n(20:58). The mass displaces the right kidney inferiorly, the gallbladder to\nthe anterior mid abdomen and the right hemicolon into the left hemiabdomen. \nThe pancreas and duodenum are displaced medially. No enlarged lymph nodes are\nidentified.\n\nNo hepatic vessel feeding the mass is identified. The hepatic veins are\ndisplaced by mass effect, but are patent centrally. The main portal vein is\nstretched but patent and the left portal vein is patent. The right portal vein\nis not seen on today's study but appears patent on CT ___. The\nsplenic vein and SMV are patent. The IVC is compressed but remains patent\n(1702:33, 20:110). The SMA and celiac axis are patent and not involved. \nUlcerating atherosclerotic plaque is seen in the infrarenal abdominal aorta\nwith areas of saccular ectasia to 2.4 cm. There is also a saccular aneurysm in\nthe left internal iliac artery. There are single renal arteries bilaterally.\nThe renal veins appear patent.\n\nThe remaining liver parenchyma is normal in signal intensity on T1 and T2\nweighted images without intrahepatic bile duct dilation. The gallbladder,\nspleen and pancreas are normal. The kidneys enhance homogenously without\nhydronephrosis. Nonenhancing T2 hyperintense cysts are seen in both kidneys,\nmeasuring up to 3.1 cm in the right renal interpolar region. Diverticula are\nseen in the colon. There is a small amount of fluid adjacent to the mass.\n\nNo bone marrow signal abnormality is seen.", "output": "Large right abdominal cystic and solid mass centered in the retroperitoneum\nwith mass effect and adjacent organ invasion as detailed above. The MR\nfeatures do not support a predominantly fatty lesion although noting the\nresult of prior biopsy pathology, this could represent a sarcoma with a mild\nfat component. The degree of invasion is more than would be expected for a\nlow grade lesion. The imaging differential diagnosis also includes an\nadrenocortical carcinoma, less likely a primary liver mass. Although renal\ncapsular invasion might be present, the appearance is not consistent with a\nprimary renal lesion." }, { "input": "Lung bases clear. There is no pleural or pericardial effusion. The heart is\nenlarged. A small hiatal hernia is seen.\n\nSusceptibility artifacts from metal stents are seen in the CBD and the central\nintrahepatic biliary ducts. The cholangiocarcinoma itself at the central duct\nbifurcation is not seen well due to the artifacts.\nThe dilatation of the bile ducts in segments 7 and 8 is more prominent\ncompared to the last study and do not contain air on this exam, as they used\nto, arising suspicion for obstruction. Evaluation of the stent potency is\nrecommended.\nThe gallbladder is distended and contains fluid-fluid level, the dependent\nportion of which has restricted diffusion (6:33) with low ADC values\nconsistent with thick inspissated contents. The lateral gallbladder wall is\ndiscontinuous (07:31) with a tract leading to a partially seen multilobular\nfluid collection abutting the hepatic flexure of the colon, measuring 4.8 x\n2.8 cm (1003:126). This appearance has not significantly changed compared\n___.\n\nIn segments 7 and 8 multiple hepatic irregular multicystic well defined\nlesions are seen in the right lobe, which are internally mildly hyperintense\non T2WI and have rim enhancement (1002:45). These are new compared to ___ and enlarged compared to ___. The largest in segment 8\nmeasures 3.8 x 2.7 cm. Patchy enhancement of the liver parenchyma is seen\naround the lesions in segment 8. These are consistent with abscesses which are\nmostly phlegmonous and not containing liquefied contents.\n\nA 3 mm cystic lesion seen in the uncinate process of the pancreas (07:36),\nrepresenting a side branch IPMN.\n\nStable bilateral renal cortical cysts are seen.\nA 2.8 cm mass seen in the left adrenal, showing areas of signal drop on the\nout of phase images compared to in phase images, and unchanged from previous\nstudies, consistent with an adrenal adenoma (5:31).\nNo free fluid seen. No lymphadenopathy is seen.\n\nDegenerative changes the spine with mild scoliosis are seen.", "output": "1. Worsening dilatation with intrahepatic ducts in segments 7 and 8 with\ndisappearance of pneumobilia, suspicious for CBD stent dysfunction. Evaluation\nof the stent potency is recommended.\n2. Multiple lesions consistent with abscesses in segments 7 and 8, which show\nworsening from the last CT which was done 2 days prior to the MRI. The\nabscesses are only mildly hyperintense on T2WI, indicating mostly phlegmonous\ncontents. This may be aspirated for micro-organism culture.\n3. Gallbladder wall discontinuity with a tract extending to the fluid\ncollection abutting the hepatic flexure of the colon, without significant\nchange from ___.\n4. Stable left adrenal adenoma." }, { "input": "LOWER CHEST: Bibasilar atelectasis with small pleural effusions.\n\nABDOMEN: Study is significantly limited by motion and by non-breath-hold\ntechnique. The liver demonstrates signal loss on out of phase as opposed to in\nphase sequences, consistent with fatty liver. The gallbladder and bile ducts\nare normal. No intra or extrahepatic bile duct dilatation. 2.5 x 1.7 cm cystic\nlesion in the head of the pancreas is consistent with a side-branch IPMN.\nThere is no obvious nodularity or concerning enhancement within this lesion.\nThe pancreatic duct is dilated to 5 mm in the pancreatic head, but is not\ndilated proximally. A few additional 3 mm and smaller T2 hyperintense lesions\nin the pancreas (05: 27, 31, 39) are also consistent with side branch IPMNs.\n\nLinear band of T2 hyperintensity without enhancement or evidence of hemorrhage\nwithin the spleen is consistent with splenic infarction. Adrenal glands are\nnormal. Simple cysts are seen in both kidneys. Heterogeneous appearance of\nthe left kidney upper pole is not well characterized on this exam because of\nrespiratory motion with mild hyperintensity on T2-WI and heterogeneous\nhypoenhancement, potentially an infarct. The ureters are normal caliber.\n\nThe stomach, small bowel, and large bowel are unremarkable other than\ndiverticulosis. No retroperitoneal lymphadenopathy. Mesenteric nodes in the\nleft mid abdomen with associated fat stranding is consistent with sclerosing\nmesenteritis, given calcification within the mesentery on ___ CT.\nTrace ascites and pelvic fluid.\n\nThe aorta is tortuous and thrombus is identified extending from the left\ncommon iliac artery through the left external iliac artery into the left\ncommon femoral artery. Thrombus appears near occlusive in the left external\niliac artery and partially occlusive within the common femoral and common\niliac arteries. There is also suggestion of thrombus in the left internal\niliac vein (17:23).\n\nThe bladder is unremarkable other than a small air-fluid level likely related\nto recent Foley catheterization. No pelvic sidewall or inguinal\nlymphadenopathy. The bone marrow signal is normal.", "output": "1. Near-occlusive thrombus in the left external iliac artery and partially\nocclusive thrombus in the left common iliac and left common femoral arteries. \nProbable thrombus in the left internal iliac vein. CTA could be obtained for\nfurther assessment if clinically desired.\n\n2. Multiple cystic lesions in the pancreas, the largest of which measures 2.5\nx 1.7 cm in the pancreatic head. Findings are consistent with multiple side\nbranch IPMNs, though combined type cannot be excluded given mild dilatation of\nthe downstream main pancreatic duct.\n\n3. Heterogeneous appearance of the left kidney upper pole is poorly\ncharacterized due to respiratory motion and may represent an infarct or\npotentially a complex cystic lesion. If needed, this can be further\ncharacterized with ultrasound.\n\n4. Prominent left mesenteric nodes with surrounding hazy fat stranding,\nconsistent with sclerosing mesenteritis.\n\n5. Fatty liver.\n\n6. Trace ascites and pelvic fluid. Small bilateral pleural effusions.\n\n7. Splenic infarction.\n\nNOTIFICATION: The findings were discussed via telephone by Dr. ___ with Dr.\n___ on ___ at 9:48 AM, 10 minutes after discovery of the\nfindings." }, { "input": "There is motion degradation artifact on multiple sequences, limiting study.\n\nLower Thorax: Trace right pleural effusion. Bibasilar atelectasis right\ngreater than left. No pericardial effusion.\n\nLiver: Cirrhotic morphology of the liver. Enhancing focus involving segment 5\nmeasuring approximately 1.5 cm (image 53, series 13), demonstrates washout\n(image 53, series 19), given limitations of the exam secondary to artifact\nfrom ascites and TIPS.\n\nBiliary: Redemonstrated minimally prominent intrahepatic ducts. CBD is mildly\nprominent, status post cholecystectomy.\n\nVessels: TIPS shunt extending from the right posterior Portal vein to the\nright hepatic vein, appears to be patent given limitations of the exam. Main\nportal vein is patent. Splenic and superior mesenteric veins are patent.\n\nPancreas: Symmetric enhancement of the pancreas. No pancreatic ductal\ndilatation.\n\nSpleen: Stable splenomegaly measuring 15.6 cm\n\nAdrenal Glands: No enhancing mass seen.\n\nKidneys: No hydronephrosis. Bilateral subcentimeter renal cysts.\n\nGastrointestinal Tract: No abnormally dilated loops of bowel.\n\nLymph Nodes: Limited evaluation.\n\nOsseous and Soft Tissue Structures: No destructive osseous lesions.", "output": "1. Cirrhotic hepatic morphology with manifestations portal hypertension\nincluding unchanged splenomegaly, large ascites. Patent TIPS and main portal\nvein.\n2. Enhancing focus involving segment 5 demonstrating washout measuring up to\n1.5 cm, however incompletely characterized given limitations secondary to\nartifact, for which short-term interval follow-up in 3 months is recommended.\n\nRECOMMENDATION(S): Liver MRI with contrast in 3 months." }, { "input": "The morphologic appearance of the liver is consistent with cirrhosis, with\nnodular contour and hypertrophy of the caudate and left lobe. There are\nscattered small T2-hyperintense lesions that are unchanged in size and\ndistribution from prior examinations. These are seen on series 6, images 7, 9,\n11, and 18, as well as series 9, image 22. Two demonstrate arterial\nenhancement and progressive enhancement following signal intensity of venous\nblood pool suggestive of hemangiomas. A third is nonenhancing, consistent with\na cyst or biliary harmartoma. Two additional lesions are only seen on T2\nweighted imaging and are too small to identify on post-contrast sequences,\npossibly tiny hemangiomas. There is no concerning hepatic mass.\n\nThere is mild splenomegaly with maximum diameter of 13 cm. There is no ascites\nor significant collateral vessel formation within the upper abdomen.\n\nThe gallbladder is surgically absent. The biliary tree is otherwise\nunremarkable. The pancreas and adrenal glands are unremarkable. Each kidney\nis notable for nonobstructed duplicated collecting systems. There is a 1 cm\nexophytic cyst arising posteriorly from the interpolar apsect of the right\nkidney. There is no lymphadenopathy. No osseous abnormality.", "output": "1. Cirrhotic liver.\n2. No concerning hepatic mass. Unchanged multiple tiny hepatic hemangiomas\nand cysts.\n3. Mild splenomegaly." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, the bilateral lung bases\nare grossly clear. There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in size and smooth in contour. There is moderate\ndiffuse hepatic steatosis with calculated fat fraction of 18%. There are\nmultiple scattered hepatic cysts or biliary hamartomas, the largest measuring\n2.9 x 2.1 cm at the border of segments II and III. There is a 1.5 x 1.1 cm T2\nhyperintense lesion in segment VII (series 7, image 15), which demonstrates\nperipheral nodular enhancement with progressive fill-in, in keeping with a\nhemangioma, corresponding to the hypervascular lesion described on CT of the\nabdomen from ___. There is a 1.3 x 1.3 cm hemangioma in segment III\n(series 7, image 25).\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation. There is no peripancreatic\nstranding or fluid collection.\n\nSpleen: The spleen is normal in size and signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are within normal limits.\n\nKidneys: The kidneys are symmetric in size. There is no focal renal lesion or\nhydronephrosis. There is no perinephric abnormality.\n\nGastrointestinal Tract: The stomach is unremarkable. Visualized upper\nabdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The left hepatic artery arises from the left gastric artery. The\nportal and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. The abdominal wall is within normal limits.", "output": "1. Combination of hepatic cysts versus biliary hamartomas and rapidly filling\nhemangiomas in the liver, including a 1.5 x 1.1 cm hemangioma in segment VII,\nwhich corresponds to the hypervascular lesion described on CT of the abdomen\nfrom ___. No suspicious hepatic lesion.\n\n2. Moderate diffuse hepatic steatosis with calculated fat fraction of 18%. \nSteatohepatitis cannot be excluded based on imaging." }, { "input": "No filling defect is seen from the level of the distal IVC to the iliac and\nsuperficial femoral veins to suggest a thrombus. Incidental note is made of\nsymmetric flow related artifact in the bilateral external iliac veins. Flow\nvoids are preserved on T2 images in both the major arterial and venous\nvasculature.\n\nThe visualized liver and spleen are grossly unremarkable. The kidneys are\nsymmetric in size without hydronephrosis. Visualized pancreas is grossly\nunremarkable. The included small and large bowel are unremarkable. The\nbladder is normal in appearance. Enlarged postpartum uterus is identified\ncontaining some heterogeneous material in the endometrium towards the left\nfundus. Bilateral ovaries are normal. There is no pelvic sidewall or\ninguinal lymphadenopathy. Soft tissues are grossly unremarkable. Marrow\nsignal is within normal limits.", "output": "1. No evidence of pelvic DVT, though the exam is slightly limited without\nintravenous contrast.\n\n2. Heterogeneous endometrium toward the left fundus. Correlate with history\nof postpartum bleeding as retained fetal products cannot be entirely excluded." }, { "input": "Motion degraded.\n\nLOWER THORAX: Clear visualized lungs. No pleural effusions.\n\nLIVER: Simple hepatic cysts. The largest is in segment 3 measures 18 mm. \nNormal visualized hepatic signal in contour. No suspicious mass.\n\nBILIARY: Unremarkable gallbladder. No biliary dilation.\n\nPANCREAS: Pancreatic atrophy. 6 mm pancreatic head cystic lesion, likely side\nbranch IPMN. No communication to the main duct. No main duct dilation.\n\nSPLEEN: Partially visualized. Homogeneous signal without splenomegaly.\n\nADRENAL GLANDS: No nodules.\n\nKIDNEYS: Simple right inferior pole cyst. No suspicious lesion. No\nhydronephrosis or hydroureter trace left perinephric fluid.\n\nGASTROINTESTINAL TRACT: Unremarkable stomach and small intestine. Left hemi\ncolonic diverticulosis. Long segment smooth sigmoid wall thickening,\nunchanged and likely sequela of diverticulosis. Trace ascites.\n\nLYMPH NODES: Mass like adenopathy of the small bowel mesentery is re-\ndemonstrated with T2 hypointensity (fibrosis, calcifications), adjacent\nadenopathy, tethering and fibrotic changes of the mesentery. Calcifications\nwere noted on CT. The enhancement pattern is difficult to ascertain given\nmotion and bowel gas artifact however, appears hypoenhancing. Findings are\nconsistent with biopsy-proven sclerosing mesenteritis, grossly unchanged.