{ "Contributors": "MIMIC", "Source": "MIMIC-IV", "URL": "https://www.physionet.org/content/mimic-iv-note/2.2/", "Categories": [ "Summarization" ], "Definition": [ "Summarize the CT imaging diagnostics' detailed findings for the Spine into a concise conclusion." ], "Reasoning": [], "Input_language": [ "English" ], "Output_language": [ "English" ], "Instruction_language": [ "English" ], "Domains": [ "Medicine", "Clinical Reports", "CT", "Spine" ], "Positive Examples": [], "Negative Examples": [], "Instances": [ { "input": "There is no evidence of acute fracture in the cervical spine. There is 3 mm\nretrolisthesis of C4 on C5, which is chronic appearing and unchanged from the\nprior exam. Severe, multilevel degenerative change is noted mostpronounced at\nC4-5 with moderate to severe spinal canal narrowing. There is moderate\nmultilevel uncovertebral and facet joint hypertrophy.\n\nNo prevertebral soft tissue swelling is present. The patient is status post\nthyroidectomy with surgical clips seen in the thyroid bed.", "output": "No evidence of acute fracture or change in alignment.\n\nMultilevel degenerative change noted throughout the cervical spine most severe\nat C4-5 with moderate central canal narrowing." }, { "input": "Alignment is preserved.No fractures are identified.Mild degenerative changes\nincluding intervertebral disc height loss at C4-5. Left worse than right\nfacet joint hypertrophy spans C2-3 through C4-5 without significant canal or\nforaminal narrowing. There is no prevertebral soft tissue swelling.\n\nThyroid is unremarkable. Dense atherosclerotic calcifications noted in the\ncarotid arteries.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Exaggerated thoracic kyphosis causes oblique quit T of the cervical spine on\naxial images, limiting evaluation. The bones are demineralized. There is a\nfracture of the anterior superior corner of C5 of unknown chronicity, image\n602:32, with associated disc bulge. No definite prevertebral edema is seen. \nThere is associated 2 mm retrolisthesis of C4 on C5 without disc space\nwidening. There is also 1-2 mm anterolisthesis of C6 on C7 with anterior disc\nspace widening. There is 1 mm anterolisthesis of C7 on T1 without disc space\nwidening.\n\nDisc protrusions and endplate osteophytes mildly indent the ventral thecal sac\nat multiple levels. There is multilevel neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nThere is calcified pleural/parenchymal scarring and mild emphysema the\nvisualized lung apices. Partially visualized thyroid gland is unremarkable. \nMultifocal arterial calcifications are noted. This exam is not technically\noptimized for evaluation of the included brain parenchyma, which is better\nassessed on the head CT from 1 day earlier on ___.", "output": "1. C4 anterior superior corner fracture of unknown chronicity. Associated 2\nmm retrolisthesis of C4 on C5 without disc space widening, and a disc bulge\nwithout definite prevertebral edema.\n2. 1-2 mm anterolisthesis of C6 and C7. Associated anterior disc space\nwidening, which may be secondary to traumatic injury versus sequela of the\nexaggerated cervical lordosis in the setting of exaggerated thoracic kyphosis.\n3. 1 mm anterolisthesis and C7 of T1, likely degenerative.\n4. Multilevel degenerative disease.\n5. Mild emphysema at the included lung apices.\n\nRECOMMENDATION(S): Cervical spine MRI to assess for ligamentous and other\nsoft tissue injury.\n\nNOTIFICATION: Impression items 1 and 2 and the recommendation for MRI were\ndiscussed over the telephone by Dr. ___ with Dr. ___ in the emergency\ndepartment on ___ at approximately 10:00." }, { "input": "Multilevel degenerate changes are seen about C5 and C6 without evidence of\nacute fracture or malalignment.\nThere is no prevertebral edema.\n\nThe lung apices are unremarkable. The thyroid is heterogeneous with a 2.6 cm\nright lower lobe nodule that can be evaluated with follow-up imaging for\nfurther characterization.", "output": "1. No evidence of acute fracture or dislocation..\n2. Multilevel degenerate changes are seen about C5 and C6 with disc space\nnarrowing.\n3. 2.6 cm right lower thyroid nodule that can be further assessed with\nfollow-up ultrasound.\n\nRECOMMENDATION(S): Recommend follow-up ultrasound for right lower thyroid\nnodule if clinically appropriate once patient is stabilized." }, { "input": "Alignment is normal. No fractures are identified. There are moderate to\nsevere degenerative changes from C3 through C6 characterized by endplate\nosteophyte formation, loss of intervertebral disc height, and anterior wedging\nof the C4 vertebral body, findings which have progressed since ___. No\nprevertebral soft tissue swelling is demonstrated.", "output": "Multilevel degenerative changes, progressed since ___, predominantly from C3\nthrough C6, however no evidence of acute fracture or malalignment." }, { "input": "There is no fracture or prevertebral soft tissue fluid. The imaged cervical\nand upper thoracic vertebral bodies are normally aligned. There is mild\nmultilevel cervical spine degenerative change, with mild disc height loss,\nendplate sclerosis, and intervertebral osteophytes. There is mild spinal\ncanal narrowing worst at C4-5 due to a posterior central disc bulge (series 3,\nimage 45). There is mild neural foraminal narrowing worst on the right at\nC3-4 (series 3 image 39) and C5-6 (series 3, image 55) due to uncovertebral\nosteophytes.\n\nThe thyroid is unremarkable. There is no cervical lymphadenopathy. The\npartially imaged lung apices are clear.", "output": "1. No cervical or upper thoracic spine fracture or prevertebral fluid. No\nmalalignment.\n2. Mild multilevel cervical spine degenerative change, as above." }, { "input": "No fracture is seen involving the cervical spine. Multilevel degenerative\ndisc disease is noted extending from C4 through C7 with disc space narrowing\nnoted. Subtle anterolisthesis of C2 on 3 and C3 on 4 is likely chronic. No\nprevertebral edema is seen. There is a cystic structure in the right\nsupraclavicular fossa best seen on series 3, image 55 measuring 2.9 x 3.9 x\n2.4 cm. This cystic lesion is partially calcified along the periphery and\ncentral attenuation suggests simple fluid content. The thyroid gland is\npartially visualized and appears normal.", "output": "1. No fracture. Subtle anterolisthesis of C2 and C3 likely chronic, though\nclinical correlation advised.\n2. Degenerative changes as stated.\n3. Cystic lesion within the right supraclavicular fossa measuring 2.9 x 3.9 x\n2.4 cm, is indeterminate. Please correlate clinically, consider ultrasound or\nMRI to further assess." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is intervertebral disc space\nnarrowing and subchondral sclerosis of the lower cervical vertebral bodies\ncompatible with degenerative changes, most significant in C5-C7. There is\ndiffuse left-sided facet arthropathy of the cervical spine. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Severe emphysematous changes are noted in the partially visualized\nlung apices. The cervical esophagus appears patulous.", "output": "1. No evidence of fracture or malalignment.\n2. Moderate degenerative changes in the cervical spine.\n3. Severe emphysematous changes in the lung apices." }, { "input": "There is mild straightening of the cervical spine. No fractures are\nidentified.There are moderate multilevel degenerative changes of the cervical\nspine with multilevel central disc protrusion and effacement of the ventral\nthecal sac. There is mild to moderate central canal stenosis from C2 through\nC7. There is no prevertebral soft tissue swelling.There is no evidence of\ninfection or neoplasm. There is diffuse osteopenia. The thyroid and partially\nvisualized bilateral lung apex are grossly unremarkable.", "output": "1. No evidence of acute cervical spine fracture.\n2. Moderate multilevel degenerative changes of the cervical spine with mild to\nmoderate central canal stenosis." }, { "input": "There is loss of normal cervical spinal lordosis; alignment is otherwise\nnormal. No fractures are identified.There is mild spinal canal narrowing at\nC6-C7 secondary to degeneration. There is no significant foraminal\nnarrowing.There is no prevertebral edema. There is calcification at the left\ncarotid siphon.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute cervical fractures." }, { "input": "Straightening of the typical cervical lordosis. Otherwise, the alignment is\nnormal. No acute cervical spine fractures are identified.There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute cervical spine fracture or traumatic malalignment." }, { "input": "Cervical vertebral bodies are maintained in height and alignment. There is no\nfracture. There is preservation of the normal cervical lordosis. Prevertebral\nsoft tissues are unremarkable. Mild degenerative changes with anterior\nosteophyte formation at the C3 and C4 level as well as C5 level are noted.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or malalignment." }, { "input": "Alignment is normal. No acute cervical spine fractures are identified. There\nis no critical spinal canal stenosis. There is no prevertebral soft tissue\nswelling. Mild degenerative changes with anterior osteophyte formation at C3,\nC4, and C5 are similar to prior. The lung apices are clear, the thyroid gland\nappears unremarkable.", "output": "There is no evidence of acute cervical spine fracture or traumatic\nmalalignment." }, { "input": "Alignment is normal. No acute fractures are identified.Degenerative changes\nwith anterior osteophytes at C3-C4 and C5 the remained stable since the prior\nexamination. There is mild, stable, multilevel central canal narrowing. \nAnterior soft tissue superior similar to comparison examination.\n\nThe visualized thyroid and lung apices are unremarkable.", "output": "1. No acute abnormality." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fractures or dislocations." }, { "input": "Dental amalgam streak artifact limits study. There is straightening of\ncervical lordosis. No fractures are identified.Multilevel degenerative\nchanges of the cervical spine are again noted, including loss of\nintervertebral disc height, disc osteophyte complexes and facet joint\nhypertrophy, with at least mild vertebral canal narrowing at C4-5. There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. Dental amalgam streak artifact limits study.\n2. No cervical spine fracture or traumatic malalignment.