\n\nVASCULATURE: Patent aorta and major branches. Mesenteric vasculature details\nare obscured by motion.\n\nOSSEOUS AND SOFT TISSUE STRUCTURES: Normal bone marrow signal. No soft tissue\nmass.", "output": "1. Biopsy-proven sclerosing mesenteritis in the small bowel mesentery,\ngrossly unchanged.\n2. Colonic diverticulosis.\n3. 6 mm pancreatic cyst, likely side branch IPMN.\n\nRECOMMENDATION(S): Patient was unable to hold his breath. Images were\ndegraded by motion and bowel gas. Follow up should be preformed with CT with\ncontrast." }, { "input": "The study is limited as there is motion on most of the acquired images.\n\nAorta: Unchanged type B aortic dissection with the largest caliber at the\nthoracic/abdominal aorta junction measuring 4.7 cm. It is difficult to\ndiscern the true from the false lumen. However both of the lumina have good\nflow. The right lumen supplies the right renal artery, and the celiac artery\npartly. The left lumen supplies the rest of the intraabdominal branches the\ndissection flap does not move indicating a chronic nature. The dissection\nflap extends into the celiac axis. It also continues to extend into bilateral\ncommon iliac arteries.\n\nLiver: Limited views of the liver appear unremarkable.\n\nBiliary: There is no biliary ductal dilatation. Gallbladder appears\nunremarkable.\n\nPancreas: Limited views of the visualized pancreas are unremarkable.\n\nSpleen: There is no splenomegaly.\n\nAdrenal Glands: Not visualized.\n\nKidneys: No hydronephrosis.\n\nGastrointestinal Tract: No bowel obstruction. There is small amount of free\nfluid in the pelvis.\n\nLymph Nodes: No retroperitoneal adenopathy.\n\nOsseous and Soft Tissue Structures: T2 hyperintense lesion within the\nvertebral body, likely represents a hemangioma. There is a right fat\ncontaining inguinal hernia.", "output": "Likely chronic type B dissection of the abdominal aorta with further details\nabove.\n\nExamination was terminated prematurely due patient discomfort and severe\nmotion degradation of images." }, { "input": "Lower Thorax: The lung bases are clear. No large pleural effusion or\npericardial effusion.\n\nLiver: The liver demonstrates normal signal intensity and contour. No\nsignificant hepatic steatosis. Scattered areas of peripheral arterial\nhyperenhancement have no T1, T2, or diffusion correlate and do not demonstrate\nwashout or pseudo capsule formation on delayed phase sequences. This is\nconsistent with transient hepatic intensity differences (THID). No suspicious\nliver lesions are identified.\n\nBiliary: No evidence of intrahepatic or extrahepatic biliary ductal\ndilatation. The gallbladder is within normal limits.\n\nPancreas: The pancreas demonstrates normal signal intensity. No focal\npancreatic lesions. No pancreatic ductal dilatation.\n\nSpleen: The spleen demonstrates normal size and signal intensity.\n\nAdrenal Glands: 0.8 x 0.5 cm left adrenal adenoma is noted (05:32). The right\nadrenal gland is normal in size and signal intensity without discrete mass.\n\nKidneys: The bilateral kidneys are symmetric. There is a 1.5 cm right lower\npole simple renal cyst. No solid enhancing renal masses are identified. \nThere is mild fullness of the left renal pelvis. No right-sided\nhydronephrosis.\n\nGastrointestinal Tract: The visualized small and large bowel loops are\nunremarkable. No obstruction. No ascites.\n\nLymph Nodes: Known left periaortic lymph node is partially evaluated and best\nseen on coronal sequence measuring 2.2 x 1.5 cm (04:25). No other enlarged\nlymph nodes are demonstrated in the upper abdomen.\n\nPreviously noted left adnexal mass not well visualized within the scope of\nthis examination.\n\nVasculature: The abdominal aorta is normal in caliber. Major aortic\ntributaries are patent. The hepatic and portal veins are patent.\n\nOsseous and Soft Tissue Structures: No concerning osseous or soft tissue\nlesions.", "output": "1. No suspicious liver lesions. No other liver lesions are demonstrated to\naccount for findings described on prior CT abdomen pelvis dated ___.\n2. Similar appearance of a previously biopsied left periaortic lymph node.\n3. 0.8 cm left adrenal adenoma." }, { "input": "Lower Thorax: No pleural or pericardial effusion.\n\nLiver: There is no hepatic steatosis. Within segment ___ there is a 2.3 x 2.0\nx 2.0 cm mildly T2 hyperintense, brightly arterially hyperenhancing mass\nwithout evidence of intravoxel or bulk fat, slightly hypointense on T1\nweighted images. The mass continues to enhance greater than background\nhepatic parenchyma on delayed images. Remainder of the hepatic parenchyma is\nunremarkable.\n\nRemainder of the liver is unremarkable. Portal vein, SMV, splenic vein\npatent. Hepatic veins patent.\n\nBiliary: Biliary tree is unremarkable. Gallbladder unremarkable.\n\nPancreas: Pancreatic parenchyma is unremarkable. No main ductal dilation.\n\nSpleen: No splenomegaly or focal splenic lesion.\n\nAdrenal Glands: Adrenal glands are normal bilaterally.\n\nKidneys: Normal symmetric morphology and signal intensity. No hydronephrosis.\n\nGastrointestinal Tract: The stomach and duodenum are unremarkable. The\nimaged loops of large and small bowel are unremarkable. No visible ascites.\n\nLymph Nodes: No adenopathy.\n\nVasculature: Aorta, IVC unremarkable. Major aortic branches are patent\nproximally.\n\nOsseous and Soft Tissue Structures: Marrow signal is unremarkable. Soft\ntissues of the body wall are unremarkable.", "output": "2.2 cm segment VI/VII enhancing mass, with MRI features suggestive of hepatic\nadenoma. Atypical FNH could also be considered.\n\nRECOMMENDATION(S):\n1. Consider initial follow-up MRI in 3 months to assess for interval change in\nsize, using Eovist intravenous contrast to help differentiate between adneoma\nand FNH.\n2. Consider consultation with hepatology if the patient is currently\nprescribed OCP's." }, { "input": "Lower Thorax: The partially imaged lung bases are unremarkable.\n\nLiver: There is an unchanged 2.2 x 1.7 cm lobulated, T2 hyperintense,\narterially enhancing lesion in segment VII. The lesion does not retain a\nsignificant amount of Eovist contrast on delayed imaging. There is no\nsignificant intralesional fat.\n\nBiliary: There is concentrated bile or sludge in the gallbladder. The\ngallbladder is otherwise normal. There is no intrahepatic or extrahepatic\nbiliary ductal dilation.\n\nPancreas: The pancreas is normal in signal intensity and enhancement. No\nfocal lesions.\n\nSpleen: The spleen is normal in size, signal intensity, and enhancement. No\nfocal lesions.\n\nAdrenal Glands: The adrenal glands are normal in size and shape. No nodules.\n\nKidneys: The kidneys are normal and symmetric in size, shape, and nephrogram. \nNo concerning lesions. No hydronephrosis.\n\nGastrointestinal Tract: The stomach and partially imaged loops of large and\nsmall bowel are unremarkable.\n\nPelvis: A partially imaged left adnexal cyst measures up to at least 2.1 cm,\nprobably physiologic given patient age.\n\nLymph Nodes: No retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions. The\nabdominal wall is unremarkable.", "output": "Findings consistent with a stable 2.2 cm hepatic adenoma." }, { "input": "The pancreatic parenchyma demonstrates normal bulk, intrinsic hyperintense\nsignal on enhancement pattern within the body, neck, head and uncinate\nprocess. There is a cystic mass noted within the pancreatic tail, paralleling\nthe imaging characteristics of the numerous hepatic lesions. This has\napproximate ___ of 3.9 x 3.4 x 3.6 cm (08:19). The mass is centrally T2\nhyperintense, T1 hypointense and nonenhancing. There is a peripheral rind of\nintermediate T1 and T2 signal, with low grade enhancement. There is abutment\nof the mass against the posterior aspect of the stomach, without obvious\ninvasion. The appearance is compatible with either cystic neuroendocrine tumor\nor necrotic adenocarcinoma.\n\nThe splenic artery courses along the superior aspect of the tumor, without\nencasement or contour abnormality. The splenic vein is occluded with\ncollateral vessels denoting chronicity.\nNo discrete omental or peritoneal nodularity is identified.\n\nThe liver is normal in size with relatively normal contour. There are\ninnumerable masses seen throughout the liver parenchyma, within each hepatic\nsegment. Each is T2 hyperintense, T1 hypointense, restricted in diffusion and\nhypoenhancing. There is a rind of surrounding parenchymal hyperenhancement\nwhich may represent peripheral non-necrotic tumor versus compressed liver\nparenchyma. The largest conglomerate of metastases is seen within the medial\naspect of segment VII, with approximate total ___ of 5.9 x 6.2 x 7 cm\n(1503:30). Additional individual metastatic foci range in size from several\nmillimeters to 4 cm. Mild of focal segmental bile duct dilation is noted\nwithin segment 6, with apparent obstruction on the basis of a central segment\nV mass (07:19).\n\nThe main portal vein, right and left portal venous branches remain in patent,\nalthough the posterior right branch is somewhat attenuated. No variant\narterial anatomy is noted. Hepatic veins are widely patent. The abdominal\naorta, celiac trunk, SMA, and renal arteries are patent and normal in caliber.\n\nThe spleen and adrenal glands are unremarkable. There bilateral simple renal\ncysts.\n\nThere is multifocal lymphadenopathy, involving porta hepatis, gastrohepatic\nligament, and retroperitoneal nodes. Several of the larger nodes demonstrate\ncentral necrosis (13 mm aortocaval node on 1503:54, 13 mm retrocaval node on\n1503:73, and 11mm left periaortic node on 1503:125).\n\nThere are no osseous lesions concerning for malignancy or infection.", "output": "1. 3.9 cm mass within the pancreatic tail with MR features compatible with\neither necrotic pancreatic adenocarcinoma or cystic neuroendocrine tumor. The\nmass abuts the posterior aspect of the stomach, without obvious invasion.\n2. Extensive necrotic hepatic metastases. Pathology from targeted liver biopsy\nis pending at the time of this report.\n3. Multifocal lymphadenopathy, some with central necrosis.\n4. Chronic splenic vein occlusion with multiple collateral veins." }, { "input": "Lower thorax: Limited assessment of the bilateral lung bases appear\nunremarkable. There is no pleural effusion. No pericardial effusion.\n\nLiver: The liver is smooth in contour. There is no significant loss of signal\non out of phase imaging to suggest hepatic steatosis. A 0.8 cm arterially\nenhancing focus in the hepatic dome without correlate on T2 or delayed imaging\nlikely represents a transient hepatic intensity difference (1201; 16). There\nare no suspicious focal lesions.\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilatation. There\nis gallbladder fundal adenomyomatosis (4; 41).\n\nPancreas: The pancreas is normal in signal intensity without main pancreatic\nductal dilatation or focal lesion.\n\nSpleen: The spleen is normal in signal intensity and size without focal\nlesion. There is trace perisplenic ascites.\n\nAdrenal Glands: The adrenal glands appear unremarkable bilaterally.\n\nKidneys: The left kidney is atrophic in size, likely sequelae of prior\nobstructive uropathy. There is interval removal of left ureteral stent and\nresolution of left hydronephrosis. There is no right hydronephrosis. There\nis no focal lesion.\n\nGastrointestinal Tract: Susceptibility artifact around the gastroesophageal\njunction and proximal stomach suggest changes from prior fundoplication. The\nvisualized small and large bowel appear normal in caliber without evidence of\nobstruction. Scattered diverticulosis are noted in the sigmoid colon.\n\nPelvis: The bladder is unremarkable. Patient is status post hysterectomy\nbilateral salpingo oophorectomy.\n\nThere is continued decrease in size of the left pelvic sidewall mass measuring\n1.4 x 2.0 cm, previously measuring 2.2 x 2.4 cm with a smaller central\nnonenhancing component consistent with necrosis. This lesion enhances\nperipherally. There is redemonstration of close proximity of the left L4\nnerve adjacent to this mass (5; 60) and encasement of the L5 nerve root (5;\n59) within the in mass. There is also redemonstration of the involvement of\nthe left distal ureter (13; 81). There is interval resolution of previously\nseen left hydroureter.\n\nThere is no free fluid in the pelvis.\n\nLymph Nodes: There is no mesenteric, retroperitoneal, or inguinal\nlymphadenopathy. The left pelvic sidewall masses as described above.\n\nVasculature: Visualized pelvic vasculature appear patent. The left common\niliac vein appears attenuated but again appears patent.\n\nOsseous and Soft Tissue Structures: Susceptibility artifact and postsurgical\nchanges are noted in the anterior abdominal wall. No suspicious osseous\nlesion is identified.", "output": "1. Status post hysterectomy and bilateral salpingo oophorectomy.\n2. Continued slight interval decrease in size of the 2.0 cm left pelvic\nsidewall mass. There is redemonstration of encasement of the left distal\nureter and the L5 nerve root and abutment of the left L4 nerve.\n3. No evidence of new metastatic disease." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates normal morphology and signal intensity. There\nis no drop in signal on out of phase imaging compared with in phase imaging to\nsuggest steatosis. There are 2 new lesions in the right hepatic lobe with\ncentral T2 hyperintensity and a rim intermediate T2 signal hyperintensity with\nassociated restricted diffusion and rim enhancement in the liver, both\nmeasuring up to 18 mm, consistent with metastatic disease (1701:75, 97). \nThere are multiple subcentimeter foci of mild T2 hyperintensity with\nrestricted diffusion in the liver which are new compared with prior, without\ndefinite correlate postcontrast sequences, however also compatible with\nmetastatic disease (13, 21, 28, 31).\n\nBiliary: There is no intra or extrahepatic biliary dilatation. There is focal\nfundal adenomyomatosis. No cholelithiasis or evidence of acute cholecystitis.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is not enlarged. There is a small accessory spleen in the\nleft upper quadrant.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The left kidney is slightly asymmetrically atrophic compared with the\nright, unchanged. No focal concerning renal lesions. No hydronephrosis.\n\nBowel: The stomach is unremarkable. The small and large bowel are\nunremarkable. There is no wall thickening, adjacent inflammatory change, or\nabnormal enhancement. There is no evidence of stricture or obstruction.\n\nPelvis: Status post hysterectomy and bilateral salpingo-oophorectomy. \nCompared with ___, there is increased size of a left pelvic\nsidewall necrotic mass, currently measuring 3.2 x 2.6 cm compared with 2.0 x\n1.4 cm previously (18:71). There are multiple adjacent new necrotic lymph\nnodes, the largest measuring up to 1.4 cm (18:18). There is hyperenhancement\nof the distal left ureteral wall in the area of a left ureteral stent (18:98).\nNo free fluid in the pelvis.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. The left common\niliac vein is attenuated in the region of the left pelvic lymphadenopathy,\nremains patent.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy. There\nis no pelvic or inguinal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion.", "output": "1. New hepatic metastatic disease, the largest two lesions in the right\nhepatic lobe measuring up to 1.8 cm.\n2. Interval increase in extent of left pelvic sidewall narcotic\nlymphadenopathy." }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: The liver is homogeneous in signal characteristics. There is no\nchemical shift on the in or out of phase sequences to suggest the presence of\nhepatic steatosis or iron deposition. The liver contours are smooth. Multiple\nsubcentimeter liver lesions are seen which are hypointense to liver parenchyma\nat precontrast T1WI and which are markedly hypoenhancing. The two largest\nlesions are seen at the junction of segments 7 and 8, measuring 7 mm lesions,\nand are noted to be additionally mildly hyperintense on the T2WI images in\naddition to the aforementioned features (3:13,14). These lesions are\nsuspicious for metastatic disease. Scattered additional smaller lesions are\nseen in the right and left lobes, also potentially suspicious for small\nmetastases. In segment 6, there is a 7 x 8 mm peripherally and progressively\nenhancing focus which is more markedly hyperintense on the T2 weighted images.\nThere is no restricted diffusion. This finding could represent a hemangioma.\n\nBiliary: There is marked intra and extrahepatic duct dilation with abrupt\ncutoff at an ampullary mass. The intrahepatic ducts measure up to 8 mm. The\ncommon bile duct is markedly dilated measuring up to 17 mm. The gallbladder\nis patulous. The cystic duct is prominent. In the region of the ampulla,\nthere is a 36 x 41 x 33 mm mass which is mildly hyperintense on the T2\nweighted images, hypointense on the T1 weighted images and demonstrates\nrestricted diffusion.\n\nPancreas: The pancreatic duct is markedly dilated measuring up to 20 mm. \nThere are multiple dilated side branches. The pancreatic parenchyma is\ndiffusely atrophic although otherwise maintains normal intrinsic hyperintense\nT1 signal and enhancement pattern.\n\nSpleen: The spleen is normal in size and signal characteristics. There are no\nfocal lesions. An incidental note is made of a small accessory spleen.\n\nAdrenal Glands: In the lateral limb of the left adrenal gland, there is a 14\nmm lesion which demonstrates signal loss on the out of phase sequence as\nopposed to the in phase sequence consistent with an adrenal adenoma. The\nright adrenal gland is unremarkable.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid or cystic lesions. \nNo hydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: There is a replaced right hepatic artery arising from the\nsuperior mesenteric artery. The visualized abdominal aorta and proximal\nmesenteric vessels appear patent without any significant areas of narrowing or\ndilatation.\n\nOsseous and Soft Tissue Structures: The bone marrow demonstrates normal signal\ncharacteristics. No concerning osseous lesions.\n\nMultiple fat containing lesions are noted in the anterior abdominal wall\nsubcutaneous tissues (18:32, 39, 64, 73). These findings are most in keeping\nwith small lipomas.", "output": "1. 4.1 cm mass in the region of the ampulla concerning for malignancy\nresulting in marked intra- and extra-hepatic biliary duct is well as\npancreatic duct dilation.\n2. Multiple hypoenhancing liver lesions are suspicious for metastases, the\nlargest located at the junction of segments 7 and 8, with additional smaller\nfoci throughout the right and left hepatic lobes. A lesion in segment 6 could\nrepresent a hemangioma.\n3. Left adrenal adenoma.\n\nRECOMMENDATION(S): If clinically indicated, a follow-up ultrasound could be\nperformed to determine if these lesions could be amenable to ultrasound guided\nbiopsy.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 23:28 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: No consolidation or pleural effusion is identified.\n\nLiver: No suspicious lesion is identified.\n\nBiliary:\nCommon bile duct stent appears to have migrated inferiorly compared to ___.\nTwo extrahepatic biliary strictures are identified: One at the level of the\nsuperior margin of the stent possibly due to kinking of the bile duct by the\nmigrated and malpositioned stent (3:17, 9:23). Comparison to the ___ MRCP\nis slightly limited as that exam was motion degraded.\n\nSecond proximal stricture is identified at the level of the common hepatic\nduct although the degree of mild intrahepatic biliary dilation is unchanged\nfrom ___ (03:15, 09:20). Previously, the stent was across this site of\nstenosis.\n\nFilling defects within the common bile duct and within the stent are likely\ndebris.\n\nPancreas: Pancreas demonstrates homogeneous enhancement throughout. \nPancreatic duct is normal caliber.\n\nSpleen: Enlarged spleen measures 16.4 cm.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral nephrograms are symmetric. There is no hydronephrosis.\n\nGastrointestinal Tract: Stomach is unremarkable. Imaged portion of small and\nlarge bowel loops are normal caliber.\n\nLymph Nodes: There is no lymphadenopathy.\n\nVasculature: Evaluation of the hepatic artery is are limited due to motion\nartifact, within this limitation the arteries appear patent. There appears to\nbe a replaced left hepatic artery, however the origin is difficult to\ndetermine.\n\nThere is severe narrowing of the inferior aspect of main portal vein\n(1202:74), similar to ___ within the limits of comparing to\nseverely motion degraded prior exam. No thrombosis is identified.\nLarge esophageal varices are noted.\nOsseous and Soft Tissue Structures: No suspicious bone or subcutaneous lesion\nis identified.", "output": "1. Common bile duct stent has inferiorly displaced compared to ___. There is kinking and stenosis of the mid common bile duct at the\nsuperior margin of the positioned stent. A separate more proximal lead\nlocated stenosis is identified at the level of common hepatic duct. On ___, the stent was across the site of stenosis. Filling defects in\nthe common bile duct and stent are likely debris.\n2. Focal severe narrowing of the inferior aspect of the main portal vein is\nsimilar to ___ within the limits of comparing to severely motion\ndegraded prior exam. No thrombosis is identified.\n3. Evaluation of hepatic arteries is limited due to motion artifact. The\nhepatic arteries appear patent, however stricture is difficult to exclude." }, { "input": "Lower Thorax: In the lower thorax multiple prominent paraesophageal varices\nare seen. There is no pleural effusion.\n\nLiver: The patient is post prior liver transplant. There are 3 new\nintrahepatic lesions noted, 2 adjoining lesions are seen in hepatic segment 7\nmeasuring 7 and 18 mm, and a 12 mm lesion is seen in segment 8. They are\nhypointense on T1, demonstrate annular enhancement and are mainly hyperintense\nbut heterogeneous on T2. No definite restriction of diffusion is noted. \nThere is associated geographic hyperemia in hepatic segment 7 and peripherally\nin hepatic segment 8\n\nBiliary: There is no intrahepatic or extrahepatic biliary dilation. The\ncommon bile duct stent is re-demonstrated. The patient is status post\ncholecystectomy.\n\nPancreas: The pancreas is grossly unremarkable. The main pancreatic duct is\nnondilated.\n\nSpleen: The spleen is enlarged measuring 16 cm in craniocaudal dimension.\n\nAdrenal Glands: The adrenal glands are unremarkable.\n\nKidneys: Both kidneys are atrophic, and contain punctate subcentimeter cysts.\n\nGastrointestinal Tract: The visualized small and large bowels are\nunremarkable.\n\nLymph Nodes: There is no retroperitoneal or mesenteric lymphadenopathy.\n\nVasculature: Aorta is nondilated. The hepatic veins are patent. The main\nportal vein demonstrates focal severe narrowing at its inferior aspect,\nsimilar to prior study.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. Several\nlateral thoracic meningoceles are incidentally noted. Soft tissues are\ngrossly unremarkable.", "output": "1. Nonspecific liver lesions in hepatic segments 7 and 8 demonstrating slight\nheterogeneous hyperintense signal on T2, hypointensity on T1, and rim\nenhancement. Even though there is a lack of definite restricted diffusion,\nthese lesions are suspicious for developing infection/abscess.\n2. Stable aspect of the focal narrowing of the inferior aspect of the main\nportal vein." }, { "input": "Lower Thorax: Within the limits of evaluation by MRI, bilateral lung bases\ngrossly clear. There is no pleural or pericardial effusion.\n\nLiver: Patient is post liver transplant. There is no hepatic steatosis. \nPreviously seen collections in segment 7 of the liver are no longer\nvisualized, however there is a residual wedge-shaped area arterial enhancement\nin segment 7 (1201:36) without significant restricted diffusion. The\npreviously seen collection in segment 8 of the liver is no longer visualized,\nhowever there is residual peripheral wedge-shaped area of enhancement without\nsignificant restricted diffusion (1201:54). A large peripheral wedge-shaped\narea of hyperenhancement in segment ___ demonstrates restricted diffusion\n(1201:74, 6:33), similar in appearance compared to the prior study.\n\nBiliary: There is mild expected pneumobilia in the setting of a biliary stent.\nThe gallbladder is surgically absent.\n\nPancreas: The pancreas is normal in signal intensity without evidence of\nductal dilation. No focal pancreatic lesions are seen.\n\nSpleen: The spleen is enlarged measuring 16.8 cm.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral kidneys demonstrate normal signal intensity. No suspicious\nrenal lesions are noted. No hydronephrosis. There is no perinephric\nabnormality.\n\nGI: The stomach and intra-abdominal loops of small and large bowel are within\nnormal limits.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: Multiple prior esophageal, gastric, and splenic varices are\nnoted. The abdominal aorta is normal in caliber without evidence of aneurysm\nor dilation. The major visualized branches of the aorta are patent.\n\nOsseous and Soft Tissue Structures: No bone marrow signal abnormalities\ndetected. No suspicious osseous or soft tissue lesions detected.", "output": "1. No residual drainable collections in the right hepatic lobe, however\nwedge-shaped areas of enhancement are compatible with resolving infection.\n2. Moderate splenomegaly." }, { "input": "The study is significantly limited due to motion artifact. Within this\nlimitation:\n\nLower thorax: The lung bases are grossly clear.\n\nLiver: The liver demonstrates cirrhotic morphology without significant signal\ndrop on out of phase imaging to suggest hepatic steatosis. There is\nredemonstration of a post TACE cavity measuring 2.2 cm in hepatic segment VIII\n(11:29), as well as a post ablation cavity in hepatic segment VII (11:55),\nmeasuring 3.3 cm, grossly unchanged compared to priors. In the inferior\nborder of the cavity in hepatic segment VII there is a small nodular area\nenhancement, less conspicuous compared to previous study. No lesions meeting\nOPTN 5 criteria for HCC are evidenced.\n\nAgain seen are scattered T2 hyperintense, nonenhancing foci, likely\nrepresenting simple cysts or biliary hamartomas.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder contains large stones without evidence of cholecystitis.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber. A 5 mm\ncystic lesion is again seen near the tail of the pancreas (4:28), overall\nunchanged compared to prior.\n\nSpleen: The spleen is enlarged, measuring 14 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel: Partially imaged loops of small and large bowel are unremarkable.\nThere is no wall thickening, adjacent inflammatory change, or abnormal\nenhancement. There is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. There is interval decrease in size in a bland thrombus seen in the\nmain portal vein extending to the confluence with the SMV, nonocclusive with a\nwider lumen compared to prior images. There are multiple paraesophageal\nvarices.\n\nLymph nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid. Large umbilical hernia containing fat and a\nvarix.", "output": "1. Interval decrease in size of bland thrombus in the main portal vein\nextending to the confluence with the SMV, nonocclusive and now with wider\nlumen.\n2. Within the limitations a motion degraded study, there are no new lesions\nmeeting OPTN 5 criteria for HCC. Given the significant motion degrading the\nquality of the most recent studies, for follow-up multiphasic CT of the liver\nis recommended rather than MRI.\n3. Cirrhotic liver with evidence of portal hypertension manifested as\nparaesophageal varices and splenomegaly.\n4. Stable posttreatment changes after embolization ablation of HCC lesions in\nsegments VII and VIII." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: There is mild cirrhotic morphology of the liver. Within the\nsubdiaphragmatic a lateral portions of segment VIII, there is a 2.7 x 2.6 cm\nT2 and T1 hypointense a demonstrates a heterogeneous arterial hyperenhancement\nwith subsequent washout and pseudo capsule on delayed phases (29:26, 30:20). \nThis lesion arises a or a dysplastic nodule seen on the prior study. Of note,\nthe post-contrast phases are relatively early and the phase labeled venous is\nin fact a late arterial phase. No other suspicious lesion is identified. \nSeveral non-enhancing T2 hyperintense foci are consistent with simple cysts or\nbiliary hamartomas.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder contains a large stone is otherwise unremarkable.\n\nPancreas: Pancreas is normal in signal intensity and morphology of the\ndilatation. There is a 6 mm cystic lesion in the pancreatic tail,\nstatistically side-branch IPMN (18:29). There may be an additional\nmillimetric cystic lesion in the pancreatic body (17:30).\n\nSpleen: Spleen is mildly enlarged measuring up to 15.5 cm (17:16).\n\nAdrenal Glands: Unremarkable.\n\nKidneys: No suspicious renal lesion or hydronephrosis.\n\nGastrointestinal Tract: Colonic diverticulosis is noted. The visualized\nloops of large and small bowel are otherwise unremarkable.\n\nPelvis: There is no free fluid. The prostate and seminal vesicles are\nunremarkable. The bladder and distal ureters are unremarkable.\n\nLymph Nodes: Mildly prominent porta hepatis lymph nodes are likely related to\nchronic liver disease (25:16, 17).\n\nVasculature: Appears to be chronic occlusion of the splenic vein with\ncollateralization. There are large paraesophageal varices. Arterial anatomy\nis conventional.\n\nOsseous and Soft Tissue Structures: There is a moderate-sized ventral\nabdominal wall hernia containing fat, mesenteric vessels, and a small amount\nof simple fluid the arising on a 1.9 cm ventral abdominal wall defect (5:7).", "output": "1. 2.7 cm OPTN 5B hepatocellular carcinoma in segment VIII.\n2. Cirrhotic liver with evidence of portal hypertension including splenomegaly\nand ascites." }, { "input": "Exam is limited by difficulty with breath holding.\n\nLower thorax: The lung bases are grossly clear.\n\nLiver: The liver is cirrhotic morphology. There is no drop in signal on out\nof phase imaging compared with in phase imaging to suggest hepatic steatosis. \nThere is a sub centered hepatic cyst or biliary hamartoma. In segment VIII at\nthe hepatic dome, there is a 3.1 x 3.0 cm arterially enhancing lesion which\ndemonstrates washout and pseudo capsule, previously measuring 2.7 x 2.6 cm\n(1104:20). There is an additional 2.8 x 2.2 cm arterially enhancing lesion\ndemonstrating washout and pseudo capsule in segment VII just posterior to the\nintrahepatic IVC (1101:54; 1103:50). This lesion was likely present on prior\nMRI, however was obscured by artifact in this region.\n\nBiliary: There is no intra or extrahepatic biliary dilatation. The\ngallbladder contains a large stone.