\n3. Multilevel degenerative changes cervical spine as described, with at least\nmild vertebral canal narrowing at C4-5." }, { "input": "Alignment is normal. No acute fractures are identified. Chronic deformity of\nthe right first rib is noted. There is no significant canal or foraminal\nnarrowing. There is no prevertebral soft tissue swelling.\n\nThyroid and lung apices are unremarkable.", "output": "No acute fracture or traumatic subluxation of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified. Mild degenerative changes of the cervical spine consistent with\nanterior and posterior spondylosis, more significant from C3-C4 through C6-C7\nlevels. There is no evidence of severe spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. The lung apices are\nclear, the thyroid gland appears unremarkable.", "output": "1. No acute fracture or traumatic subluxation.\n\n2. Multilevel degenerative changes throughout cervical spine, more\nsignificant from C3-C4 through C6-C7 levels." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Mild multiple degenerative\nchanges of the cervical spine with anterior and posterior osteophytes,\nendplate sclerosis and disc space narrowing. There is mild asymmetry of the\nleft atlantooccipital joint due to patient head rotation. There is a small\ndisc bulge at C4-C5 causing mild canal narrowing, better characterized on MR\ncervical spine from ___. Mild left neural foraminal narrowing at C5-C6 and\nC6-C7 from facet and uncovertebral hypertrophy is unchanged. There is no\nevidence of new spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\n There is no evidence of infection or neoplasm. There is subtle fat stranding\nalong the left lower lateral neck (03:42) without associated fluid collection.", "output": "1. No acute fracture or acute malalignment.\n2. Mild multilevel degenerative changes of cervical spine with small posterior\ndisc bulge at C4-C5 causing mild canal narrowing as well as C5-C6 and C6-C7\nmild left neural foraminal narrowing, unchanged from ___ MR.\n3. Mild fat stranding of left lower lateral neck likely represents seat belt\ninjury with soft tissue contusion." }, { "input": "There is no evidence for a fracture. There is near complete fusion of C3 and\nC4 vertebral bodies and right C3-C4 facet joint, and complete fusion of the\nleft C3-C4 facet joint. There is mild anterolisthesis of C4 on C5 and mild\nretrolisthesis of C5 on C6. There is a levoconvex curvature centered in the\nthoracic spine, incompletely evaluated. There is advanced disc space\nnarrowing with endplate cystic changes and endplate osteophytes from C4-C5\nthrough C6-C7. There is also ossification of the anterior longitudinal\nligament at C5-C6 through C6-C7.\n\nC2-C3: No significant spinal canal narrowing. Mild right neural foraminal\nnarrowing by facet osteophytes.\n\nC3-C4: Broad-based posterior endplate osteophytes minimally indent the ventral\nthecal sac. Mild to moderate right and moderate left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Central disc protrusion and overlying endplate osteophytes indent the\nventral thecal sac with mild-to-moderate spinal canal narrowing. Also\nmoderate right and severe left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC5-C6: Broad-based central disc protrusion and overlying endplate osteophytes,\nlarger on the right than left, cause moderate spinal canal narrowing. There\nis severe, right greater than left neural foraminal narrowing by uncovertebral\nand facet osteophytes.\n\nC6-C7: Small central disc protrusion may minimally indent the ventral thecal\nsac. There is moderate right and moderate to severe left neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nC7-T1: No significant spinal canal narrowing. Moderate narrowing of the\ndistal right neural foramen by facet osteophytes. Moderate to severe\nnarrowing of the left neural foramen by facet osteophytes.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma. Visualized posterior fossa appears grossly unremarkable. The\nthyroid is grossly unremarkable. Visualized upper lungs are clear.", "output": "1. Multilevel cervical degenerative disease with up to moderate spinal canal\nstenosis at C5-C6, as well as up to severe multilevel neural foraminal\nnarrowing.\n2. Ossification of the anterior longitudinal ligament from C5 C6 through C6.\n3. No evidence for a fracture.\n4. Near complete fusion of C3 and C4.\n5. Mild anterolisthesis of C4 on C5 and mild retrolisthesis of C5 on C6 is\nlikely degenerative, though there are no comparison exams to confirm\nchronicity." }, { "input": "Alignment is normal. No fractures are identified.There is minimal multilevel\nosteophytosis and intervertebral disc height loss with incidental note made of\nC4-C5 facet arthrosis on the left. No significant osseous spinal canal or\nneural foraminal narrowing.There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm.", "output": "1. No evidence of fracture or malalignment.\n2. Minimal cervical spine osteoarthritis." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. There is no significant spinal canal\nstenosis or neural foraminal narrowing.\nThe thyroid gland is unremarkable. Minimal paraseptal emphysema is noted in\nthe lung apices. There is no cervical lymphadenopathy.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Postoperative changes of spinal fusion identified from L3 to L5 level. There\nis no compression fracture seen. At L2-3 level there is spinal canal\nnarrowing identified. At L3-4 L4-5 and L5-S1 levels laminectomies are seen. \nAt L4-5 grade 1 spondylolisthesis of L4 over L5 seen. There is no evidence of\nspondylolysis at L2 level. Vascular calcifications are identified. No\ncompression fracture is seen. The metallic implants appear unchanged in\nposition compared to the previous CT of ___ with left L5 screw\nprojecting anteriorly. No lucencies are seen surrounding the implants.", "output": "1. Postoperative changes are identified. Spinal stenosis is seen at L2-3\nlevel above the level of surgery. This is better demonstrated on the MRI of\nthe same day. No evidence of an acute fracture identified. Osteopenia seen." }, { "input": "The lumbar spine alignment appears maintained.No acute lumbar spine fractures\nare identified.Mild degenerative changes are visualized in the lower lumbar\nspine consistent with diffuse disc bulging at L3-L4, causing mild anterior\nthecal sac deformity and mild bilateral neural foraminal narrowing,\nadditionally there is mild articular joint facet hypertrophy with sclerotic\nchanges.\n\nAt L4-5 level, there is diffuse disc bulge causing mild bilateral neural\nforaminal narrowing, mild bilateral articular joint facet hypertrophy is seen.\n\nAt L5-S1 level, there is a prominent osteophytic formation causing anterior\nthecal sac deformity, mild diffuse disc bulge is seen causing mild bilateral\nneural foraminal narrowing, there is also mild articular joint facet\nhypertrophy.\n\nThe sacroiliac joints and the visualized paravertebral structures are\nunremarkable, vascular atherosclerotic calcifications are seen in the\nabdominal aorta and iliac arteries.", "output": "1. There is no evidence of lumbar spine fracture or lumbar spine malalignment.\n2. Mild-to-moderate multilevel degenerative changes throughout the lower\nlumbar spine, more significant at L3-L4, L4-5 and L5-S1 levels.\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified.There is no significant canal or foraminal narrowing.There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Endotracheal tube and\nenteric tube are noted. Several foci of gas are present behind the left\nclavicle, please see separate CT chest from the same day.", "output": "No acute fracture or traumatic malalignment in the cervical spine.\nSeveral foci of gas are present posterior to the left clavicle. Please see\nsame-day CT chest for further description of these findings." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Within the limits of this noncontrast study, there is no\nevidence of infection or neoplasm. The lung apices appear clear. The thyroid\ngland is preserved. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Nonspecific subcentimeter cervical lymph nodes as described, which may be\nreactive." }, { "input": "Exam is mildly motion degraded at the C2 level. Alignment is normal. No\nfractures are identified.There is no significant canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or malalignment." }, { "input": "Minimal anterolisthesis of C4 on C5 is likely degenerative.No fractures are\nidentified.There is no prevertebral soft tissue swelling. There is no severe\nneuroforaminal or spinal canal narrowing. Multilevel degenerative changes\npresent with disc height loss, facet arthropathy, osteophytosis, worse from C5\nthrough C7. A hemangioma is present in the T3 vertebral body, partially\nvisualized\n\nSurgical clips are consistent with prior right partial thyroidectomy. Right\napical lung scarring is re-demonstrated, minimally more prominent than in\n___. Calcified left cervical and axillary some lymphadenopathy is\nre-demonstrated consistent with prior granulomatous infection.", "output": "1. No fracture or traumatic malalignment in the cervical spine.\n2. Multilevel degenerative changes mild anterolisthesis of C4 on C5, likely\ndegenerative." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm.", "output": "No acute fracture traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are noted with loss of disc height and mild anterior and posterior\nosteophytes worse at C4-5 and C5-6. Small disc osteophyte complexes at C4-5\nand C5-6 indent the thecal sac anteriorly. There is no prevertebral soft\ntissue swelling.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Motion artifact limits assessment, study was repeated twice.\n\nPatient is in a collar. Alignment is maintained.\n\nNo acute cervical spine fractures are identified.\n\nMild multilevel posterior disc osseous complex, early uncovertebral arthrosis\nand facet hypertrophy, most pronounced at C2-C3 and C4-C5 and C6/C7 with up to\nmild central canal narrowing, but no significant neural foraminal narrowing.\n\nThere is no prevertebral soft tissue swelling. The thyroid is mildly\nheterogeneous, but no discrete thyroid nodules are identified.\n\nThe imaged lung apices are unremarkable.", "output": "1. No evidence of acute cervical spine fracture or traumatic malalignment.\n2. Mild, multilevel degenerative changes." }, { "input": "No acute fracture. There is retrolisthesis of L2 on L3 as well as L3 on L4,\nlikely degenerative nature. There is no prevertebral soft tissue swelling. \nMultilevel, multifactorial degenerative changes are identified with extensive\nvacuum disc phenomenon, disc space narrowing, endplate osteophyte formation\nand irregularity. There is also extensive facet hypertrophy throughout the\nentire lumbar spine. There is a large disc bulge at L4 to L5 causing at least\nmoderate spinal canal stenosis and a disc bulge at L5-S1 causing moderate to\nsevere spinal canal narrowing. There is also likely narrowing of the left\nneural foramen at L4-L5 as well as bilateral neural foraminal narrowing at\nL5-S1.\n\nEvaluation of the paraspinal soft tissues demonstrate moderate atherosclerotic\ndisease of the abdominal aorta. There is sigmoid diverticulosis. Coarse\ncalcifications are noted within the uterus. A 2 mm nonobstructing stone is\nnoted in the interpolar region of the left kidney.", "output": "1. No acute fracture of the lumbar spine.\n2. Extensive multilevel degenerative changes as described above, most severe\nat L4-L5 and L5-S1 with moderate to severe neural foraminal narrowing and\nspinal canal stenosis.\n3. Sigmoid diverticulosis.\n4. 2 mm punctate non obstructing left renal stone." }, { "input": "Alignment is normal. No spine fractures are identified.There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nRight clavicular and left posterior second rib fracture are seen on concurrent\nCT torso.\n\nThe thyroid and included lung apices are unremarkable. Endotracheal and\nenteric tubes are partially visualized.", "output": "No acute cervical fracture or subluxation." }, { "input": "There is mild-to-moderate dextroscoliosis of the mid lumbosacral spine\ncentered at approximately L3. Mild right lateral spinal listhesis of L4 on L5\nis unchanged. Otherwise, the imaged lumbar vertebral bodies are normally\naligned. Vertebral body heights are preserved. Mild anterior wedging of T12\nis unchanged since the prior MR ___. Minimal anterior height\nloss of T11 is likely physiologic. Elsewhere, there is no evidence of lumbar\nspine fracture or traumatic malalignment. A right L5 pars defect is\nunchanged.\n\nThere is severe multilevel, multifactorial lumbar spine degenerative change. \nAlthough the degree of spinal canal and neural foraminal narrowing is not well\nassessed by CT, there is probably at least moderate spinal canal narrowing at\nL4-5 due to a posterior disc bulge/protrusion (series 2, image 85). \nMultilevel neural foraminal narrowing appears severe on the right at L5-S1 and\non the left at L4-5 (see series 602b, images 42 and 31). There are no\nconcerning focal lytic or sclerotic osseous lesions identified. There is\ndiffuse subjective osseous demineralization.\n\nThere is severe infrarenal abdominal aortic calcification without aneurysm or\ndilation. There is no evidence of retroperitoneal mesenteric lymphadenopathy.\nNo evidence of acute focal abnormality within the imaged retroperitoneum,\nabdomen, or pelvis.", "output": "1. No evidence of fracture or new malalignment within the lumbar spine.\n2. Within limitation of CT scan, no appreciable interval change in severe\nmultilevel, multifactorial lumbar spine degenerative change causing multilevel\nspinal canal and neural foraminal narrowing which is suboptimally assessed by\nCT. Grossly, there is unchanged spinal canal narrowing which is at least\nmoderate and most pronounced at L4-5 due to disc disease, as well as left L4-5\nand right L5-S1 severe neural foraminal narrowing, also not appreciably\nchanged." }, { "input": "The imaged cervical vertebral bodies are normally aligned. Re- demonstrated\nis C5-7 anterior spinal fusion hardware which appears intact without evidence\nof fracture, perihardware lucency to suggest loosening, or other hardware\nrelated complication. Osseous ankylosis of the C5 through C7 vertebral bodies\nis unchanged. There is no evidence of fracture through the fused vertebral\nbodies. The facet joints are normally aligned. There is trace prevertebral\nfluid primarily seen at the level of C4-5 (2, 40), new from the prior exam of\n___. There is no discrete fracture or new malalignment seen. There\nis mild multilevel cervical spine degenerative change. Mild spinal canal\nnarrowing is most pronounced at C3-4 due to a posterior disc bulge (3, 30). \nMild neural foraminal narrowing is most pronounced on the right at C5-6 (3,\n44) due to uncovertebral osteophytosis.\n\nCarotid bulb calcifications are noted bilaterally. The thyroid gland is\nmildly heterogeneous and demonstrates internal calcifications but without\ndiscrete, measurable nodule. A calcified right level III calcified focus is\nunchanged, possibly phleobliths with a venolymphatic malformation or a\ncalcified lymph node. Otherwise, there is no cervical lymphadenopathy. \nPartially visualized is right mastoid air cell opacification.", "output": "1. New trace prevertebral edema is noted, nonspecific. It is difficult to\nexclude ligamentous injury given this appearance. If clinically indicated, MRI\nwould better assess for ligamentous injury.\n2. Otheriwse, no CT evidence of cervical spine fracture or malalignment.\n3. Intact C5-7 anterior spinal fusion hardware without evidence of\ncomplication.\n4. Mild multilevel cervical spine degenerative change causing mild right-sided\nneural foraminal narrowing at C4-5. No spinal canal stenosis.\n5. Right mastoid air cell opacification.\n6. Unchanged right level III calcified focus, venolymphatic malformation\nversus calcified lymph node." }, { "input": "There is no traumatic malalignment. No acute fracture is identified. Patient\nis status post anterior spinal fusion from C5 through C7 with osseous fusion\nat those levels. Postsurgical changes are noted along the posterior vertebral\nbodies at C5 through C7. Mild spinal canal narrowing at C3-4 due to\nuncovertebral hypertrophy and disc protrusion is stable. There is no\nprevertebral soft tissue swelling. Calcified nodules in the thyroid are\nunchanged. Sclerotic focus at T2 is likely a bone island, unchanged. A 13 mm\nsoft tissue nodule with internal calcification in the neck on the right is\nstable and may represent a vascular/lymphatic malformation or calcified lymph\nnode. Mucosal thickening of the subglottic airway is overall stable, mildly\nnarrowing the level of the false and true cords. This is likely due to post\nradiation changes.", "output": "1. No traumatic malalignment or acute fracture.\n2. Postsurgical changes from anterior spinal fusion from C5 through C7." }, { "input": "Again noted is a displaced type 2 dens fracture, with approximally 9 mm of\nposterior displacement of the superior fracture fragment, and 2 mm of inferior\ndisplacement, overall not significantly changed in alignment allowing for\ndifferences in patient positioning. A posterior portion of sheared cortex\nwhich is bowed is similar to prior. There has been interval minimal increase\nin sclerosis of the fracture lines, with no significant interosseous bridging.\nPosterior subluxation of the lateral masses of C1 with respect to C2 is\nsimilar to prior. There is associated narrowing of the spinal canal at C1,\nwith no definite associated cord impingement. Tiny ossific fragments anterior\nto the dens are similar to prior, and may represent calcification of the\nlongus ___. There has been interval slight decrease in prevertebral soft\ntissue swelling.\n\nAlignment is otherwise maintained, with no additional fractures seen. Mild\nmultilevel degenerative changes throughout the remainder of the cervical spine\nare similar to prior.\n\nA 1.6 x 1.2 cm calcified right thyroid nodule is not significantly changed.", "output": "Re- demonstration of a posteriorly and inferiorly displaced type 2 dens\nfracture, with associated posterior subluxation of the lateral masses of C1,\nand narrowing of the spinal canal without definite cord impingement, not\nsignificantly changed in alignment allowing for differences in patient\npositioning. There has been interval minimal sclerosis of the fracture line,\nwith no significant interosseous bridging." }, { "input": "CERVICAL SPINE:\nMild to moderate degenerative changes are seen in the cervical spine with\nexaggeration of the normal cervical lordosis.\n\nWithin the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is a hypodensity with calcifications within the right\nthyroid lobe, measuring up to 2.8 cm (series 3: Image 90), as well as a\nhypodensity within the left thyroid lobe, measuring up to approximately 1.0\ncm, likely thyroid nodules. Extensive atherosclerotic vascular calcifications\nare noted.\n\nThere is no prevertebral soft tissue swelling.. The visualized portion of the\nposterior fossa, cervicomedullary junction, paranasal sinuses and lung\napicesare preserved.\n\nAt the C1-2, there is a chronic appearing type II odontoid process fracture\nwith approximately 8 mm of posterior displacement of the odontoid fracture\nfragment, which is stable compared to the prior CT exam in ___. \nAgain seen is posterior subluxation of the lateral masses of C1 with respect\nto C2, also not significantly changed since the prior study.\n\nThere is mild sclerosis surrounding the fracture site which is reflective of\nhealing, without evidence of significant interval intraosseous bridging or\ncallus formation, potentially concerning for nonunion.\n\n At C2-3 there is no vertebral canal narrowing. Mild bilateral neural\nforaminal narrowing is noted due to facet joint hypertrophy and uncovertebral\nhypertrophy.\n\nAt C3-4 there is mild posterior disc bulge which is seen narrowing the ventral\nCSF space. No evidence of neural foraminal stenosis.\n\nAt C4-5 there is mild posterior disc bulge, uncovertebral hypertrophy, and\nbilateral facet joint hypertrophy causing narrowing of the vertebral canal\nwith contact upon the ventral thecal sac and mild bilateral neural foraminal\nstenosis.\n\nAt C5-6 there is mild posterior disc bulge and uncovertebral hypertrophy which\ncauses narrowing of the central CSF space without evidence of neural foraminal\nstenosis.\n\nAt C6-7 there is no vertebral canal or neural foraminal stenosis.\n\nAt C7-T1 there is no vertebral canal or neural foraminal stenosis.", "output": "1. At the C1-C2, there is unchanged appearance of a known type 2 odontoid\nprocess fracture with continued 8 mm of posterior displacement of the fracture\nfragment as well as persistent posterior subluxation of the lateral masses of\nC1 moved respect to C2 since the prior exam in ___. No evidence\nof significant interval intraosseous bridging or callus formation, which is\nconcerning for potential nonunion.\n2. Multilevel mild degenerative changes are seen throughout the cervical\nspine.