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. There is a 5 mm T2 hyperintense lesion in the\npancreatic tail, stable. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is enlarged to 16 cm, stable. No focal splenic lesions.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: The kidneys enhance and excrete symmetrically without suspicious\nlesions or hydronephrosis.\n\nBowel: Partially imaged loops of small bowel are unremarkable. There are\nscattered colonic diverticula with no evidence of acute diverticulitis. There\nis no wall thickening, adjacent inflammatory change, or abnormal enhancement. \nThere is no evidence of stricture or obstruction.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. Hepatic arterial anatomy is conventional. The portal vein, splenic\nvein and SMV are patent. There are paraesophageal varices.\n\nLymph nodes: A 11 mm porta hepatis lymph node is stable and likely related to\nchronic liver disease. There is no mesenteric or retroperitoneal\nlymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. There is a large umbilical hernia containing fat and\nmesenteric vessels. No free fluid.", "output": "1. 3.1 cm lesion in segment VIII appears slightly increased in size from\nprior, previously measuring up to 2.7 cm, and again meeting OPTN 5B criteria\nfor hepatocellular carcinoma.\n2. Additional 2.8 lesion in segment VII was likely present on prior study,\nhowever was obscured by artifact, also meeting OPTN 5B criteria for\nhepatocellular carcinoma.\n3. Cirrhosis with splenomegaly and paraesophageal varices. No ascites.\n4. Conventional hepatic arterial anatomy.\n5. Stable 5 mm likely side-branch IPMN.\n6. Cholelithiasis.\n7. Liver volumes have been requested, and an addendum will be added when\navailable." }, { "input": "Lower Thorax: Visualized lung bases shows minimal dependent atelectasis. The\ncardiomediastinal structures are normal.\n\nLiver: Normal in size. Parenchyma is normal in signal and enhancement. No\nsolid mass. No evidence of hepatic steatosis on the dual-echo GRE images.\n\nBiliary: Intrahepatic and extrahepatic bile ducts are not dilated. Gallbladder\nis normal. There is a gallstone.\n\nPancreas: Normal in size. Parenchyma is normal in signal and enhancement. Main\npancreatic duct is not dilated. There is a 6 mm solid lesion within the distal\nmost aspect of the pancreatic tail shows signal identical to the spleen on T1\nweighted, T2 weighted, and contrast-enhanced images and likely shows\nrestricted diffusion but is not well seen on the DWI. This represents\nintrapancreatic splenic tissue. There is 1 punctate cystic lesion within the\npancreatic head and at least 1 additional punctate cystic lesions in the\npancreatic body. No concerning feature. These are most consistent with\nside-branch IPMN.\n\nSpleen: Normal in size, signal, and enhancement.\n\nAdrenal Glands: Normal in size, signal, and enhancement. No nodularity.\n\nKidneys: No hydronephrosis. Normal in size, signal, and enhancement. No solid\nmass.\n\nGastrointestinal Tract: No evidence of obstruction. No mass. Normal\nenhancement.\n\nLymph Nodes: No enlarged mesenteric or retroperitoneal lymph node.\n\nVasculature: Aorta is of normal caliber. Normal branching pattern of the\nceliac axis. Origin of the superior mesenteric artery and inferior mesenteric\nartery are patent. Portal veins and hepatic veins are patent.\n\nOsseous and Soft Tissue Structures: No mass. Normal bone marrow signal.", "output": "1. Within the pancreatic tail there is a 6 mm focus of soft tissue with\nidentical imaging appearance to the spleen. This likely represents\nintrapancreatic accessory splenic tissue.\n2. There is at least 1 punctate cystic lesion within the pancreatic body and\nan additional cystic lesion within the pancreatic head. These are most\nconsistent with side-branch IPMNs. No follow-up is recommended per department\nguidelines." }, { "input": "Limited evaluation due to patient motion.\n\nLower Thorax: Limited evaluation of the lung bases is notable for right lower\nlobe atelectasis. No pleural effusion. No pericardial effusion.\n\nLiver: Mild signal drop on out of phase imaging is consistent with hepatic\nsteatosis. Fat fraction of 9.4%.\n\nLimited evaluation of the arterial phase due to motion. In comparison to ___ the previously seen lesion within segment 8 is unchanged, measuring 1.7\ncm (previously 1.7 cm) with a slightly lobulated contour and demonstrating\nrestricted diffusion. This lesion is mildly T2 hyperintense and T1 hypointense\non precontrast imaging. On post-contrast imaging the previously characterized\narterial hyper enhancement is not well evaluated due to motion. On subsequent\nsequences there is retention of contrast and on delayed hepatobiliary phase\nthere is mixed enhancement with retention of contrast along the periphery of\nthe lesion which is isointense to hepatic parenchyma, similar to prior\nexamination, however the ___ the lesion is mildly hypointense (06:30;\n23:35). The liver is otherwise homogeneous and signal intensity without new\nlesion. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilatation. Gallbladder\nfundal adenomyomatosis is noted. Gallstones are present. No gallbladder wall\nthickening or dilation.\n\nPancreas: The pancreas is homogeneous and signal intensity without focal\nlesion. No pancreatic duct dilatation. No peripancreatic fat stranding.\n\nSpleen: The spleen is homogeneous in signal intensity without focal lesion.\n\nAdrenal Glands: Bilateral adrenal glands are unremarkable.\n\nKidneys: Bilateral subcentimeter T2 hyperintense cortical renal cysts are\nnoted. The kidneys are otherwise unremarkable. No hydronephrosis. No\nperinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus, stomach, visualized small bowel is\nunremarkable. Ascending and descending colonic diverticulosis is noted\nwithout evidence of acute diverticulitis.\n\nLymph Nodes: No retroperitoneal, mesenteric, or periportal lymph node\nenlargement.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, bilateral renal\narteries, and SMA are patent.\n\nOsseous and Soft Tissue Structures: There is diastasis rectus. Osseous\nstructures and soft tissues are otherwise unremarkable.", "output": "1. Limited evaluation due to patient motion.\n2. Stable 1.7 cm segment 8 focal nodular hyperplasia. No worrisome hepatic\nlesions.\n3. Chronic findings including cholelithiasis, gallbladder adenomyomatosis,\nand diverticulosis" }, { "input": "Lower Thorax: The lung bases are clear. No pleural or pericardial effusion.\n\nLiver: 3.0 x 2.8 cm mildly T2 hyperintense lesion in hepatic segment III\n(04:08), which demonstrates progressive peripheral discontinuous enhancement,\ncompatible with a hemangioma. There is signal loss on in and out of phase\nimaging consistent with hepatic steatosis, fat fraction measuring 10%. Tiny\nright hepatic lobe biliary hamartoma (04:27). No concerning hepatic lesion\nidentified.\n\nBiliary: No intra- or extra-hepatic duct dilatation. The common bile duct is\nwithin normal limits. The gallbladder is unremarkable. No cholelithiasis.\n\nPancreas: Focal ductal dilatation in the uncinate process measuring 5 mm. \n(07:30) The pancreatic parenchyma maintains normal bulk, intrinsic\nhyperintense T1 signal and enhancement pattern. No focal lesion or ductal\nabnormality is seen.\n\nSpleen: Multiple lobulated T2 hyperintense lesions, which show progressive\nenhancement, most compatible with hemangiomas or other benign splenic lesions.\nSmall inferior splenic nonenhancing lesion likely cyst. No concerning lesion\nidentified.\n\nAdrenal Glands: Normal in size and signal characteristics. No focal lesions.\n\nKidneys: The kidneys are normal in size and signal characteristics. The\ncorticomedullary differentiation is well-maintained with normal excretion of\ncontrast on the delayed phase images. There are no solid lesions. No\nhydronephrosis or hydroureter.\n\nGastrointestinal Tract: The GI tract is of normal caliber throughout.\n\nLymph Nodes: No significant mesenteric, retroperitoneal or porta hepatis\nlymphadenopathy by size criteria.\n\nVasculature: Probable replaced right hepatic artery off the SMA although\nvisualization is not optimal. The visualized abdominal aorta and proximal\nmesenteric vessels appear patent without any significant areas of narrowing or\ndilatation.\n\nOsseous and Soft Tissue Structures: Thoracolumbar posterior spinal fusion\nhardware is noted. No concerning osseous lesion.", "output": "1. Left hepatic lobe benign hemangioma. No concerning liver lesions\nidentified.\n2. Multiple splenic lesions, consistent with hemangiomas and a cyst.\n3. Moderate hepatic steatosis.\n4. 5 mm focal ductal dilatation in the pancreatic uncinate process, likely\nrepresenting side-branch IPMN.\n\nRECOMMENDATION(S): ___ year follow-up MRI for likely side-branch IPMN." }, { "input": "Lower Thorax: Lung bases are clear, within limitations of MRI. No pleural or\npericardial effusion\n\nLiver: Liver demonstrates normal contours without morphological signs of liver\ncirrhosis. There is diffuse drop of signal on the out of phase imaging as\ncompared to the in-phase imaging, compatible with diffuse hepatic steatosis. \nThe fat fraction measures 17%. There are multiple T2 hyperintense\nnonenhancing lesions scattered throughout the liver, the largest two located\nwithin segment VIII measuring 1.3 and 0.7 cm respectively (series 8, image 11\nand 17), compatible with cysts/biliary hamartomas. There are no suspicious\nenhancing hepatic mass lesions to suggest metastases.\n\nBiliary: The gallbladder is present containing pneumobilia. No gallbladder\nwall thickening or pericholecystic fluid. There is minimal dilatation of the\nintrahepatic ducts with pneumobilia, stable since prior CT dated ___. Susceptibility artifact is noted within the distal CBD, related to a\nmetallic stent. There is progressive biliary duct wall enhancement of the\ncommon bile duct just proximal to the stent, likely reactive.\n\nPancreas: Revisualization of a hypoenhancing mass lesion at the level of the\npancreatic head with an abrupt cut off of the main pancreatic duct that is\ndilated to approximately 7 mm and atrophy of the pancreatic body and tail, not\nsignificantly changed from prior. There is abutment of the SMV by less than\n180 degrees without contour irregularity or focal vessel narrowing better\nvisualized on CT of the abdomen performed on the same day. There is slight\nfat stranding surrounding the pancreatic head, likely related to resolving\npancreatitis.\n\nSpleen: Spleen is normal in size and signal characteristics. It enhances\nhomogeneously without focal mass lesion.\n\nAdrenal Glands: Adrenal glands are normal bilaterally without focal nodules.\n\nKidneys: Kidneys are symmetric in size bilaterally and demonstrate good\ncorticomedullary differentiation. There are stable simple renal cyst in the\nupper and lower pole of the left kidney measuring up to 5 mm. No suspicious\nrenal masses or hydronephrosis bilaterally. No perinephric abnormality.\n\nGastrointestinal Tract: Small hiatal hernia. The hernia stomach, visualized\nsmall bowel and colon in the upper abdomen are within normal limits. No\nascites.\n\nLymph Nodes: There are few stable subcentimeter porta hepatis lymph nodes\nmeasuring 6 mm in short axis diameter (series 1801, 67 and 65). No suspicious\nretroperitoneal or mesenteric lymphadenopathy by size criteria.\n\nVasculature: Abdominal aorta and its major branches are patent. Hepatic\narterial anatomy is conventional. The splenic vein, SMV, portal vein and\nhepatic veins are patent\n\nOsseous and Soft Tissue Structures: Multiple stable T2 hyperintense osseous\nlesions within the lower thoracic and lumbar spine, most likely intraosseous\nhemangiomas. No suspicious osseous or soft tissue mass lesion.", "output": "1. Hypoenhancing mass lesion at the pancreatic head compatible patient's\nknown pancreatic adenocarcinoma with stranding around the SMV by less than 180\ndegrees however no contour irregularity or focal vessel narrowing, better\nvisualized on CTA of the abdomen performed on the same day.\n\n2. No suspicious enhancing hepatic mass lesions to suggest metastasis.\n\n3. Few stable subcentimeter porta hepatis lymph nodes measuring 6 mm in short\naxis diameter." }, { "input": "A right lower and interpolar renal mass is again seen, hypointense to the\nrenal parenchyma on T2 weighted sequences and relatively isointense to renal\nparenchyma on the T1 weighted sequences, with moderate contrast enhancement\nalong the periphery. The mass extends medially along the right kidney,\nabutting the upper pole. The mass has slightly decreased in size since ___, currently measuring 12.6 x 7.5 x 8.6 cm, previously measuring 13.1 x 7.2 x\n9.1 cm. A previously-seen hematoma long the mid and superior aspect of the\nmass has nearly completely resolved. A round lower-central non-enhancing\nhematoma within the mass remains hyperintense on the T1 weighted precontrast\nimages, decreased in size, currently measuring 4.8 x 3.1 cm (series 10, image\n55), previously 5.5 x 4.8 cm. Collateral vessels surrounding the lesion are\nunchanged.\n\nA wedge shaped nonenhancing focus along the lower pole of the right kidney is\nconsistent with known infarction (series 1203, images 44 to 48 and series\n___, image 45) which has not progressed since ___, likely the sequela\nof prior embolization. The upper pole of the right kidney remains well\nperfused.\n\nWithin the upper pole of the left kidney a 4 mm lesion denoted by an ___\nartifact, consistent with an angiomyolipoma, unchanged since the prior study\n(series 4A, image 31). There is no hydronephrosis.\n\nA heterogeneous enhancing right adrenal mass appears hyperintense on the T2\nweighted sequences and measures 19 x 12 mm (series 6, image 14). previously\nmeasuring 18 x 14 mm, previously characterized as a pheochromocytoma. The\nleft adrenal gland is normal.\n\nAn 8 mm hepatic lesion demonstrates hyperintense signal on T2 weighted images\nand extensive signal drop off on T1-weighted out of phase sequences,\nconsistent with an angiomyolipoma. The hepatic parenchyma is normal in signal\nintensity, without concerning mass. There is no intra extrahepatic biliary\nduct dilation. The gallbladder appears normal. The spleen enhances\nhomogeneously. The pancreas is without pancreatic duct dilation. Arising from\nthe tail of the pancreas is a non-enhancing 7 mm lesion appearing hyperintense\non T2 weighted sequences (series 6, image 22), likely a side-branch\nintraductal papillary mucinous neoplasm.\n\nThe lung bases are clear. The visualized portions of the stomach and small\nand large bowel appear normal. There is no lymphadenopathy. There is no\nascites. The aorta is normal in caliber. The bone marrow signal is normal.", "output": "1. A large right exophytic enhancing lesion (previously characterized as an\nangiomyolipoma) arising from the inferior pole of the right kidney has\ndecreased in size since ___, reflecting response to prior\nembolizations. A low-central hemorrhagic component has decreased in size,\nwith superior blood products having resolved. No new hemorrhage. Unchanged\nchronic infarct of the lower pole of the right kidney.\n\n2. A right adrenal lesion measuring 1.9 cm is stable since ___,\npreviously characterized as a pheochromocytoma.