\n3. A calcified right thyroid nodule is similar to prior exam in ___, but should be further evaluated with a dedicated thyroid ultrasound.\n\nRECOMMENDATION(S): Point 3. A calcified right thyroid nodule is similar to\nprior exam in ___, measuring up to 2.8 cm (series 3: Image 90),\nevaluation with a dedicated thyroid ultrasound is recommended for further\ncharacterization." }, { "input": "Again seen is a transverse fracture through the anterior right arch of C1 and\ncomminuted fracture of the posterior right arch of C1.There is anterolateral\ndistraction of the right lateral mass of C1 with respect to the remainder of\nthe C1 vertebral body. This appears increased compared to ___,\neven allowing for differences in planes of scanning (for example,\nanterolateral distraction measuring 8 mm on axial view at 2:20, previously 5\nmm, or 10 mm on coronal view on 601b:20, previously 7 mm).An ossific fragment\nadjacent to the dens compatible with transverse ligament avulsion. However,\nthe interval between the anterior and posterior arches of C1 and the dens\nremains preserved.There is persistent mild edema anterior to the C1 and C2\nvertebral bodies.\n\nThere is widening of the articulations of the the C1-2 lateral masses\nbilaterally. This appears unchanged since the prior study.\n\nAgain seen is expansion and sclerosis of the body in ankle of the left\nmandible most suggestive of fibrous dysplasia. Within the limits of this\nnoncontrast exam, there is no evidence of infection or neoplasm.", "output": "1. Increased anterolateral distraction of the right lateral mass of C1 with\nrespect the remainder of the C1 vertebral body.\n2. Findings compatible with transverse ligament avulsion. However, the\ninterval between the anterior and posterior arches of C1 and the dens remain\npreserved, unchanged.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 7:35 ___, 10 minutes after\ndiscovery of the findings." }, { "input": "Again seen is a transverse fracture through the anterior right arch of C1 and\na comminuted fracture of the posterior right arch of C1. Anterolateral\ndistraction of the right lateral mass of C1 with respect to the remainder of\nthe C1 vertebral body has remained stable since the prior examination,\napproximately 8 mm (2: 13). An ossific fragment is again seen adjacent to\nthe dense. The interval between the anterior and posterior arches of C1 and\nthe dens appears preserved. Widening of the articulations of the C1/2 lateral\nmasses is stable.", "output": "1. Overall stable examination since ___ of known C1 fracture ." }, { "input": "Alignment is normal. No fractures are identified.At L4/L5 and L5/S1 levels,\nthere is mild disc bulge, causing anterior thecal sac deformity, partially\nevaluated in this exam, correlation with MRI is advised for further\ncharacterization if clinically warranted. There is no prevertebral soft tissue\nswelling.No concerning lytic or sclerotic lesions identified in the lumbar\nspine. There is no abnormal enhancement on post contrast imaging. Partially\nimaged intra-abdominal structures are grossly unremarkable. Please note that\nthis study is not tailored for evaluation of abdominal lymphadenopathy, which\nwould be better assessed with a contrast enhanced abdominal CT.", "output": "Mild disc bulging is identified at L4/L5 and L5/S1 levels, partially evaluated\nin this exam, if clinically warranted, correlation with MRI of the lumbar\nspine is recommended for further characterization. There is no evidence of\nabnormal enhancement.\n\nRECOMMENDATION(S): Mild disc bulging is noted at L4/L5 and L5/S1 levels,\npartially evaluated in this exam, correlation with MRI of the lumbar spine is\nrecommended for further characterization and if clinically warranted." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no abnormal enhancement on post contrast imaging. \nNo concerning lytic or sclerotic lesion is identified.\n\nEvaluation of the partially imaged lung parenchyma is limited by respiratory\nmotion. There is suggestion of an opacity at the right lung base (3:75),\nwhich may be due to atelectasis, although superimposed infection cannot be\nexcluded. Additionally, this study is not tailored for evaluation of\nintrathoracic lymphadenopathy.", "output": "1. No fracture or malalignment.\n2. Limited evaluation of the lung parenchyma reveals a right lung base opacity\nthat most likely represents atelectasis. If there is concern for pneumonia, a\nchest radiograph should be obtained.\n3. Please note that this study is not tailored for evaluation of mediastinal\nlymphadenopathy, which would be better assessed with a contrast enhanced chest\nCT." }, { "input": "Alignment of the cervical spine is normal. No fractures are identified. \nThere is no prevertebral soft tissue swelling.\n\nThere are enlarged cervical lymph nodes bilaterally, measuring up to 1.4 cm at\nlevel II on the right (6b:21), and up to 1.2 cm at level II on the left\n(6b:19). At level 3 on the right, the largest lymph node measures up to 1.3\ncm in short axis (6b:21).\n\nThere are changes of degenerative disc disease with a broad bulge of the disc\nat C2-3 mildly encroaching on the spinal canal. The neural foramina appear\nnormal.\n\nAt C3-4, there is a midline disc protrusion that indents the anterior surface\nof the spinal cord. The neural foramina appear normal.\n\nAt C4-5, there is a midline protrusion of the intervertebral disc. The neural\nforamina appear normal.\n\nAt C5-6, there is a broad bulge of the intervertebral disc that contacts the\nanterior surface of the spinal cord. The neural foramina appear normal.\n\nThere are no significant abnormalities at C6-7 or C7-T1.", "output": "Bilateral cervical lymphadenopathy, for which the differential includes\nunderlying infection, inflammatory process or malignancy.\nDegenerative disc disease at multiple levels with disc bulges and protrusions\nnarrowing the spinal canal." }, { "input": "Alignment is normal. No fractures are identified.There is no prevertebral soft\ntissue swelling.Multilevel moderate degenerative changes along with\ncongenitally shortened pedicles cause up to moderate spinal canal narrowing at\nC4-C5, C5-C6, and C6-C7. There is moderate to severe right neural foraminal\nnarrowing at C6-C7. Soft tissue edema and locules of gas overlying the left\nmandible are compatible with laceration, better assessed on dedicated\nmaxillofacial CT exam. The lung apices are clear. Prominent posterior\nnasopharyngeal soft tissue is seen.", "output": "1. No acute fracture or traumatic malalignment in the cervical spine.\n2. Moderate cervical spondylosis.\n3. Prominence of the posterior nasopharyngeal soft tissues for which direct\nvisualization is recommended.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 7:25 pm, 4 minutes after\ndiscovery of the findings." }, { "input": "Alignment is normal. No acute fractures are identified.Multilevel\ndegenerative changes are seen, most extensive at C6-C7 and notable for\nmoderate bilateral neural foraminal stenosis.There is no prevertebral edema. \nMinimal fat in the fat planes are seen on this study.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is no evidence of acute fracture or prevertebral soft tissue swelling. \nMild anterolisthesis of C7 on T1 is likely degenerative in nature. Otherwise,\nthe cervical vertebral bodies demonstrate normal alignment. There is mild\nspinal canal narrowing due to prominent posterior osteophytes at C5-6 and\nC6-7. There is moderate to severe multilevel cervical spine degenerative\nchange. There is moderate to severe neural foraminal narrowing due to\nmultilevel uncovertebral osteophytosis and facet hypertrophy, worst on the\nleft at C3-4 (series 2, image 38). No concerning focal lytic or sclerotic\nosseous lesions are seen. An approximately 2.0 x 1.4 cm midline hypoenhancing\nthyroid nodule is identified within the isthmus (series 3, image 60). There\nis no cervical lymphadenopathy by CT size criteria. The partially imaged lung\napices are clear.", "output": "1. No fracture or prevertebral soft tissue fluid.\n2. Mild C7 on T1 anterolisthesis is likely degenerative in nature.\n3. Moderate to severe multilevel cervical spine degenerative change, as above.\n4. 2.0 x 1.4 cm midline/isthmic hypoenhancing thyroid nodule.\n\nRECOMMENDATION(S): Nonurgent/routine thyroid ultrasound could be performed\nfor 2.0 x 1.4 cm hypoenhancing midline/isthmic thyroid nodule, if not\npreviously performed elsewhere." }, { "input": "There is no evidence of fracture or malalignment within the thoracic spine. \nThere is severe multilevel, multifactorial degenerative change throughout the\nimaged thoracic spine, with multilevel disc height loss and confluent, flowing\nanterior and bridging osteophytes, compatible with diffuse idiopathic skeletal\nhyperostosis (DISH). There is mild spinal canal narrowing at T5-6 and at\nT12-L1 due to prominent disc osteophyte complexes at those levels. \nIncidentally noted is a 12 x 9 mm sclerotic density in the left aspect of the\nT3 vertebral body.\n\nAn 18 mm simple renal cyst arises from the superior right renal pole. \nModerate atherosclerotic calcification of the abdominal aorta is noted. \nOtherwise, the partially imaged abdominal and retroperitoneal solid and hollow\nviscous organs are unremarkable.\n\nAlso noted at right lung base is an area of irregular linear opacity in\napparent bronchovascular distribution, likely reflective of some component of\natelectasis and possibly superimposed small airways disease. There is no\npleural effusion. The large isthmic thyroid nodule is better characterized on\nsame-day CT cervical spine.", "output": "1. No evidence of fracture or malalignment.\n2. Severe multilevel, multifactorial degenerative change of the imaged\nthoracic spine, as above, including multilevel disc height loss and confluent,\nflowing anterior bridging osteophytes, compatible with diffuse idiopathic\nskeletal hyperostosis (DISH).\n3. Incidentally noted 12 x 9 mm sclerotic density in the left aspect of the T3\nvertebral body. Correlate with any history of malignancy.\n\nRECOMMENDATION(S): Nonurgent/routine bone scan could be performed for further\nevaluation of T3 sclerotic density if there is a history of malignancy." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies. Focal,\nwell-corticated scalloping involving the superior end-plate of the L2 and L3\nvertebral bodies likely represent chronic Schmorl's nodes. A Schmorl's node\nis additionally seen in the superior endplate of L1, with internal vacuum disc\nphenomenon. Levoscoliosis of the lumbar ___ at L4 is noted. \nAdditionally, there is approximately 10 mm of left lateral subluxation of L4\non L5, likely degenerative in nature. Additionally, there is grade 1 L4 on L5\nanterolisthesis, also likely degenerative. There is severe multilevel,\nmultifactorial degenerative change in the imaged lumbar spine, with marked\nmultilevel disc height loss, large anterior and posterior intervertebral\nosteophytes, and posterior element hypertrophy. Posterior element hypertrophy\nin addition to a prominent posterior osteophyte results in at least moderate\nspinal canal narrowing at L2-3 (series 3, image 31).\n\nColonic diverticula partially imaged. Mild to moderate atherosclerotic\ncalcifications are seen within the aorta and major branches. The partially\nimaged retroperitoneal and intra-abdominal solid and hollow viscous organs are\ngrossly unremarkable.", "output": "1. No evidence of acute fracture.\n2. Grade 1 L4-5 anterolisthesis, in addition to 10 mm of left lateral\nsubluxation of L4 on L5, are likely degenerative in nature.\n3. Marked levoscoliosis centered at L4.\n4. Severe multilevel, multifactorial lumbosacral spine degenerative change, as\nabove. In particular, there is moderate spinal canal narrowing at L2-3 due to\na prominent posterior osteophyte and facet hypertrophy." }, { "input": "No acute fracture identified. Moderate-to-severe multilevel degenerative\nchanges of the cervical spine, with disc height loss, disc bulge, facet joint\nhypertrophy, uncovertebral osteophytes, subchondral cyst formation and\nendplate sclerosis, most notable at C5-C6. Grade 1 listhesis of C7 on T1 is\nsimilar to prior. Posterior osteophytes and disc bulge C4-C5, C5-C6 and C6-C7\nresults in mild spinal canal narrowing. Moderate-to-severe the level\nneuroforaminal narrowing secondary to vertebral osteophytes and facet joint\nhypertrophy, most\nThe partially imaged 2.0 x 1.5 cm midline thyroid nodule is seen within the\nisthmus (3:55), also seen on the prior study. Lung apices are clear. There is\nno cervical lymphadenopathy by CT size criteria.", "output": "1. No acute fracture seen.\n2. Moderate-to-severe multilevel degenerative changes of the cervical spine.\nGrade 1 C7 on T1 anterolisthesis is similar to prior, likely degenerative in\nnature.\n3. Partially imaged 2.0 x 1.5 cm midline/isthmic thyroid nodule ;\nrecommendations remain per the prior study. Nonurgent thyroid ultrasound\ncould be performed, if not previously performed elsewhere." }, { "input": "Thoracic spine: Alignment is normal. No fractures are identified.Multilevel\ndegenerative changes are noted with bridging anterior osteophytes consistent\nwith DISH, loss of intervertebral disc height and facet arthropathy.There is\nno evidence of a paraspinal hematoma. There is a stable 1.2 cm sclerotic\nfocus in the left T3 vertebral body.\n\nLumbar spine: There is stable grade 1 anterolisthesis of L4 on L5. There is\nlevoconvex scoliosis centered at L3-L4. Focal linear lucency through the\nanterior bridging ossification at L2-3 is new since ___ and may be chronic,\nbut is of indeterminate age. There is no evidence of a paraspinal\nhematoma.Multilevel degenerative changes are noted with bridging anterior\nosteophytes and loss of intervertebral disc height.\n\nThere is mild left lung base atelectasis. A 1.9 cm stable hypodense thyroid\nnodule is seen in the isthmus. Atherosclerotic calcifications are seen along\nthe thoracic and abdominal aorta. There is diverticulosis of the colon\nwithout evidence of diverticulitis.", "output": "1. Focal linear lucency through the anterior ossification at L2-3, new since\n___ and of indeterminate age, but may be chronic, there is no evidence of\nparaspinal hematoma. No acute fracture seen elsewhere.\n2. Severe degenerative changes in the thoracic spine." }, { "input": "There is minimal anterolisthesis of C4 on C5 and C7 on T1, similar to prior. \nNo fractures are identified.Multilevel degenerative changes are seen, most\nextensive at C5-6 and C6-7 and notable for loss of intervertebral disc height,\nosteophytosis, and uncovertebral and facet hypertrophy causing mild spinal\ncanal narrowing. There is multilevel moderate neural foraminal narrowing. \nThere is fusion of the left C2-3 facet joints. There is no prevertebral\nedema.\n\nA 1.9 cm thyroid nodule is again seen in the isthmus stable. The included\nlung apices are unremarkable.", "output": "Multilevel degenerative changes of the cervical spine without acute fracture\nor traumatic malalignment." }, { "input": "Thoracic spine: Alignment is normal. No fractures are identified.Multilevel\ndegenerative changes are noted with bridging anterior osteophytes consistent\nwith DISH, loss of intervertebral disc height and facet arthropathy.There is\nno evidence of a paraspinal hematoma. There is a stable 1.2 cm sclerotic\nfocus in the left T3 vertebral body.\n\nLumbar spine: There is stable grade 1 anterolisthesis of L4 on L5. There is\nlevoconvex scoliosis centered at L3-L4. Focal linear lucency through the\nanterior bridging ossification at L2-3 is new since ___ and may be chronic,\nbut is of indeterminate age. There is no evidence of a paraspinal\nhematoma.Multilevel degenerative changes are noted with bridging anterior\nosteophytes and loss of intervertebral disc height.\n\nThere is mild left lung base atelectasis. A 1.9 cm stable hypodense thyroid\nnodule is seen in the isthmus. Atherosclerotic calcifications are seen along\nthe thoracic and abdominal aorta. There is diverticulosis of the colon\nwithout evidence of diverticulitis.", "output": "1. Focal linear lucency through the anterior ossification at L2-3, new since\n___ and of indeterminate age, but may be chronic, there is no evidence of\nparaspinal hematoma. No acute fracture seen elsewhere.\n2. Severe degenerative changes in the thoracic spine." }, { "input": "There is minimal anterolisthesis of C4 on C5 and C7 on T1, unchanged compared\nto most recent prior and likely due to degenerative changes. Alignment is\notherwise anatomic.No acute fractures are identified.Severe multilevel\ndegenerative changes are again seen, most extensive at C5 through C7 and\nnotable for loss of intervertebral disc height, osteophytosis, and\nuncovertebral and facet hypertrophy, causing mild spinal canal narrowing. \nMultilevel moderate neural foraminal narrowing. There is fusion of the left\nC2-3 facet joints. No prevertebral soft tissue swelling is identified. \nVisualized on the apices are unremarkable. Incidentally noted in the thyroid\ngland is an unchanged 1.8 cm hypodense nodule, unchanged compared to multiple\nprior.", "output": "1. No acute fracture or traumatic subluxation of the cervical spine.\n2. Severe, multilevel degenerative changes, most severe at C5 through C7, as\nabove.\n3. Unchanged 1.8 cm hypodense nodule in the thyroid gland." }, { "input": "Alignment is normal. No acute fractures are identified.Again seen are\nmultilevel degenerative changes with bridging anterior osteophytes, consistent\nwith DISH, as well as loss of intervertebral disc height and facet\narthropathy. There is no evidence of paraspinal hematoma.There is no\nprevertebral soft tissue swelling.There is an unchanged sclerotic focus in the\nleft portion of the T3 vertebral body. Partially visualized adrenal glands\nare unremarkable. There is no hydronephrosis. There is mild cortical\nthinning of the partially visualized bilateral kidneys. Bilateral lung fields\nare without focal consolidation.", "output": "1. No acute fracture or traumatic subluxation identified in the thoracic\nspine.\n2. Severe degenerative changes in the thoracic spine, as above." }, { "input": "There is levo-scoliotic curvature of the visualized lumbar spine with apex at\nthe L3-4 intervertebral disc. There is unchanged grade 1 anterolisthesis of\nL4 on L5. Previously seen linear lucency through the anterior bridging\nossification of L2-3 is less apparent on today's examination. No acute\nfractures are identified.There is no paraspinal hematoma. Multilevel\ndegenerative changes are severe and unchanged from prior, with bridging\nanterior osteophytes and loss of intervertebral disc height.", "output": "1. No acute fracture identified.\n2. Severe degenerative changes in the lumbar spine, similar compared to prior." }, { "input": "There is minimal anterolisthesis of C4 on C5 and C7 on T1, similar to prior. \nNo acute fractures are identified. There is no prevertebral edema. Mild retro\ndental degenerative pannus. Severe multilevel degenerative changes are again\nnoted, most extensive at C5-C7, with near complete loss of intervertebral disc\nspace height, osteophytosis, uncovertebral hypertrophy, and facet hypertrophy.\nThere is mild spinal canal narrowing at C5-C7 secondary to degenerative\nchange, similar to prior. Multi level facet arthropathy results in severe\nleft C3-C4 moderate to severe bilateral C4-C5, moderate bilateral C5-C6 and\nC6-C7 neural foraminal narrowing, similar to prior exam.\n\nThere is a 1.9 cm thyroid isthmus hypodense nodule. There are no pulmonary\nnodules in the visualized lung apices. There is no cervical lymphadenopathy\nby size criteria.", "output": "1. No acute cervical fractures identified. No traumatic malalignment.\n2. Severe degenerative changes as described above, similar to ___.\n3. Thyroid isthmus 1.9 cm hypodense nodule, unchanged from prior exam. Of\nnote, this had been previously biopsied on ___." }, { "input": "Minimal anterolisthesis of C4 on C5 and mild anterolisthesis of C7 on T1 is\nunchanged. No fractures are seen. Severe multilevel degenerative changes are\nagain noted, most extensive at C5-C7, with near complete loss of\nintervertebral disc height, there are vertebral osteophytes, uncovertebral and\nfacet osteophytes. There is mild spinal canal narrowing at C5-C7 due to\ndegenerative disease, similar to prior. Multilevel facet osteophytes results\nin severe left C3-4, moderate to severe bilateral C4-5, moderate bilateral\nC5-6 and C6-7 neural foraminal narrowing, similar to prior. There is no\nprevertebral edema.\n\n1.9 cm thyroid isthmus hypoattenuating nodule is unchanged. The included lung\napices are unremarkable.", "output": "No evidence of fracture.\nMild degenerative subluxation, unchanged.\nDegenerative disease with spinal canal and neural foraminal narrowing at\nmultiple levels." }, { "input": "Alignment is normal. No acute cervical spine fractures are\nidentified.Multilevel degenerative changes of the cervical spine are most\nsevere at C5-6 level, with posterior osteophytes result in mild canal\nnarrowing with indentation on the anterior thecal sac. Multilevel neural\nforaminal narrowing is present, most severe on the left at C4-5 where it is\nmoderate.There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nThe imaged lung apices are clear. Thyroid gland is unremarkable. Cervical\nlymph nodes are not enlarged by CT size criteria.", "output": "1. No acute cervical spine fracture or traumatic subluxation.