\n\n3. Subcentimeter hepatic and left renal angiomyolipomas are stable." }, { "input": "The left kidney is normal in size and demonstrates normal enhancement. The\ncorticomedullary differentiation is normal. There is a sub 5 mm T2\nhyperintense lesion in the upper pole of the left kidney likely representing a\nsimple cyst. There is a 4 mm lesion in the upper pole of the left kidney\n(series 4, image 13) which demonstrates ___ ink artifact and likely\nrepresents an angiomyolipoma.\n\nThere is an exophytic 6.1 x 6.1 x 11.1 cm mass involving the lower pole of the\nright kidney with the medial portion extending superiorly to the level of the\nupper pole. The distribution of the mass is stable compared to the prior exam\nhowever it measures smaller in size. Previously the mass measured\napproximately 7.6 x 8.4 x 12 cm. There is enhancement around the periphery of\nthe mass. There are enhancing nodules along the lateral aspect of the mass\n(series 1101, image 62) measuring 3.7 x 2.8 x 3.8 cm and along the inferior\nmargin measuring 3.1 x 2.5 x 1.4 cm (series 1101, image 58). Centrally, there\nis mixed T1 and T2 signal without enhancement compatible with hematoma.\n\nThe visualized spleen, gallbladder and bowel loops are normal. There is a 7\nmm nodule in the right hepatic lobe (series 4, image 7) which demonstrates\nsignal loss on out of phase imaging compatible with a small angiomyolipoma,\nunchanged since the prior examination. There is no osseous abnormality. The\nleft adrenal gland is normal. There is a 2.3 x 1.8 cm right adrenal mass\npreviously characterized as a pheochromocytoma. Note is made of a T2\nhyperintense lesion in the tail of the pancreas (see series 5, image 14),\nstable across prior exams, likely a small side-branch IPMN.\n\nThe abdominal aorta is normal in caliber. There is dilation of the celiac\nartery at its origin (series 14, image 51) measuring up to 13 mm with luminal\nnarrowing appearing worse since the ___ examination, but likely\nreflecting arcuate ligament compression during the expiratory phase of\nimaging. The visualized osseous structures are normal.", "output": "1. Large right exophytic renal mass previously characterized as an\nangiomyolipoma, status post embolization, with continued enhancing components.\nCompared to the prior exam, the overall ___ have decreased in size.\n2. Persistent nodular enhancement along the lateral and inferior margin of the\nmass compatible with residual tumor.\n3. Focal narrowing of the proximal celiac artery which appears worse since\nprior examinations, likely due to imaging during expiration. Attention to\nthis area recommended on followup.\n3. 7 mm cystic pancreatic lesion in the pancreatic tail suspicious for an\nIPMN. Recommend continued attention to this lesion on subsequent exams.\n4. 1.9 cm mass in the right adrenal gland stable from prior exams and\npreviously reported as a pheochromocytoma." }, { "input": "The lung bases are clear. There is no pleural effusion.\n\nIn the medial portion of segment 8, there are 2 lesions measuring 10 mm and 3\nmm (5003, 16 and 5003, 17), with mild rim enhancement, and restricted\ndiffusion. More laterally, in segment 5, the previously seen hypodense areas\non recent CT in segment 5 are high in signal on T2 images, without enhancement\nand likely represent small amount of postoperative fluid or retraction related\nchanges. There is no intrahepatic or extrahepatic biliary duct dilatation. \nThe gallbladder is absent. The spleen is normal. The adrenal glands are\nnormal. There are multiple T2 hyperintense nonenhancing lesions in the\nkidneys bilaterally consistent cysts. There is hemorrhagic material layering\nin an interpolar right renal cyst which measures 2.7 cm. The largest cyst on\nthe left measures 6.1 cm and the largest on the right measures 6.5 cm.\n\nProminent mesenteric lymph nodes are again seen consistent with mesenteric\npanniculitis. Enlarged portahepatic lymph nodes are again seen, the largest\nmeasuring 1.1 cm (12, 28). Tiny cysts are seen in the remaining pancreatic\nbody and tail measuring up to 6 mm (3, 23 and 27). The patient is status post\nWhipple procedure. The visualized small and large bowel are unremarkable.\n\nThe intra-abdominal vasculature is patent.\n\nA hemangioma is seen in the T11 vertebral body. No suspicious osseous\nlesions.", "output": "Lesions in the medial portion of segment 8 measuring 10 and 3 mm are highly\nsuspicious for metastatic lesions. Given the lack of surrounding edema or\ncholangitis, abscesses are considered very unlikely.\n\nEnlarged portahepatic lymph nodes.\n\nProminent mesenteric lymph nodes consistent with mesenteric panniculitis.\n\nPancreatic cysts in the remaining pancreatic body and tail measuring up to 6\nmm." }, { "input": "The bases of the lungs are clear. The visualized heart and pericardium are\nunremarkable.\n\nRe- demonstration of a markedly nodular liver contour in keeping with\npatient's known history of cirrhosis. Diffuse reticular contrast enhancement\nis most suggestive of confluent fibrosis, unchanged when compared to prior\nexamination. Prior ill-defined arterial hyperenhancement along the periphery\nof segment ___ is no longer visualized. There is a subcentimeter region of\nenhancement within segment VI (12:61) which demonstrates no correlate on\ndelayed images, diffusion weighted sequences, or noncontrast images. No\nevidence of washout or pseudocapsule. The portal and hepatic veins are\npatent. There is re-demonstration of perisplenic and periesophageal varices\nas well as a recanalized paraumbilical vein suggestive of chronic portal\nhypertension. The spleen is stably enlarged.\n\nAgain identified are several subcentimeter cortical renal cysts bilaterally as\ndemonstrated by a high internal signal intensity on T2 and low signal\nintensity on T1 weighted images. The largest within the lower pole of the\nleft kidney is stable in size and appearance with a thin nonenhancing septa\nnoted.\n\nThe gallbladder, pancreas, and bilateral adrenal glands are unremarkable. \nVisualized loops of small large bowel are normal. There is no mesenteric or\nretroperitoneal adenopathy. No appreciable free fluid is seen. Note is made\nof a small likely mixed hiatal hernia.\n\nThe abdominal aorta is normal in caliber without aneurysmal dilatation. The\nceliac trunk, superior mesenteric artery and renal arteries bilaterally are\npatent.\n\nNo suspicious osseous lesion is identified.", "output": "1. Nodular liver in keeping with patient's history of cirrhosis.\nSubcentimeter region of enhancement without correlates on delayed, diffusion\nweighted or noncontrast images thought to be perfusional in origin. Continued\nsurveillance is recommended.\n2. Stable minimally complex left lower pole renal cyst.\n3. Mild splenomegaly, perisplenic and periesophageal varices as well as a\nrecanalized paraumbilical vein reflect the sequelae of chronic portal\nhypertension.\n4. Small mixed type hiatal hernia." }, { "input": "The bases of the lungs are grossly clear. There is no pleural or pericardial\neffusion. A moderate hiatal hernia is noted (9:9).\n\nThe liver is nodular in appearance, compatible with known cirrhosis. There is\nno intra or extrahepatic biliary ductal dilation. The gallbladder is\nunremarkable. The portal veins appear patent. Note is made of recanalization\nof the umbilical vein (1404:52).\n\nAn enlarging nodule in hepatic segment VI measures 0.8 x 1.1 cm (1401:94),\npreviously approximately 6 mm in maximal dimension. There is early arterial\nenhancement, with washout on portal venous phase images (1402:95), enhancing\npseudocapsule, and restricted diffusion (10:16). No intrinsic T2 signal\nabnormality is identified in this region. A 7 mm intrinsically T1 hyperintense\nnodule is noted in hepatic segment V, with a tiny focus of enhancement on the\nearly arterial phase images (1401:59), but no evidence of washout or diffusion\nabnormality, possibly a regenerative nodule. An 8 mm focus of enhancement in\nhepatic segment III (1401:67) likewise demonstrates no washout of contrast,\ndiffusion restriction, or intrinsic T2 signal abnormality.\n\nOPTN CRITERIA\nMaximum lesion diameter (late arterial or portal venous phase): 1.1cm\nLocation: Segment VI\nArterial enhancement: yes\nWashout:yes\nLate capsule or pseudocapsule enhancement on delayed phase: yes\nGrowth (maximal diameter increase >50% in <=6 months): yes\nClassification: Class 5A: size 1-2cm, arterially enhancing, growth.\n\nThe bilateral adrenal glands and pancreas are unremarkable. The spleen is\nmildly enlarged, measuring up to 15.1 cm in maximal dimension (08:19),\npreviously 13.9 cm. Numerous left upper quadrant varices are again noted, also\nrelated to underlying cirrhosis. Several subcentimeter cortical renal cysts\nare again noted bilaterally, with unchanged appearance of a septated cyst in\nthe lower pole of the left kidney (07:21).\n\nVisualized loops of small and large bowel are unremarkable. There is no\nmesenteric or retroperitoneal lymphadenopathy. The intra-abdominal aorta is of\nnormal caliber throughout its course, with widely patent celiac axis, superior\nmesenteric and bilateral single renal arteries. The anatomic configuration of\nthe hepatic arterial supply is conventional.", "output": "1. Enlarging hepatic segment VI nodule with imaging features compatible with\nHCC, representing an OPTN Class 5A lesion.\n2. Subcentimeter enhancing nodule in hepatic segment III, which does not meet\nOPTN criteria based on size, but remains suspicious for malignancy. Attention\non follow-up imaging is recommended.\n3. Subcentimeter enhancing segment V nodule is intrinsically T1 hyperintense,\nlikely a regenerative nodule.\n4. Sequelae of hepatic cirrhosis includes recanalized umbilical vein,\nextensive perisplenic ascites, and splenomegaly.\n5. Stable renal cysts.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 11:32 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "The lung bases are clear. There is no pleural or pericardial effusion. Small\nhiatal hernia is present.\n\nThe liver is cirrhotic in morphology, with nodular border and progressive\nreticular enhancement. There is mild drop of signal on gradient echo T1 out\nof phase images compared to inphase images, consistent with borderline\nsteatosis. In segments III a 9 mm lesion with arterial hyper enhancement is\npresent (14:66), without definite washout, not definitely seen on DWI (06:48).\nPreviously described lesion in segment V/VI, that met OPTN criteria on MRI\nfrom ___, is less exophytic and smaller in size, measuring 6 mm on the\narterial phase (14:80), with subtle washout, without pseudocapsule and without\ncorrelation on DWI or T2 WI. Additional tiny focus of arterial hyper\nenhancement in segment IV (14:32) does not have correlates on other sequences.\nConventional hepatic anatomy is present. The portal and hepatic veins are\npatent. Recannulized periumbilical vein is present. Spontaneous splenorenal\nshunt is present.\n\nThe gallbladder is normal. The intra and extrahepatic biliary ducts are\nnormal in caliber.\n\nThe spleen is enlarged to 14 cm.\n\nThe pancreas is normal in size and signal, without focal masses or ductal\ndilatation.\n\nThe kidneys and adrenals are normal.\n\nThere is no free fluid in the abdomen.\n\nThere is no concerning retroperitoneal or mesenteric lymphadenopathy. \nProminent portocaval lymph nodes are reactive to underlying liver disease.\n\nThe bone marrow signal is normal.", "output": "1. Regression of segment V/VI lesion, that met OPTN criteria on MRI from\n___. Now the lesion is smaller than 1 cm and seen only on the arterial\nphase without definite washout.\n2. 9 mm arterial hyperenhancing lesion without washout or capsule in segment\nIII remains suspicious for HCC, not meeting OPTN criteria.\n3. Cirrhosis with portal hypertension." }, { "input": "LOWER THORAX: Moderate hiatal hernia. 6 mm right lung base pleural-based\nnodule, better assessed on same day CT thorax. No pleural effusions.\n\nLIVER: Nodular slightly shrunken liver with heterogeneous parenchyma\nconsistent with known cirrhosis.\n\nHepatic parenchymal signal loss on out of phase images compared to in phase\nimages consistent with moderate steatosis.\n\nThe lesion previously seen in segment III is re- demonstrated and is\nisointense to hepatic parenchyma on precontrast T1 and T2 weighted images, and\nagain shows arterial phase hyper enhancement, without definitive washout or\npseudocapsule, delayed than not clearly visualized on diffusion-weighted\nimages. This is unchanged in size at 7 x 9 mm (previously 7 x 9 mm), (series\n10, image 69).\n\nThe second lesion which was previously seen in hepatic segment ___ remains\nisointense to hepatic parenchyma on precontrast T1 and T2 weighted images,\nshows arterial phase hyper enhancement without definite washout or pseudo\ncapsule formation, and is not clearly visible on diffusion-weighted images. \nThis measures 8 x 10 mm (previously 7 x 8 mm), (series 10, image 91).\n\nThroughout the remainder of the liver, there are innumerable subcentimeter\nfoci of T1 hyperintensity without abnormal enhancement. No ascites.\n\nBILIARY: No cholelithiasis or choledocholithiasis. No ductal dilation.\n\nPANCREAS: No ductal dilation or suspicious lesions.\n\nSPLEEN: 14.6 cm splenomegaly.\n\nADRENAL GLANDS: Symmetric without nodules.\n\nKIDNEYS: 3.1 x 3.2 cm renal cyst with thin septation in the left inferior\npole, unchanged (nonsuspicious). Subcentimeter bilateral simple cysts. No\nhydronephrosis or suspicious lesions.\n\nGASTROINTESTINAL TRACT: No intestinal obstruction. No mesenteric adenopathy.\n\nLYMPH NODES: No adenopathy.\n\nVASCULATURE: Patent hepatic vasculature with conventional anatomy. Splenic\nvarices with splenorenal shunt.Recanalized paraumbilical vein. Patent aorta,\nIVC and\nmajor branches.\n\nOSSEOUS AND SOFT TISSUE STRUCTURES: Normal bone marrow signal. No soft tissue\nmass.", "output": "1. No change in size or features of the lesions in segment III (9 mm) and\nsegment V/VI (10 mm) which show arterial hyperenhancement without clear\nwashout or pseudocapsule formation and do not currentlly meet OPTN criteria\nfor HCC.\n2. No new suspicious lesions identified.\n3. Hepatic steatosis, cirrhosis, mild splenomegaly and varices. No ascites.\n4. 6 mm right lung base pleural-based nodule, better assessed on same day CT\nthorax.\n\nRECOMMENDATION(S): Continued short interval follow up." }, { "input": "Lower Thorax: Visualized lower thorax is unremarkable.\n\nLiver: There is mild steatotic change. There is dysmorphic shrunken liver\nwith nodular contour compatible with the known underlying cirrhosis.\n\nThere is revisualization of 2 arterially enhancing nodules, the first\nmeasuring 1.1 cm in segment 3 (10:65), second measuring 1.0 cm in segment 6\n(10:80). Neither of these demonstrate washout or pseudo capsule, although\nthey both demonstrate diffusion restriction. Both of these areas are\nunchanged.\n\nThere are no lesions meeting OPTN criteria on the current examination.\n\nThere is reticular enhancement keeping with fibrosis.\n\nBiliary: There is uncomplicated cholelithiasis. Remainder of the visualized\nintra and extrahepatic biliary tree is unremarkable.\n\nPancreas: Visualized pancreas is unremarkable.\n\nSpleen: The spleen is enlarged measuring up to 13.5 cm. There are no\nsuspicious splenic lesions identified.\n\nAdrenal Glands: The adrenal glands are within normal limits.\n\nKidneys: 3.0 x 3.2 cm cyst with a solitary thin septation noted at the\ninferior aspect of the left kidney. The kidneys are otherwise unremarkable.\n\nGastrointestinal Tract: There is a small hiatus hernia.\n\nLymph Nodes: No definite size significant lymphadenopathy is identified.\n\nVasculature: The portal vein is patent. The hepatic arterial anatomy is\nconventional.\n\nThere are multiple splenorenal collaterals noted.\n\nOsseous and Soft Tissue Structures: No suspicious osseous or soft tissue\nlesions identified.", "output": "1. Stable arterially enhancing foci measuring 1.1 cm in segment 3 (10:65) and\n1.0 cm in segment 6 (10:80), both of which demonstrate diffusion restriction. \nThey do not meet OPTN criteria but are suspicious, and warrant close\nevaluation of follow-up.\n2. There are no lesions meeting OPTN criteria.\n3. Incidental findings detailed above.\n\nRECOMMENDATION(S): Continued followup of the liver in ___ months." }, { "input": "Lower thorax: The lung bases are grossly clear.\n\nLiver: The liver is shrunken and nodular in appearance, consistent with\nhistory of cirrhosis. There is slight signal loss on the out of phase\nsequence as opposed to the in phase sequence consistent with mild hepatic\nsteatosis.\nA previously seen 1.0 cm arterial enhancing lesion in segment 6 of the liver\nis newly T1 hypointense, T2 slightly hyperintense, and displays washout on\ndelayed imaging, with no definite pseudo capsule (6:28, 8:93, 1001:94,\n1004:94). An approximate 1.0 cm arterial enhancing lesion in segment 3 of the\nliver is similar to prior, with no washout or pseudo capsule on delayed\nimaging (1001:68). Two foci of T1 hyperintensity without T2 correlate,\nabnormal enhancement or washout are unchanged, and consistent with\nregenerative nodules (8: 55,60).\n\nBiliary: There is no intra or extrahepatic biliary dilatation. There is\nslight gallbladder wall edema, nonspecific in the setting of chronic liver\ndisease. There are no gallstones or pericholecystic fluid.\n\nPancreas: Pancreas demonstrates normal signal intensity on T1 weighted images\nand enhances homogeneously. Pancreatic duct is normal in caliber.\n\nSpleen: The spleen is mildly enlarged, measuring 13 cm.\n\nAdrenals: Adrenal glands are normal.\n\nKidneys: A partially imaged 3.2 x 3.0 T2 hyperintense cystic lesion with a\nsingle thin internal septation arising from the lower pole of the left kidney\nis unchanged (3:21). The kidneys otherwise enhance and excrete symmetrically\nwithout suspicious lesions or hydronephrosis.\n\nBowel: There is a moderate hiatal hernia. There is congestion in the right\npericolic fat. Partially imaged loops of small and large bowel are otherwise\nunremarkable.\n\nVasculature: Abdominal aorta is normal in caliber and major branch vessels are\npatent. The portal vein, splenic vein and SMV are patent. Hepatic arterial\nanatomy is conventional. There is a recannulized paraumbilical vein. \nSplenorenal shunt and splenic varices are similar to prior. There are minimal\nesophageal varices.\n\nLymphatics: The thoracic duct is prominent. There is no mesenteric or\nretroperitoneal lymphadenopathy.\n\nOsseous/Soft Tissue: There is no abnormal marrow signal or focal suspicious\nosseous lesion. No free fluid.", "output": "1. A 1.0 cm arterial enhancing lesion in segment 6 of the liver has new T2 and\nT1 precontrast correlate compared with prior, and displays new washout on\ndelayed imaging, with no definite pseudocapsule. Although this lesion does\nnot meet strict OPTN criteria for ___, the interval development of washout and\nT2/T1 correlates are very suspicious, and either biopsy or 3 month follow up\nMRI is recommended. If desired, this lesion may be amenable to\nultrasound-guided biopsy.\n2. Stable 1.0 cm arterially enhancing lesion in segment 3 of the liver, with\nno washout or pseudo capsule, does not meet OPTN criteria, however attention\non follow-up is recommended. No new suspicious hepatic lesions.\n3. Cirrhosis with evidence of portal hypertension including splenomegaly and\nvarices.\n4. Slight gallbladder wall edema is nonspecific in the setting of chronic\nliver disease.\n\nRECOMMENDATION(S): Recommend biopsy or three-month follow-up MRI of\nsuspicious segment 6 lesion." }, { "input": "Lower Thorax: The lung bases are grossly clear.\n\nLiver: Liver shrunken and nodular in appearance consistent with cirrhosis. \nThere is mild hepatic steatosis.\n\nThe previously described 1 cm arterial enhancing lesion in segment VI of the\nliver is high in signal on T2 weighted sequences, demonstrates brisk arterial\nenhancement and mild washout, but no pseudo capsule (Series 14, image 80,\nseries 6, image 22 and series 19, image 80). The previously described high\nsignal on T1 weighted sequences was likely artifactual as it is not seen\ntoday. The lesion has minimally increased in size since ___,\ncurrently measuring 1.4 cm, previously 1 cm.\n\nThe previously described 1 cm arterial enhancing lesion in segment III has\nslightly increased in size now measuring 1.2 cm. The lesion demonstrates new\nT2 hyperintensity and T1 hypointensity (series 14, image 63 and series 8 image\n69), but no washout or pseudo capsule.\n\nTwo foci of T1 hyperintensity without T2 correlate, abnormal enhancement or\nwashout are unchanged and consistent with regenerative nodules (series 8,\nimages 46 and 55).\n\nBiliary: There is no intrahepatic or extrahepatic biliary duct dilation. \nThere is minimal gallbladder wall edema, likely reactive. There is no\npericholecystic fluid. There is a stone in the gallbladder.\n\nPancreas: The pancreas is homogeneous in echotexture. There is no pancreatic\nduct dilation.\n\nSpleen: The spleen is homogeneous in echotexture and enlarged measuring up to\n14 cm.\n\nAdrenal Glands: The adrenal glands are normal.\n\nKidneys: In the lower pole the left kidney a cyst with a few thin septations\nmeasures 3 x 3.4 cm (series 4, image 17), unchanged. There is no\nhydronephrosis.\n\nGastrointestinal Tract: Asymmetric focal enhancement in the distal antrum in\nthe prepyloric region (series 14, image 84) is new. There is a moderate\nhiatal hernia. The visualized loops of small and large bowel appear normal.\n\nLymph Nodes: No lymphadenopathy.\n\nVasculature: There is a splenorenal shunt and a recanalized paraumbilical\nvein.\n\nOsseous and Soft Tissue Structures: No concerning bone or soft tissue\nfindings.", "output": "1. Asymmetric focal enhancement in the distal antrum in the prepyloric region\ncould reflect gastritis as seen on the prior EGD, but should be confirmed with\nan EGD as it is focal.\n2. Segment VI 1.4 cm lesion with arterial enhancement, subtle washout, no\nclear pseudo capsule has increased in size and remains concerning for ___,\nhowever, the lesion does not meet strict OPTN criteria.\n3. Segment III 1 cm lesion demonstrates new T2 hyperintensity and T1\nhypointensity but no washout. Although this lesion does not meet strict OPTN\ncriteria the new T2 hyperintensity and washout are concerning for ___. \nFollow-up MRI in 3 months is recommended.\n4. Cirrhosis with evidence of portal hypertension including splenomegaly,\nrecanalized paraumbilical vein and a splenorenal shunt.\n5. Gallstones.\n\nRECOMMENDATION(S): EDG.\nFollow-up liver MRI in 3 months." }, { "input": "Lower Thorax: The lung bases are grossly clear.\n\nLiver: The liver appears shrunken with a nodular contour, consistent with\ncirrhosis.\n\nThe previously seen lesion located peripherally in segment VI now measures 1.4\nx 1.4 cm, the previously 1.2 x 1 cm, and continues to demonstrate T2\nhyperintensity, arterial enhancement, mild washout, and no pseudo capsule\n(12:61, 8:31).\n\nThe previously seen lesion in segment III now measures 1.4 x 1.2 cm,\npreviously 1.1 x 1 cm, and continues to demonstrate T2 hyperintensity,\narterial enhancement, mild washout, and no pseudo capsule (12:47, 8:24).\n\nAn additional 0.8 x 0.6 cm arterially enhancing lesion in segment VII\ndemonstrates mild washout with no pseudo capsule, and no obvious T2 correlate\n(12:23), appears stable from ___.\n\nAn area of arterial enhancement without T2 or delayed phase correlate within\nsegment V (12:38) is most consistent with a transient hepatic intensity\ndifference.\n\nBiliary: No intra or extrahepatic biliary ductal dilatation. Again seen is\ncholelithiasis, without evidence of gallbladder-wall thickening or\npericholecystic stranding.\n\nPancreas: Pancreas demonstrates normal signal intensity, without evidence of\nductal dilatation or focal mass lesions.\n\nSpleen: Mild splenomegaly, measuring 14 cm.\n\nAdrenal Glands: The adrenal glands are normal in size and shape.\n\nKidneys: A 3.1 x 3.1 cm cyst with a few thin internal septations in the lower\npole of the left kidney is unchanged. There is no hydronephrosis.\n\nGastrointestinal Tract: There is a moderate size hiatal hernia. Partially\nimaged loops of small and large bowel are otherwise unremarkable.\n\nLymph Nodes: No pathologically enlarged or abnormal appearing retroperitoneal\nor mesenteric lymph nodes.\n\nVasculature: There is a splenorenal shunt and a recanalized paraumbilical\nvein.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is within normal\nlimits. No concerning soft tissue findings.", "output": "1. A 1.4 cm lesion in segment VI has slightly enlarged since the prior MRI\nexamination, and remains concerning for hepatocellular carcinoma, although it\ndoes not meet strict OPTN-5 criteria due to lack of pseudo capsule.\n2. A 1.4 cm lesion in segment III has slightly enlarged, and also remains\nconcerning for hepatocellular carcinoma, but also does not meet strict OPTN-5\ncriteria due to lack of a pseudo capsule.\n3. A 8 mm lesion in segment VII is unchanged, with intermediate suspicion for\nhepatocellular carcinoma, but not meeting OPTN-5 size ut criteria.\n4. Cirrhosis, with sequela of portal hypertension, including splenomegaly,\nsplenorenal shunt, and recanalized paraumbilical vein.\n5. Moderate-sized hiatal hernia.\n6. Cholelithiasis." }, { "input": "Lower Thorax: Please refer to the dedicated CT chest report from the same day\nfor description of findings in the thorax.\n\nLiver:\nThe liver remains shrunken and nodular, compatible with history of cirrhosis.\n\nThere are post-treatment changes and perfusional changes in the area of the\nsegment III lesion status-post TACE.\n\nThe RFA bed to treat the segment VI lesion now measures 2.4 x 1.9-cm with\npost-treatment changes and no definite associated or adjacent arterial\nenhancing lesions with washout.\n\nSeveral subcentimeter arterial enhancing lesions without definite washout\nstill do not meet OPTN-5 criteria for HCC and are unchanged from the prior\nexam but are slightly more conspicuous since ___:\n- an 8 x 6-mm arterial enhancing lesion in segment VII (series ___, image\n33).\n- a 4-mm subcapsular arterial enhancing lesion in segment VII (series 101,\nimage 31).\n- a 6-mm arterial enhancing lesions segment VIII/V (series 101, image 45).\n\nNo new arterial enhancing lesions or lesions meeting OPTN criteria for HCC.\n\nNo ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary ductal dilation. The\ngallbladder is non-distended. A small filling defect within the gallbladder\nlumen is consistent with a non-obstructing stone, similar to prior CT (series\n3, image 17).\n\nPancreas: The pancreas is normal and signal intensity. No evidence of a\npancreatic mass. No main pancreatic ductal dilation or peripancreatic fluid\ncollection.\n\nSpleen: The spleen is minimally enlarged, measuring up to 13.7 cm.\n\nAdrenal Glands: The adrenal glands are normal in size and configuration\nwithout evidence of a focal mass.\n\nKidneys: The kidneys are normal and symmetric in size. A 3.6 x 3.3-cm left\nlower renal pole exophytic cyst has a single thin septation and is unchanged\n(series 3, image 20). Tiny T2-hyperintense lesion left upper renal pole\ncortex and right lower renal pole cortex are also unchanged, likely cysts\n(series 3, image 26, 28). No hydronephrosis or perinephric abnormality.\n\nGastrointestinal Tract: A hiatal hernia is small (series 3, image 19). The\npartially imaged small and large bowel are unremarkable.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. Hepatic artery anatomy\nappears conventional. The main and right portal veins are patent. The left\nportal vein is attenuated, similar the prior exam. Recanalization of the\numbilical vein is consistent with sequelae of chronic portal hypertension,\nunchanged. Similarly, abdominal wall varices, splenic varices, splenorenal\nshunt, and esophageal varices are again demonstrated. The splenic vein is\npatent.\n\nOsseous and Soft Tissue Structures: No osseous lesions concerning for\nmalignancy. Small disc-osteophyte complexes at L4-L5 and L5-S1 are\nincompletely imaged on scout views. A fat-containing umbilical hernia is\nsmall.", "output": "1. Post-TACE treatment changes in segment III and post-RFA changes in segment\nVI. No residual tumor within these treatment regions.\n2. Three subcentimeter arterial enhancing lesions without definite washout,\nslightly more conspicuous since ___, but none meeting OPTN-5 size or\nenhancement criteria for HCC. Continued MRI surveillance recommended as these\nlesions remain suspicious for small foci of HCC.\n3. Cirrhotic liver with sequelae of portal hypertension including mild\nsplenomegaly and varices as above. No ascites.\n4. Small hiatal hernia." }, { "input": "Lower Thorax: There is a 0.9 x 0.9 cm avidly enhancing pleural based nodule in\nthe right lower lobe without intravoxel fat, present on CT of the chest from\n___ but new since CT of the chest from ___, nonspecific. \nShort interval follow-up with CT of the chest is recommended.\n\nLiver: The liver is nodular in contour, compatible with cirrhosis. There\ndiffuse, progressive reticular enhancement of the hepatic parenchyma is in\nkeeping with fibrosis.\n\nThe patient is status post radiofrequency ablation of a lesion in segment VI\non ___ and chemoembolization of a lesion in segment III on ___. The 2.1 x 1.7 cm radiofrequency ablation zone in segment VI\ndemonstrates intrinsic T1 hyperintensity, compatible with coagulation\nnecrosis. There is no internal enhancement to suggest recurrent or residual\ntumor. There has been further interval decrease in size of a treated lesion\nin segment III which now measures 0.9 x 0.8 cm, previously 1.5 x 1.2 cm, and\ndemonstrating no internal enhancement indicate viable tumor.\n\nAgain seen are small arterially hyperenhancing lesions, as follows:\n- 1.1 x 0.8 cm lesion in segment VII (series 11, image 27), without definite\nwashout or a pseudocapsule, minimally increased in size and previously 1.0 x\n0.6 cm, not meeting OPTN 5 criteria for hepatocellular carcinoma but remaining\nsuspicious\n- 0.6 x 0.6 cm arterially hyperenhancing lesion in segment V without washout\nor a pseudocapsule (series 11, image 40), unchanged in size and not meeting\nOPTN 5 criteria for hepatocellular carcinoma\n- 0.8 x 0.3 cm subcapsular lesion in segment VII (series 11, image 28),\nwithout washout or a pseudocapsule, unchanged in size and not meeting OPTN 5\ncriteria for hepatocellular carcinoma\n\nHepatic arterial anatomy is conventional. There is a recanalized\nparaumbilical vein, perisplenic varices and a splenorenal shunt. The portal\nand hepatic veins are patent.\n\nBiliary: The gallbladder is within normal limits. There is no intra- or\nextrahepatic biliary ductal dilatation.\n\nPancreas: The pancreas is normal in bulk and signal intensity. There is no\nfocal pancreatic lesion or main ductal dilatation.\n\nSpleen: The spleen is enlarged, measuring 13.2 cm in length and 14.5 cm AP,\nand normal in signal intensity.\n\nAdrenal Glands: The right and left adrenal glands are normal in size and\nshape.\n\nKidneys: The kidneys are symmetric in size and demonstrate normal\ncorticomedullary differentiation. There is a 3.4 x 3.2 cm dominant cyst in\nthe lower pole of the left kidney with a thin internal septation and a few\nother tiny cortical cysts in both kidneys. There is no hydronephrosis.