\n2. Multilevel degenerative changes throughout the cervical spine, as described\nabove, more pronounced C5-C6 level." }, { "input": "Alignment is preserved.No fractures are identified. Mild multilevel\ndegenerative changes with intervertebral disc space narrowing, endplate\nsclerosis and anterior osteophyte formation is most pronounced at C6-7. Mild\ncentral canal narrowing due to a moderate disc bulges seen at C5-6. There is\nno high-grade neural foraminal stenosis. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nA nondisplaced fracture of the posterior right second rib is partially\nvisualized. Additionally, a right apical pneumothorax is partially seen as\nwell.", "output": "1. No acute fracture or traumatic malalignment.\n2. Partially visualized nondisplaced fracture of the posterior second right\nrib and right-sided pneumothorax are better assessed on same day CT torso." }, { "input": "No traumatic malalignment is identified. No fractures are identified. There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\nMultilevel degenerative changes are most notable at C5/C6 level, consistent\nwith posterior osteophyte, causing moderate spinal canal and severe bilateral\nneural foraminal narrowing (image 41, series 2).", "output": "1. No fracture is identified.\n2. Multilevel degenerative changes are most notable for C4-5 posterior\nosteophyte causing moderate spinal canal and severe bilateral neural foraminal\nnarrowing." }, { "input": "There is no acute fracture or alignment abnormality within the lumbar spine. \nSignificant facet arthropathy is noted in the lower lumbar spine extending\ninferiorly from L3-4 through L5-S1. No significant disc disease. No large\nhematoma. The imaged intra-abdominal structures are unremarkable aside from\nthe presence of diverticulosis and aortic calcification. Gallstones partially\nvisualized in the gallbladder.", "output": "No lumbar spine fracture or malalignment." }, { "input": "Minimal anterolisthesis of the C3 on C4 and C4 on C5 vertebral bodies is\nunchanged compared ___. No acute fracture is identified. Multilevel\nneural foraminal narrowing due to facet hypertrophy is noted. There is no\nprevertebral soft tissue swelling.Thyroid is unremarkable. Carotid bulb\ncalcifications are noted.", "output": "No acute fracture. Mild C3 and C4 listhesis is stable." }, { "input": "The bones are severely osteopenic.\n\nThere is marked kyphosis of the thoracic spine. No subluxation.\n\nAn acute two-column compression fracture is noted at the T11 vertebral body,\nwith surrounding hematoma and roughly 25% vertebral body height loss. No\nretropulsion is noted. The central canal is patent.\n\nModerate multilevel degenerative changes are noted within the thoracic spine\nwith bridging anterior osteophytes. No high-grade central canal stenosis is\npresent.\n\nDextroscoliosis of the lumbar spine is demonstrated without spondylolisthesis.\nThere is no acute lumbar spine fracture. Moderate multilevel degenerative\nchanges are seen in the lumbar spine with intervertebral disc space height\nloss and mild disc bulging. Additionally, mild central canal narrowing is\ndemonstrated at L2-3, L3-4, and L4-5 due to small disc bulges and ligamentum\nflavum hypertrophy. Additionally, mild left neural foraminal narrowing at\nL2-3 is present..\n\nA sclerotic lesion is seen in the right third rib (2:63), concerning for an\nosseous metastases. Healed fractures are seen of the right twelfth posterior\nrib as well as the right transverse processes of the L1 and L2 vertebrae.\n\nLimited evaluation of the lungs demonstrates bibasilar atelectasis and\nbiapical scarring. Heart demonstrates mild left atrial enlargement and\ndiffuse coronary artery calcifications. A small hiatal hernia is present. \nScattered calcifications in the spleen may reflect prior granulomatous\ndisease. Hepatic hypodensity measuring 10 mm is noted in the right lobe,\nlikely a cyst. The thoracic aorta is tortuous. Extensive fecal loading is\nnoted within the colon. The rectum is markedly distended with fecal matter,\nwith mild presacral edema. The prostate is enlarged and the bladder\ndemonstrates multiple diverticula with bladder wall thickening suggestive of\nchronic outlet obstruction. Moderate atherosclerotic calcifications are seen\nin aorta and mesenteric vessels. 12 mm left subcutaneous cyst within the left\nupper back is noted (03:48).", "output": "1. Acute compression fracture of the T11 vertebral body with approximately 25%\nloss of height without retropulsion of bony fragments.\n2. Large fecal load with large stool ball in the rectum.\n3. Sclerotic metastasis involving the right third rib.\n4. Remote right twelfth rib and right L1 and L2 transverse process fractures.\n5. Prostatomegaly with evidence chronic bladder outlet obstruction." }, { "input": "There is very minimal retrolisthesis of C2 over C3, which may be degenerative.\nNo acute fractures are identified.Multilevel degenerative changes are seen,\nmost extensive at C4-5 and notable for loss of intervertebral disc height,\nosteophytosis, and uncovertebral and facet hypertrophy causing mild neural\nforaminal narrowing..There is no prevertebral edema.\n\nA 6 mm hypodense nodule is seen in the right thyroid lobe. The included lung\napices show biapical scarring.", "output": "Multilevel degenerative changes of the cervical spine without acute fracture\nor dislocation. Very minimal retrolisthesis of C2 over C3 may be\ndegenerative." }, { "input": "Alignment is normal. No acute fractures are identified.There is subtle focal\nprevertebral soft tissue edema anterior to the vertebral body of C4.\n\nDegenerative changes are present most notable at C2-C3 and C3-C4 including\nosteophytosis and uncovertebral joint hypertrophy. Multilevel disc bulges\nresult in mild spinal canal narrowing. Incidentally noted is a calcified\nright stylohyoid ligament.", "output": "1. No acute fracture or malalignment.\n2. Focal prevertebral soft tissue edema anterior to C4 which raises the\npossibility of ligamentous injury. If focally tender in this area, MRI could\nbe obtained if clinically indicated.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D.\nby ___, M.D. on the telephone on ___ at 11:17 AM, 2 minutes\nafter discovery of the findings." }, { "input": "Alignment is normal. No acute fractures are identified. Multilevel\ndegenerative changes with intervertebral disc space narrowing and osteophyte\nformation. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or dislocation of the cervical spine." }, { "input": "Evaluation is limited by streak artifact from dental hardware. Multilevel\ndegenerative changes include facet arthropathy, loss of intervertebral disc\nheight, vacuum disc phenomenon, subchondral cyst formation, and osteophytosis.\nThere is mild anterolisthesis at C3-C4 and C6-C7, which is likely\ndegenerative. Alignment is otherwise normal. No fractures are\nidentified.There is mild bony vertebral canal stenosis at C4-C5. There is no\nprevertebral soft tissue swelling.", "output": "1. No acute cervical spine fracture.\n2. Multilevel degenerative changes." }, { "input": "There is mild anterolisthesis of C3 on C4, C6 on C7 and C7 on T1 unchanged. \nNo traumatic malalignment detected. No fractures are identified.Multilevel\ndegenerative changes of the cervical spine are again seen including loss of\nheight of the intervertebral discs, endplate sclerosis and osteophyte\nformation.\n\nThere is a disc bulge at C 2 3 that mildly encroaches on the spinal canal but\ndoes not contact the spinal cord. The neural foramina appear normal.\n\nAt C3-4, intervertebral osteophytes and bulging of the disc narrow the spinal\ncanal and in concert with ligamentum flavum thickening flatten the spinal\ncord. Uncovertebral and facet osteophytes produce severe bilateral neural\nforaminal narrowing.\n\nAt C4-5, intervertebral osteophytes and disc bulging flatten the spinal cord. \nUncovertebral and facet joints osteophytes produce severe bilateral neural\nforaminal narrowing.\n\nAt C5-6, intervertebral osteophytes and a bulge of the disc flatten the spinal\ncord. Uncovertebral and facet osteophytes produce severe neural foraminal\nnarrowing.\n\nAt C 6 7, small intervertebral osteophytes and subluxation of 6 on 7 mildly\nnarrow the spinal canal. The neural foramina appear normal.\n\nAt C7-T1 and the included portions of the upper thoracic spine there is no\nspinal canal or neural foraminal narrowing. There is again seen compression\nof the superior endplate of the T1 vertebral body.\n\nSuperior endplate deformity at T1 is unchanged, presumably degenerative. There\nis no prevertebral soft tissue swelling.\n\nThere are bilateral hypodense thyroid nodules, better seen on the current\nexamination but which do not appear enlarged since the prior study. The\nlargest of these, on the right, measures approximately 15 mm in greatest\ndimension. This meets ___ College of Radiology criteria for further\nevaluation with ultrasound of an incidental thyroid nodule. There is mild\npleuroparenchymal scarring in the lung apices.", "output": "-No evidence offracture or traumatic malalignment.\n-15 mm right thyroid nodule that meets ___ College of Radiology\nguidelines for further evaluation\n\nRECOMMENDATION(S): Thyroid nodule. ___ College of Radiology guidelines\nrecommend further evaluation with ultrasound for incidental thyroid nodules\ngreater than 1.0 cm in patients under age ___ or 1.5 cm in patients age ___ or\nolder.\n\nNOTIFICATION: The finding of a 1.5 mm right thyroid nodule and recommendation\nof ultrasound for further evaluation were entered in the Radiology department\nnon urgent critical imaging findings system at 13:57 ___ by Dr.\n___" }, { "input": "There is mild anterolisthesis, 3 mm, of C6 on C7, unchanged over multiple\nprior examinations.No acute fractures are identified.There is moderate to\nsevere multilevel uncovertebral, facet, anterior, and posterior osteophytosis.\nA combination of osteophytes and posterior disc bulges/protrusions results in\nmoderate spinal canal narrowing at C4-C5, C5-C6, and C6-C7. There is severe\nleft neural foraminal narrowing at C3-C4, moderate bilateral neural foraminal\nnarrowing at C4-C5, moderate bilateral neural foraminal narrowing at C5-C6,\nand mild left neural foraminal narrowing at C6-C7.No prevertebral soft tissue\nswelling. Carotid bifurcation calcifications are moderate. The thyroid gland\nis nodular and heterogeneous, no nodules larger than 1.5 cm. Mild biapical\nscarring.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Heterogeneous and multinodular thyroid gland. No nodules larger than 1.5\ncm. Per ACR guidelines on incidentally discovered thyroid nodules, no imaging\nfollow-up is recommended." }, { "input": "Alignment is unchanged with re-demonstration of mild anterolisthesis of C3 on\nC4, C6 on C7, and C7 on T1.No fractures are identified.Moderate multilevel\ndegenerative changes with disc height loss, endplate sclerosis and\nirregularity, and anterior and posterior osteophytes are seen throughout the\ncervical spine, worse at C4-5, C5-6, and C6-7. The cervical spinal vertebral\nbody heights are preserved. Uncovertebral and facet osteophytes moderate left\nneural foraminal narrowing at C3-4, moderate bilateral neural foraminal\nnarrowing at C4-5 and C5-6. Disc bulge and bridging osteophytes cause mild to\nmoderate canal stenosis at C3-4, C4-5 and C5-6.No prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm. There is a 0.9 cm\nleft thyroid lobe hypodense nodule (series 3, image 51) which does not need\nfurther imaging follow-up per ACR criteria. Bilateral lung apices demonstrate\nscarring.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel moderate degenerative changes of the cervical spine most severe\nat C3-4, C4-5 and C5-6." }, { "input": "There is no acute fracture. Mild anterolisthesis is unchanged at C3 on 4, C6\non 7, and to a lesser extent C7 on T1. Multilevel degenerative disc disease\nis unchanged, from prior performed 1 month ago. No prevertebral edema. Mild\nscarring in the apices. Thyroid appears unremarkable.", "output": "No acute fracture or change in alignment." }, { "input": "There is mild motion degradation at the C2 level. There is no visualized\nfracture. There is no new malalignment. Minimal anterolisthesis of C3 on C4,\nC6 on C7 and C7 on T1 are unchanged. Multilevel degenerative changes are\nnotable for intervertebral disc height loss, posterior osteophytes and\nuncovertebral joint hypertrophy most notably at C4-5, C5-6 and C6-7. No\ncritical canal narrowing. There is moderate foraminal narrowing on the left\nat C3-4 on the right at C4-5. Mild to moderate bilateral foraminal narrowing\nat C5-6. There is no prevertebral soft tissue swelling.\n\nThere is mild scarring at the apex of the lungs bilaterally. The thyroid is\nheterogeneous without visualized nodule larger than 1.5 cm. A 1 cm left level\nfive lymph node is unchanged. Atherosclerotic calcifications noted at the\ncarotid bulbs.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is anatomic. No acute fractures are identified.Multilevel\ndegenerative changes are seen, most extensive at C5-6 and notable for\nintervertebral disc disease, anterior osteophytes and mild-to-moderate left\nneural foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Scarring is seen in the bilateral lung apices. \nDebris is noted in the upper esophagus.", "output": "No evidence of acute fracture or traumatic malalignment. Debris noted in the\nupper esophagus." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nedema.\n\nDegenerative changes noted at C5-C6 with intervertebral disc height loss and\nuncovertebral joint hypertrophy. Posterior osteophytes and disc bulge\ncontribute to effacement of the ventral CSF, mild to moderate canal narrowing\nand may contact the ventral aspect of the cord. There is also moderate left\nforaminal narrowing at this level.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "There are 12 rib-bearing vertebrae with short ribs at T12. There is\ndextroconvex scoliosis centered at T8-T9 and incompletely assessed levoconvex\nscoliosis centered at L1-L2. The bones are demineralized. Vertebral body\nheights are within normal limits, and no fractures are seen. Subcentimeter\nsclerotic foci within T4 and T8 vertebral bodies are nonspecific but\ncompatible with bone islands.\n\nEvaluation of the thoracic spinal canal detail by CT is limited, particularly\ngiven the streak artifact from the pacemaker, and even more extensive streak\nartifact through C7 and T1 at the level of the shoulder girdles.\n\nSmall central disc protrusions are noted at T1-T2 and T4-T5, and mild disc\nbulges are noted at T10-T11 through T12-L1, without evidence for significant\nspinal canal narrowing.\n\nLigamentum flavum calcification is seen at T2-T3 on the right, T4-T5\nbilaterally, and at T9-T10 and T10-T11 bilaterally, without mass effect on the\nthecal sac.\n\nFacet arthropathy is present at:\nT2-T3 on the left without significant neural foraminal narrowing,\nT4-T5 bilaterally with mild left neural foraminal narrowing,\nT5-T6 bilaterally without significant neural foraminal narrowing,\nT6-T7 bilaterally with mild left neural foraminal narrowing,\nT7-T8 bilaterally with mild, right greater than left neural foraminal\nnarrowing,\nT8-T9 bilaterally with mild bilateral neural foraminal narrowing,\nT9-T10 bilaterally without significant neural foraminal narrowing,\nT10-T11 bilaterally without significant neural foraminal narrowing.\n\nLinear opacities in the visualized portion of the basal left lower lobe are\nsimilar to CT chest from ___, compatible with scarring with possible\nsuperimposed atelectasis.\nCalcified plaque is seen in the visualized portion of the aorta and at\nbilateral subclavian artery origins.\nA prosthetic mitral valve is again noted, with evidence of median sternotomy.\nThere is a small hiatal hernia, as seen previously.", "output": "1. S-shaped thoracolumbar scoliosis.\n2. Evaluation of the spinal canal detail by CTs limited, especially given the\nstreak artifact from the pacemaker. Small central disc protrusions and mild\ndisc bulges are noted at several levels without evidence for significant\nspinal canal narrowing.\n3. Multilevel facet arthropathy with mild neural foraminal narrowing at\nseveral levels, as detailed above." }, { "input": "There is no acute fracture or malalignment of the cervical spine. Mild loss\nof height anteriorly of the C5 vertebral body appears to be chronic. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema.\n\nThe aerodigestive tract appears patent. Lung apices are clear. Thyroid gland\nappears normal.", "output": "No acute fracture or malalignment of cervical spine." }, { "input": "No evidence of acute fracture is seen. Chronic appearing osseous\nfragmentation seen just superior to the anterior arch of C1. There is no\ndislocation. Multilevel degenerative changes are seen. These include mild\ndisc space narrowing and C5 through C7 with there are also prominent anterior\nand small posterior osteophytes.. No prevertebral soft tissue swelling is\nseen.\nPartially imaged lung apices show no focal consolidation. Apical paraseptal\nemphysema is noted bilaterally.", "output": "No acute fracture or dislocation of the cervical spine. Multi-level\ndegenerative changes." }, { "input": "Alignment is normal. No fractures are identified. There is mild multilevel\ndegenerative changes of the cervical spine, most notable at C5-C6 and C6-C7\nwith loss of disc space, osteophyte formation, and vacuum phenomenon. There\nis moderate spinal canal stenosis at C5-C6 and mild neural foraminal narrowing\nat C5-C6 and C6-C7. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No evidence of cervical spine fracture. No traumatic malalignment." }, { "input": "Alignment is normal. No acute fractures are identified. There is no\nprevertebral edema.\n\nThe lung apices show centrilobular emphysema. There also appears to be some\nseptal thickening which can be seen with pulmonary edema.\n\nPosterior to the right lobe of the thyroid on series 3A, image 46, is a 1.0 x\n0.9 cm soft tissue structure which could represent a thyroid nodule or\nenlarged parathyroid gland.", "output": "No acute fracture or traumatic malalignment.\n\n1.0 x 0.9 cm soft tissue structure just posterior to the right lobe of the\nthyroid could represent a thyroid nodule or prominent parathyroid gland. \nRecommend further assessment with outpatient ultrasound.\n\nPartially imaged lung apices demonstrate septal thickening which can be seen\nwith pulmonary edema." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute findings." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling.\n\nModerate degenerative changes are present from C4-C6 including spurring and\ndisc space height loss. There is probably mild central canal narrowing at\nC4-C5, C5-C6 levels. Posterior element degenerative changes. Probably\nmoderate bilateral C5-C6 foraminal narrowing.\n\nThe thyroid gland is unremarkable. There is mild biapical scarring in the\nlung.", "output": "1. No fracture.\n2. Degenerative changes spine, as described." }, { "input": "Study is somewhat limited by streak artifact from dental hardware. Multilevel\ndegenerative changes include facet arthropathy, osteophytosis, and loss of\nintervertebral disc height. Alignment is normal.No acute fracture is seen. \nThere is no prevertebral soft tissue swelling.\n\nImaged portion of the lung apices is unremarkable. The thyroid gland is\nunremarkable.", "output": "No acute cervical spine fracture or traumatic malalignment." }, { "input": "There is a triangular bone fragment of the anterior inferior corner of the C5\nvertebral body, without clearly corticated margins (602b:42), of unclear\nchronicity. No evidence for prevertebral edema, disc space widening, or\ndistraction of the posterior elements is seen. Alignment is normal. There is\nno evidence of spinal canal narrowing. Right C3-4 neural foramen is mildly\nnarrowed by uncovertebral osteophytes.\n\nVisualized lung apices are clear. There are numerous tiny lymph nodes at the\nthoracic inlet caudal to the right thyroid lobe. There are also small\nbilateral supraclavicular lymph nodes, right greater than left.", "output": "1. Anterior inferior corner fragment of the C5 vertebral body, of unclear\nchronicity, without evidence for prevertebral edema. Normal alignment.\n2. Numerous tiny lymph nodes are the thoracic inlet caudal to the right\nthyroid lobe, and small bilateral supraclavicular lymph nodes, right greater\nthan left. Please correlate clinically.\n\nRECOMMENDATION(S): MRI could assess for marrow edema and ligamentous edema,\nif clinically warranted.\n\nNOTIFICATION: These findings were communicated via telephone by Dr.\n___ to Dr. ___ at 01:11 on ___ ." }, { "input": "Numbering of the cervical spine is provided on series 602b, image 34.