\n\nGastrointestinal Tract: No esophageal varices are seen. Visualized upper\nabdominal bowel loops are normal in caliber.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: There is no abdominal aortic aneurysm. The celiac artery, SMA\nand bilateral renal arteries are normal in caliber and patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is\nidentified. The bone marrow increases in signal in the out-of-phase images,\ncompatible with iron deposition.", "output": "1. Cirrhosis of the liver with findings of portal hypertension, including\nsplenomegaly, recanalized paraumbilical vein, and a splenorenal shunt. No\nevidence of tumor recurrence within treated sites in segment VI and III. \nRedemonstration of small arterially enhancing lesions in segments V and VII as\ndescribed, not meeting OPTN 5 criteria for hepatocellular carcinoma, though\nattention on follow-up is warranted.\n\n2. Iron deposition in the bone marrow.\n\n3. 0.9 x 0.9 cm avidly enhancing pleural based nodule in the right lower lobe,\npresent on CT of the chest from ___ but new since CT of the chest from\n___, nonspecific. Short interval follow-up with CT of the chest\nis recommended." }, { "input": "Lower Thorax: Pleural-based right lower lobe nodules are evaluated on the\nseparate chest CT from the same date.\n\nLiver: The liver is again noted to be cirrhotic with confluent fibrosis, as on\nprior studies. Decrease in signal intensity on in-phase compared to out of\nphase sequences is consistent with iron deposition.\n\nThe RFA cavity in segment VI measures 2.0 x 1.8 cm with internal hemorrhage,\nis unchanged (14:54). There is no finding of recurrence within the cavity.\nStable post tace changes are noted in segment III. No findings of recurrence\n(14:44).\nAgain demonstrated are numerous arterial enhancing foci that persist on\ndelayed phases, which are nonspecific:\n\nUnchanged 1.5 cm focus in segment VII (17:22).\n\nUnchanged 8 mm focus in segment VII (17:24).\nUnchanged 7 mm focus in hepatic segment V (17:37).\nTwo new foci of arterial enhancement without washout are present in hepatic\nsegment VI measuring 6 mm each (17:53, 49).\n\nBiliary: There is cholelithiasis without evidence of cholecystitis. No\nbiliary dilation.\n\nPancreas: The pancreas is unremarkable.\n\nSpleen: Decreased signal on in-phase images is suggestive of iron deposition.\nStable size, measuring 13.4 cm.\n\nAdrenal Glands: Low signal intensity on in-phase images just above iron\ndeposition.\n\nKidneys: The kidneys are unremarkable except of a left lower pole renal cyst\nwith a thin septation measures 3 cm, unchanged. Additional punctate simple\ncysts are also noted.\nGastrointestinal Tract: There is a moderate hiatus hernia. No bowel\nobstruction.\nLymph Nodes: No enlarged retroperitoneal or mesenteric lymph nodes.\nVasculature: The abdominal aorta and its major branches are normal in caliber.\nHepatic vascular anatomy is conventional. The hepatic and portal veins are\npatent. A splenorenal shunt is present. The umbilical vein is recanalized,\nreflecting portal hypertension.\nOsseous and Soft Tissue Structures: Diffuse low signal on in phase images\nthroughout the imaged osseous structures is compatible with iron deposition. \nNo suspicious osseous lesions. There is a small fat containing umbilical\nhernia.", "output": "1. No recurrence or new lesions concerning for hepatocellular carcinoma.\n2. Numerous arterial enhancing foci with persistent enhancement on delayed\nphase images do not meet OPTN criteria for hepatocellular carcinoma.\n3. Cirrhotic liver with fibrosis and portal hypertension. Iron deposition in\nupper abdominal organs, as on prior.\n4. Pleural based masses. Please refer to the separately dictated CT chest from\nthe same date for thoracic findings." }, { "input": "There are bilateral hydrosalpinges, large greater than left. There is no\nfocal solid lesion or fat stranding related to the hydrosalpinges. No visible\ndebris or complexity is seen. There is no fluid collection in the pelvis\nconcerning for an abscess.\n\nOtherwise the patient is status post hysterectomy. A linear enhancing scar in\nthe anterior abdominal wall of the lower pelvis is likely related to the\nsurgical procedure. There is no fluid collection or any other abnormality in\nanterior abdominal wall. The vaginal canal is normal in appearance. No\novarian abnormalities are identified. There is no pelvic wall lymphadenopathy\nor pelvic free fluid.\n\nThe partially distended bladder is grossly unremarkable. The visualized bowel\nloops are within normal limits. There is no significant pelvic or inguinal\nlymphadenopathy. The osseous structures are unremarkable.", "output": "Bilateral hydrosalpinges without visible debris or complexity. Otherwise\nunremarkable pelvic MRI examination in this patient who is post prior\nhysterectomy." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The visualized portions of the liver appear homogeneous in signal\nintensity. There is diffuse loss of signal intensity on T1 out of phase\nimages suggestive of hepatic steatosis. There is small area of fatty sparing\nadjacent to the gallbladder fossa. There is a small hepatic cyst or biliary\nhamartoma noted, measuring 10 mm (series 4, image 20).\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder appears within normal limits.\n\nPancreas: Pancreas appears normal in signal intensity. There is no pancreatic\nductal dilatation.\n\nSpleen: The spleen appears homogeneous in signal intensity and is not\nenlarged.\n\nAdrenal Glands: The adrenal glands appear within normal limits.\n\nKidneys: The kidneys are symmetric in size and enhance symmetrically after\ncontrast administration. There is no hydronephrosis or concerning focal mass\non the left. Left renal calculi seen on the prior ultrasound are not clearly\nseen on the MR examination.\n\nIn the lower pole of the right kidney there is a 1.7 x 1.6 x 1.3 cm T2\nhyperintense and avidly enhancing renal mass (series 3, image 22; series 1103,\nimage 45), compatible with a clear cell renal cell carcinoma. This is\napproximately 50% exophytic.\n\nThere is susceptibility artifact posterior to the right kidney with focal\ncortical thinning likely related to prior intervention. In the right renal\npelvis there is a approximately 2 cm calculus with a possible staghorn\nconfiguration (series 4, images 28 & 29). There are multiple adjacent cystic\nstructures in the mid right kidney (series 3, image 19; series 1103, image\n39). These likely correspond to focally obstructed renal calices/mild\nhydronephrosis.\n\nSmall T2 hyperintense foci without enhancement in both kidneys are compatible\nwith small renal cysts.\n\nGastrointestinal Tract: Visualized portions of the gastrointestinal tract\nappear within normal limits.\n\nLymph Nodes: No pathologic lymphadenopathy.\n\nVasculature: No abdominal aortic aneurysm. The renal arteries and veins\ndemonstrate a conventional anatomic configuration.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. There is a\nprobable vertebral hemangioma at L1. There is small umbilical hernia\ncontaining fat.", "output": "1. 1.7 cm, partially exophystic right lower pole renal mass compatible with a\nclear cell renal cell carcinoma.\n2. Calculus in the right renal pelvis with a possible staghorn configuration\nresulting in adjacent focal mild hydronephrosis. Noncontrast CT can be\nobtained to further assess the degree of stone burden, if needed.\n3. Hepatic steatosis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 12:12 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Lower Thorax: The visualized lung bases are grossly clear. No pleural\neffusion.\n\nLiver: There is marked loss of signal on out of phase images suggestive of\nhepatic steatosis. Few small geographic foci adjacent to the gallbladder are\nspared this phenomenon, likely areas of focal fatty sparing. A 0.8 cm hepatic\ncyst or biliary hamartoma in the right hepatic lobe (12:10) is unchanged. An\nadditional 1.0 cm hepatic cyst or biliary hamartoma in the left hepatic lobe\nhas increased in size, previously measuring 0.7 cm on the MR in ___. \nThere are no suspicious enhancing foci within the partially evaluated liver.\n\nBiliary: The gallbladder is unremarkable. No intrahepatic or extrahepatic\nbiliary ductal dilatation.\n\nPancreas: There is homogeneous parenchymal signal and enhancement. No\npancreatic ductal dilatation or peripancreatic fluid collections. No focal\npancreatic lesions.\n\nSpleen: The spleen is normal in size. No focal lesions.\n\nAdrenal Glands: The bilateral adrenal glands are normal in size and shape. No\nfocal nodularity/mass.\n\nKidneys: The kidneys are normal and symmetric in size. No concerning renal\nmass on the left. No hydronephrosis.\n\nAgain seen in the lower pole of the right kidney is a contour-deforming mass\nwhich is predominantly T2 hyperintense and avidly enhancing (4:16, 12:25, and\n1601:49), unchanged in size since the MR in ___, measuring 1.7 x 1.5\nx 1.3 cm, previously measuring 1.7 x 1.6 x 1.3 cm. Multiple adjacent cystic\nstructures previously seen within the interpolar region to lower pole of the\nright kidney persist but are less apparent than before.\n\nGastrointestinal Tract: The partially visualized stomach is unremarkable. \nVisualized loops of small and large bowel are normal in caliber. Although\nlimited by motion, there is no frankly abnormal bowel enhancement.\n\nLymph Nodes: No mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. The celiac axis, SMA,\nand ___ are widely patent. There are 2 left renal arteries arising closely\ntogether off of the abdominal aorta. No renal vein thrombus.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesion. Probable\nvertebral hemangioma within the L1 vertebra appears grossly similar. Soft\ntissues are unremarkable.", "output": "1. Stable 1.7 cm partially exophytic right lower pole renal mass,\nbiopsy-proven renal cell carcinoma. No new solid renal enhancing masses. No\nlocal lymphadenopathy or renal vein thrombosis.\n2. Hepatic steatosis." }, { "input": "Lower Thorax: There is no pleural or pericardial effusion.\n\nLiver: The liver is normal in signal intensity and morphology without focal\nlesion. The portal and hepatic veins are patent.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is unremarkable.\n\nPancreas: The pancreas is atrophic without focal lesion or ductal dilatation. \nPancreas divisum morphology is noted.\n\nSpleen: The spleen is top-normal in size measuring up to 13.4 cm (04:50).\n\nAdrenal Glands: Unremarkable.\n\nKidneys: No suspicious focal lesion or hydronephrosis.\n\nGastrointestinal Tract: There is a small hiatal hernia. The visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: There is no suspicious lymphadenopathy.\n\nVasculature: Unremarkable.\n\nOsseous and Soft Tissue Structures: A 2.7 x 2.7 T2 hypointense, T1 mildly\nhyperintense enhancing lesion with restricted diffusion in posterior aspect of\nthe L3 vertebral body with extension into the spinal canal is increased\nslightly in size from the recent prior study at which time it measured 2.6 x\n2.5 cm when measured in similar planes (05:35). Additional osseous lesions\nwith similar signal characteristics are seen at: The right pedicle and\ntransverse process of T11 (16:21), the left L1 pedicle, facets, transverse\nprocess, and lamina (05:23), the left superior facet of L2 (16:67), spinous\nprocess of L3 (16:92), the left transverse process of L4 (16:100), and the\nleft iliac crest (16:111).", "output": "1. No findings to explain rising bilirubin. No suspicious liver lesion and no\nbiliary duct dilatation.\n2. Slight interval increase in size of multiple enhancing lesions compatible\nwith known multiple myeloma with slightly progressed invasion into the spinal\ncanal by the L3 lesion, which causes moderate central and moderate to severe\nright paracentral spinal canal stenosis and impinges upon the exiting L3 nerve\nroot." }, { "input": "Lower Thorax: Bibasilar atelectasis is present, right greater than left, with\nsmall bilateral pleural effusions. The visualized heart and pericardium are\nunremarkable.\n\nLiver: There is no significant hepatic steatosis. There are no morphologic\nchanges concerning for cirrhosis. There are no focal liver lesions.\n\nBiliary: There is no intrahepatic or extrahepatic biliary ductal dilatation. \nThe gallbladder is distended, and a 4 mm polyp is noted. There is no\ncholelithiasis or sludge. There are no findings concerning for cholecystitis.\n\nPancreas: The pancreas is not well visualized due to artifact from proximal\nsplenic embolization coils. The main pancreatic duct is dilated, with the\nproximal portion measuring 6 mm (series 7, image 34).\n\nThe main pancreatic duct and common bile duct terminate fairly abruptly at the\nampulla. A focal area of T2 hypointense signal at the ampulla may represent\nthe ampulla itself, but a stone at the ampulla or ampullary stenosis cannot be\nexcluded.\n\nSpleen: The spleen is normal in size. There is no evidence of focal splenic\nlesions.\n\nAdrenal Glands: The right adrenal gland is unremarkable. The left adrenal\ngland is difficult to visualize given adjacent artifact.\n\nKidneys: The kidneys are normal in size without hydronephrosis. Multiple\nsimple cysts are seen in the kidneys. The largest is in the upper pole of the\nright kidney measuring 3.0 cm.\n\nGastrointestinal Tract: Artifact from proximal splenic artery embolization\ncoils limits assessment of the stomach. Assessment for a gastric tumor cannot\nbe performed on diffusion or pre or postcontrast images. However, the\nportions of gastric wall better visualized on the out of phase and T2 weighted\nimages appear unremarkable. There is no abnormal T1 hyperintensity to suggest\nectopic pancreas. Again seen is a hematoma just outside the gastric body,\nintimately associated with the gastric wall. This intimate association raises\nthe consideration of a gastric wall or a gastroepiploic vessel abnormality\nresulting in hematoma. There is a small focus of T1 hyperintensity within the\nhematoma, suggestive of blood products of a variant age (series 9, image 67). \nThere is no evidence of active extravasation.\n\nLymph Nodes: There is no mesenteric or retroperitoneal lymphadenopathy.\n\nVasculature: The abdominal aorta is normal in caliber. The patient is status\npost coil embolization of the proximal splenic artery, with resultant\nartifact. The celiac and SMA are not well assessed due to artifact. Portions\nof the portal vein are also not well assessed. The hepatic veins and IVC are\npatent.\n\nOsseous and Soft Tissue Structures: Bone marrow signal is normal.", "output": "1. Limited exam due to the artifact from splenic artery embolization coils. \nDiffusion, and pre and post contrast sequences cannot be used to assess for\ntumor given this artifact. However, no obvious signal abnormality or other\nfinding is seen in the gastric wall on other T1 or T2 weighted sequences.\n2. Similar appearance of hematoma along the greater curvature of the stomach,\nintimately associated with the gastric wall, again raising the possibility of\na gastroepiploic artery or gastric wall vascular abnormality as the etiology\nof this finding.\n3. Main pancreatic ductal dilation to 6 mm without extrahepatic or\nintrahepatic biliary dilation. A stone at the ampulla or ampullary stenosis\nis not excluded.\n4. Bibasilar atelectasis, right greater than left.\n5. 4 mm gallbladder polyp. No specific follow-up is needed for this finding.\n\nRECOMMENDATION(S): ERCP may be considered to further evaluate the pancreatic\nduct and ampulla if clinically indicated.\n\nNOTIFICATION: The change from the initial wet read to the final Impression\nwas discussed by Dr. ___ with Dr. ___ on the telephone on ___ at\napproximately 11:00 AM." }, { "input": "Lower Thorax: Left pleural plaque, stable. Otherwise the visualized sections\nof the lower thorax are unremarkable.\n\nLiver: The liver has normal morphology and signal intensity. There are\nmultiple T2 hyperintense nonenhancing liver lesions. The largest is seen in\nsegment ___ and measures 24 x 35 mm. Some have mildly increased in size\ncompared to the remote prior examination of ___. No suspicious\nliver lesions. The enhancing lesions described on prior remote MR are no\nlonger visualized.\n\nBiliary: No intra- or extrahepatic biliary dilation. Gallbladder is surgically\nabsent.\n\nPancreas: Status post distal pancreatectomy for adenocarcinoma. Multiple\ncystic pancreatic lesions are noted. The largest seen in the uncinate\nprocess. It measures 9 x 11 mm and appears to be communicating with the main\npancreatic duct. The lesion previously measured 7 mm on the MR ___. The other cystic lesions have also increased minimally in size\nwithout additional suspicious features. No significant dilatation of the main\npancreatic duct. No enhancing intraductal or pancreatic masses.\n\nSpleen: The spleen has been surgically removed.\n\nAdrenal Glands: Adrenal glands are thin without nodularity.\n\nKidneys: Multiple renal cortical and parapelvic cysts.\n\nGastrointestinal Tract: Stomach is grossly unremarkable. Visualized large\nand small bowel loops are unremarkable.\n\nLymph Nodes: There is no mesenteric or retroperitoneal adenopathy.\n\nVasculature: Atherosclerotic changes of the abdominal aorta without aneurysmal\ndilatation.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesions.", "output": "1. Status post distal pancreatectomy for adenocarcinoma. No enhancing\npancreatic masses to suggest recurrence.\n2. Cystic pancreatic lesion within the uncinate process which appears to\ncommunicate with the main pancreatic duct without main duct dilatation. This\nlikely represents an IPMN. It has minimally increased in size compared to the\nremote MRI of ___.\n\nRECOMMENDATION(S): For management of pancreatic cyst(s) between 6-15 mm in\npatients greater than ___ years at presentation, recommend non-contrast MRCP\nfollow-up every other year x 2.\n\nFor cysts measuring up to 1.5 cm:\n(a) These guidelines apply only to incidental findings, and not to patients\nwho are symptomatic, have abnormal blood tests, or have history of pancreas\nneoplasm resection.\n(b) Clinical decisions should be made on a case-by-case basis taking into\naccount patient's comorbidities, family history, willingness to undergo\ntreatment, and risk tolerance.\n\nLocal ___ follow-up guidelines adopted from:\n___" }, { "input": "Of note, MRCP images were highly degraded due to the presence of ascites. The\nexam was done utilizing free breathing technique due to inability to hold\nbreath.\n\nLower Thorax: The ascending aorta measures 4 cm, as on prior exam.\n\nLiver: Cirrhotic liver morphology is redemonstrated without findings of\nhepatocellular carcinoma.\n\nBiliary: There is no biliary ductal dilatation. Diffuse gallbladder wall\nthickening is likely secondary to cirrhosis.\n\nPancreas: The pancreas is unremarkable aside from stable pancreatic cystic\nlesions, likely representing side-branch IPMNs. The main pancreatic duct is\nnormal in caliber.\n\nSpleen: The spleen is again noted to be enlarged measuring 15.0 cm\ncraniocaudally.\n\nAdrenal Glands: Adrenal glands are unremarkable.\n\nKidneys: The kidneys are unremarkable except for bilateral simple cysts\nmeasuring up to 5.5 cm in the interpolar region of the left kidney.\n\nGastrointestinal Tract: No bowel obstruction.New moderate to large amount of\nascites.\n\nLymph Nodes: No enlarged upper abdominal or retroperitoneal lymph node is\nseen.\n\nVasculature: The portal, splenic and superior mesenteric veins are patent.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion is seen.", "output": "1. Cirrhotic liver with portal hypertension, evidenced by splenomegaly and\nascites, the latter worse than on prior exam. No HCC.\n2. Stable cystic pancreatic lesions likely representing side-branch IPMNs,\nmeasuring up to 1.5 cm, which could be re-evaluated during routine ___\nscreening." }, { "input": "Lower Thorax: There is minimal bibasilar dependent atelectasis. Minimal\ngynecomastia noted.\n\nLiver: The liver surface is nodular with enlargement of the left and the\ncaudate lobes and relative atrophy of the right lobe.\nNo focal hepatic lesions with arterial enhancement or washout suspicious for\nHCC.\nThere is diffuse lace-like reticular enhancement on the delayed phases\ninvolving the entire liver as seen with diffuse fibrosis.\nThe portal vein and its branches are widely patent. The hepatic veins are\npatent.\n\nBiliary: There is no intra or extrahepatic biliary ductal dilation. The\ngallbladder is present with no calculi within it.\n\nPancreas: Again visualized is a lobulated T2 hyperintense cystic lesion in the\nhead of the pancreas measuring 1.7 x 1.0 cm in size (series 2, image 12)\nconnected to the main pancreatic duct, likely a side branch IPMN, overall\nunchanged in size compared to the prior exam. An additional 3 mm T2\nhyperintense nonenhancing cystic lesion in the body of the pancreas (series 3,\nimage 31) also remains unchanged. A third lesion measuring 0.7 cm in size in\nthe uncinate process of the pancreas (series 3, image 39) is also unchanged\ncompared to the prior exam.\n\nSpleen: The spleen is enlarged and measures 15 cm in the craniocaudal axis, as\nbefore. No focal splenic lesions.\n\nAdrenal Glands: No adrenal nodules.\n\nKidneys: No hydronephrosis or solid enhancing renal masses seen on either\nside. There are bilateral renal simple cortical cysts including a lobulated\ncyst arising from the lower pole of the left kidney with thin internal\nseptations and no solid enhancing nodules measuring approximately 5.6 by 4.8\ncm in size, unchanged compared to the prior exam.\n\nGastrointestinal Tract: No bowel obstruction.\n\nLymph Nodes: There are no enlarged lymph nodes in the upper abdomen.\n\nVasculature: The portal vein and its branches are patent. The visualized\nportion of the abdominal aorta and IVC is patent. There are small varices in\nthe splenorenal region on the left.\n\nOsseous and Soft Tissue Structures: No enhancing osseous lesions identified.\n\nPreviously visualized ascites has resolved in the interim.", "output": "1. Cirrhotic morphology of the liver with no focal hepatic lesions suspicious\nfor HCC.\n2. At least 3 cystic lesions in the pancreas as detailed above compatible\nwith side branch IPMNs with the largest in the head measuring 1.7 x 1.0 cm in\nsize, unchanged compared to the prior MRI. Continued attention on follow-up\nliver MRs recommended.\n3. Interval resolution of previously visualized ascites, unchanged\nsplenomegaly, patent portal vein and its branches and small splenorenal\nvarices noted." }, { "input": "Lower Thorax: Limited evaluation of the lung bases is notable for right lower\nlobe atelectasis. No pleural effusion.\n\nLiver: Liver is macronodular in contour consistent with provided history of\ncirrhosis with diffuse reticular enhancement from fibrosis. No signal drop on\nout of phase imaging to suggest hepatic steatosis. Limited post contrast\nevaluation due to respiratory motion. Given this limitation, no suspicious\nhepatic mass meeting OPTN 5 criteria for HCC. No ascites.\n\nBiliary: No intrahepatic or extrahepatic biliary duct dilation. High riding\ngallbladder is notable for a 0.3 cm gallstone. Gallbladder is otherwise\nunremarkable.\n\nPancreas: There is mild pancreatic atrophy. Three T2 hyperintense nonenhancing\npancreatic cystic lesions noted, largest measuring 1.1 x 0.9 cm within the\npancreatic head, unchanged since ___ (07:31). No pancreatic duct\ndilatation or peripancreatic fat stranding.\n\nSpleen: Spleen is mildly enlarged measuring 15 cm. No suspicious mass.\n\nAdrenal Glands: Bilateral adrenal glands are symmetric in size without\ndiscrete nodule.\n\nKidneys: Bilateral T2 hyperintense nonenhancing renal cysts are noted, largest\nmeasures 5.2 x 6.4 cm within the interpolar region of the left kidney. \nKidneys are otherwise homogeneous in signal intensity without suspicious mass.\nNo hydronephrosis or perinephric fat stranding.\n\nGastrointestinal Tract: Distal esophagus is unremarkable. The gastric wall is\nmildly thick walled possibly related to portal colopathy. Visualized small and\nlarge bowel are unremarkable. No obstruction.\n\nLymph Nodes: 0.7 cm distal paraesophageal node is again noted (07:15). \nSubcentimeter porta hepatis and periportal lymph nodes are unchanged ___, likely reactive due to adjacent hepatic dysfunction. Retroperitoneal\nand mesenteric lymph nodes are nonenlarged. Left splenorenal shunt noted.\n\nVasculature: No abdominal aortic aneurysm. Celiac axis, SMA, bilateral renal\narteries are patent. Hepatic anatomy is conventional. Hepatic veins, main\nportal vein, SMA, and splenic vein are patent. Small splenorenal varices\nagain noted.\n\nOsseous and Soft Tissue Structures: No aggressive osseous lesions. Soft\ntissues are unremarkable.", "output": "1. Limited post contrast evaluation due to respiratory motion. Given this\nlimitation, no suspicious hepatic lesions meeting OPTN 5 criteria for HCC.\n2. Cirrhosis with sequelae of portal hypertension including mild splenomegaly\nand left splenorenal shunt. No ascites.\n3. Pancreatic cystic lesions largest measuring 1.1 cm within the pancreatic\nhead, likely side branch IPMN, unchanged since ___.\n\nRECOMMENDATION(S): Close attention on follow-up is recommended of the\npancreatic cystic lesions." }, { "input": "Lower Thorax: There is mild dependent atelectasis in bilateral lower lobes.\n\nLiver: The liver demonstrates cirrhotic morphology with regular reticular\nprogressive enhancement compatible with fibrosis. Within the limitations of\nmotion degradation, there is no suspicious liver lesion. There is trace\nperihepatic ascites.\n\nBiliary: There is no intra- or extrahepatic biliary dilatation. The\ngallbladder is unremarkable.\n\nPancreas: The pancreas demonstrates normal signal morphology. There is no\nmain ductal dilatation. There are multiple T2 hyperintense nonenhancing foci\nmeasuring up to 1.0 cm in the head of the pancreas (04:33), unchanged dating\nback to MRI liver ___.\n\nSpleen: The spleen is enlarged measuring 15.5 cm in length (03:28). There is\nno focal lesion.\n\nAdrenal Glands: Both adrenal glands are unremarkable.\n\nKidneys: There are simple cortical cysts in both kidneys measuring up to 5.1\ncm in the lower pole of the left kidney (03:24). There is no hydronephrosis\nor perinephric abnormality.\n\nGastrointestinal Tract: The stomach and partially visualized small and large\nbowel loops are unremarkable.\n\nLymph Nodes: A prominent periportal lymph node measuring 1.0 cm in short axis\n(1002:82) is unchanged from MRI liver ___. There is no\nretroperitoneal lymphadenopathy.\n\nVasculature: Splenorenal varices are again noted. Conventional hepatic\narterial anatomy is demonstrated.\n\nOsseous and Soft Tissue Structures: There is no suspicious osseous lesion. \nGynecomastia is noted.", "output": "1. No OPTN-5 lesions.\n2. Cirrhotic morphology liver with extensive confluent fibrosis and sequelae\nof portal hypertension including trace ascites, splenomegaly, and splenorenal\nvarices.\n3. Pancreatic cystic lesions measuring up to 1.0 cm in the head of the\npancreas, likely representing side-branch IPMNs, are unchanged dating back to\nMRI liver ___.\n\nRECOMMENDATION(S): Attention on follow-up MRIs for pancreatic cystic lesions\nis recommended." }, { "input": "Lower Thorax: The lung bases are grossly clear. There is no pleural or\npericardial effusion. There is no cardiomegaly.\n\nLiver: Cirrhotic morphology of the liver is re-demonstrated with a nodular\ncontour and evidence of portal hypertension and a moderate perihepatic and\nperisplenic ascites and varices. Multiple arterially hyperenhancing lesions\nare present.\n\nThere is a dominant hepatic mass arising from segment VI and extending\nexophytically beyond the liver capsule, measuring up to 5.6 x 6.3 x 7.9 cm in\noverall ___ (10:40, 2:27). This is heterogeneously hyperintense on T2,\npredominantly hypointense on T1 with areas of intrinsic T1 hyperintensity\nposteriorly that likely represent hemorrhage. There is early heterogeneous\nhyperenhancement posteriorly with subsequent washout on delayed imaging and\nareas that demonstrate progressive enhancement, likely related to necrosis. \nThis extends beyond the liver capsule and contacts the lateral wall. This is\nconsistent with a OPTN 5B lesion.\n\nThere is a 1.6 cm arterially hyperenhancing lesion in segment III that\ndemonstrates washout on delayed phase imaging with pseudo capsule consistent\nwith OPTN 5A (10:39, 12:39).\n\nA 1.1 cm arterially hyperenhancing lesion in segment ___ demonstrates washout\nand pseudo capsule on delayed phase imaging consistent with OPTN 5A (10:18).\n\nHeterogeneous nodular arterial hyperenhancement in segment VIII is associated\nwith moderate distal biliary ductal dilatation and focal areas of washout,\nmeasuring up to 4.3 x 2.9 cm in greatest extent (10:26). This meets OPTN 5B\ncriteria for HCC.\n\nA T2 hypointense, T1 hyperintense cavity measuring 3.3 x 2.5 cm at the\njunction of segment II and segment III demonstrates no enhancement on\npostcontrast imaging and is consistent with an area of prior ablation (14:34).\nSuperior and slightly posterior to this is an area of nodular arterial\nhyperenhancement without correlate on delayed phase imaging, possibly due to\nperfusional change. No definite evidence of local recurrence.\n\nMultiple additional areas of arterial hyperenhancement have no correlate on\ndelayed phase imaging and are indeterminate, possibly transient hepatic\nintensity differences or perfusional changes (10:26, 10:23, et al). Attention\non follow-up imaging is recommended.\n\nBiliary: Aside from the segmental biliary ductal dilatation in segment ___\ndescribed above, there is no intra or extrahepatic biliary ductal dilatation. \nThe gallbladder is contains numerous gallstones and is otherwise unremarkable.\n\nPancreas: The pancreas is normal in signal intensity and morphology without\nductal dilatation. There is no focal lesion.\n\nSpleen: A simple cyst is noted within the spleen (___:27).\n\nAdrenal Glands: Bilateral adrenal glands are normal.\n\nKidneys: There is no hydronephrosis. There is no suspicious renal lesion.\n\nGastrointestinal Tract: No focal abnormality.\n\nLymph Nodes: No lymphadenopathy by imaging criteria.\n\nVasculature: No focal abnormality. Hepatic arterial anatomy is conventional.\n\nOsseous and Soft Tissue Structures: No suspicious osseous lesion. No focal\nabnormality.", "output": "1. Multifocal HCC as described above with 2 lesions meeting OPTN 5B criteria\nand 2 lesions meeting OPTN 5A criteria.\n2. The largest HCC extends exophytically through the liver capsule. A smaller\nHCC in segment ___ causes upstream biliary obstruction.\n3. Post treatment changes in segment II related to prior ablation without\ndefinite local recurrence.\n4. Cirrhotic liver with sequelae of portal hypertension including moderate\nascites and variceal formation." } ] }