\n\nAlignment of the cervical spine is unremarkable. There is no acute fracture. \nNo prevertebral soft tissue swelling. Moderately severe multilevel\ndegenerative changes and noted in the form of anterior/posterior osteophytes,\nloss of intervertebral disc space height and uncovertebral hypertrophy, most\npronounced at C5-C6 and C6-C7 where there is mild indentation of the ventral\nthecal sac at these levels. Facet joint arthropathy is also noted at multiple\nlevels, more pronounced on the right. C2-C3 facets are fused on the right. \nC5-C6 facets are fused on the left. Low attenuation at T1 vertebral body in\nthe sagittal reformations (image 34, series 602b) apparently is artifactual\ndue to streak artifact.\n\nImaged thyroid gland is grossly unremarkable in appearance, within the\nlimitations of this study. Bilateral pleural parenchymal scarring is noted at\nthe lung apices.", "output": "No acute cervical spine fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis.Moderate to severe multilevel\ndegenerative changes have progressed in the interval with partial fusion of\nthe C4 through C6 vertebral bodies and bilateral facet joints of C4 and C5. \nMultilevel mild central canal and bilateral neural foraminal narrowing is\npresent without high-grade stenosis. There is no evidence of infection or\nneoplasm.\n\nThe thyroid gland is diffusely enlarged with a partly rim calcified isodense\nleft nodule measuring approximately 15 mm, similar to the prior exam. The\nlung apices are clear.", "output": "1. No acute fracture or malalignment.\n2. Moderate to severe cervical spondylosis, progressed in the interval, most\npronounced from C4 through C6 vertebral body levels.\n3. Diffusely enlarged thyroid gland with partly rim calcified isodense left\nthyroid nodule measuring up to 15 mm, similar to the prior exam. Thyroid\nultrasound can be obtained for further assessment, if not previously performed\nand if clinically warranted.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "No fracture is identified. There is again mild retrolisthesis of the C5 on C6\nvertebral bodies with decreased disk space height at this level, unchanged\ncompared to ___. No new malalignment is seen. There is no prevertebral\nsoft tissue abnormality. At the C2-3 and C3-4 levels is mild disc bulge, with\nindentation of the anterior thecal sac. There is mild neural foraminal\nnarrowing on the left at the C2-3 level, moderate on the right at the C3-4\nlevel, and moderate to severe bilaterally at the C5-6 level. There is no\nevidence of infection or neoplasm.", "output": "1. No fracture or prevertebral soft tissue abnormality identified.\n2. Unchanged mild retrolisthesis of the C5 on C6 vertebral bodies with\ndecreased disk space height at this level.\n3. Mild spinal canal an neural foraminal narrowing at multiple levels, likely\nrelated to multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures. No prevertebral soft tissue swelling.\nMultilevel degenerative changes, disc osteophyte complexes, hypertrophic\nchanges. Multilevel mild-to-moderate central canal narrowing, most prominent\nat C5-C6, C6-C7 levels. Multilevel moderate to severe foraminal narrowing.\n There is no evidence of infection or neoplasm. Small thyroid nodules do not\nmeet ACR criteria for further evaluation. Nonspecific soft tissue density in\nthe right external auditory canal likely represents cerumen.", "output": "No acute fracture or malalignment of the cervical spine.\nAdvanced degenerative changes cervical spine." }, { "input": "The bones are demineralized without evidence for a displaced fracture.\nPrevertebral soft tissues are unremarkable. There is minimal anterolisthesis\nof C2 on C3, unchanged compared to ___ brain MRI, and minimal\nretrolisthesis of C4 on C5, unchanged compared to ___ pituitary\nMRI, without disc space widening, which are likely secondary to facet\narthropathy. There is no acute subluxation. There is a kyphotic curvature\ncentered at C3-4. There are multilevel degenerative changes. At C3-4, a disc\nosteophyte complex mildly to moderately indents the ventral thecal sac. There\nis multilevel neural foraminal narrowing by uncovertebral osteophytes.\n\nThere is minimal dependent atelectasis in the visualized right upper lung. The\nthyroid gland is not visualized. There are no surgical clips in the thyroid\nbed. There are calcifications at the internal carotid artery origins, right\ngreater than left, and at the left subclavian artery origin.", "output": "1. Demineralized bones without evidence for a fracture. No acute subluxation.\n2. Multilevel degenerative disease.\n3. The thyroid gland is not visualized. Please correlate clinically." }, { "input": "No acute cervical spine fractures are identified. There is no prevertebral\nsoft tissue swelling.\n\nAlignment of the cervical spine is anatomic. There are no suspicious\nosteoblastic or lytic lesions.\n\nThere are severe multilevel degenerative changes of the cervical spine,\nincluding facet joint and uncovertebral hypertrophy, osteophytosis, loss of\nintervertebral disc space, and endplate changes, which is most prominent at\nC5-C6 and C6-C7. Specifically, there is severe bilateral C2-C3 and right C5-6\nneural foraminal narrowing. No severe canal narrowing. There is fusion of\nthe bilateral C3, C4, and C5 facets, with large bridging anterior osteophytes\nat C5, C6, and C7.\n\nThe visualized portion of the lungs are unremarkable. The visualized portion\nof the thyroid is unremarkable. There is no lymphadenopathy by CT size\ncriteria.", "output": "1. No acute cervical spine fracture or malalignment. No prevertebral edema.\n2. Severe multilevel degenerative changes of the cervical spine, as described." }, { "input": "Alignment is normal. No acute fractures are identified.Multilevel\ndegenerative changes are seen, most extensive at C5-C6 and notable for disc\nspace narrowing and severe anterior osteophyte formation. No foraminal\nnarrowing is seen, including on the right at C5-C6. There is also mild\nnarrowing of the central canal at C5-C6, related to posterior disc osteophyte.\nOsseous fusion of the bilateral C3, C4, and C5 facets is redemonstrated. \nThere is no prevertebral edema.\n\nThere is respiratory motion through the imaged lung apices, but no focal\nconsolidation is identified. The imaged thyroid gland is grossly homogeneous.\nPartially imaged fluid is seen superior to the sternum. Please refer to\nconcurrent CT torso for further details.", "output": "1. No acute fracture or traumatic subluxation.\n2. Multilevel degenerative changes, stable since most recent prior.\n3. Partially imaged fluid seen in the midline superior to the sternum. Please\nrefer to concurrent CT torso for further details." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.The thyroid and lung apices are unremarkable.", "output": "Normal study." }, { "input": "No traumatic malalignment or acute fractures of the cervical spine are\nidentified.No prevertebral soft tissue edema.\n\nThere are multilevel degenerative changes of the cervical spine most\npronounced at C5-C6 where there is moderate loss of the disc space and\nbilateral mild-to-moderate neural foraminal narrowing. There is no high-grade\ncentral spinal canal narrowing.\n\nThe thyroid is unremarkable. There are moderate calcifications of the carotid\nbulbs bilaterally. There is mild biapical emphysema and re-demonstration of a\n11 x 9 mm spiculated right apical pulmonary nodule, similar to the prior exam\nfrom ___ when it was first seen, however remains concerning and warrants\nfurther evaluation with PET-CT or biopsy.", "output": "1. No traumatic malalignment or acute fractures of the cervical spine.\n2. Right apical 11 x 9 mm spiculated pulmonary nodule is stable since ___ when it was first seen, however morphology remains concerning and\nwarrants further evaluation with PET-CT and/or biopsy.\n3. Multilevel degenerative changes worst at C5-C6." }, { "input": "No acute fracture or traumatic alignment abnormality. When compared with\nprior CT performed 4 days earlier, there has been no significant change. \nMultilevel degenerative changes with disc disease most pronounced at C5-6 and\nC6-7 levels. No critical central canal or neural foraminal stenosis. Again\nseen at the right lung apex, is a suspicious nodular structure measuring\napproximately 13 mm. No prevertebral edema. The imaged thyroid is\nunremarkable.", "output": "1. No fracture or malalignment.\n2. Suspicious pulmonary nodule at the right lung apex up to 13 mm. Agree with\nprior recommendations for further workup with PET-CT or biopsy." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C5-C6 and notable for disc space narrowing\nand anterior and posterior osteophyte formation..There is no prevertebral\nedema.\n\nThe thyroid is unremarkable. There is scarring of the right lung apex\nincompletely evaluated. This is decreased in size compared with ___ but\nstable since ___. This was further evaluated by chest CT of ___.", "output": "1. No acute fracture or traumatic subluxation.\n2. Multilevel degenerative changes most extensive at C5-C6.\n3. Right upper lung nodule which was further evaluated by chest CT of ___. Correlate with findings and recommendations of that study." }, { "input": "There is no acute fracture or malalignment of the cervical spine. There is\nmild loss of disc height at C5-C6 with mild inferior endplate changes at C5\nand superior endplate changes at C6, consistent with degenerative change. \nPosterior osteophytes and uncovertebral joint hypertrophy contribute to mild\ncanal and mild bilateral foraminal narrowing, worse on the left. \\No\nprevertebral edema.\n\nThe aerodigestive tract appears patent. Paraseptal apical emphysema, right\ngreater than left. Thyroid appears normal. Left mastoidectomy changes are\nvisualized. Atherosclerotic calcifications noted at the carotid bulbs\nbilaterally.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Minimal degenerative changes at C5-C6.\n3. Paraseptal apical emphysema." }, { "input": "Alignment is normal. No fractures are identified.There are mild multilevel\ndegenerative changes of the cervical spine worst at the C5-6 level there is\nmild disc height loss and small posterior anterior intervertebral osteophytes.\nDisc bulges C4-5 and C5-6 causes mild spinal canal narrowing. Uncovertebral\nand facet hypertrophy cause mild bilateral neural foraminal narrowing at C5-6.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. Thyroid gland is unremarkable. There is paraseptal\nemphysema of the partially imaged stone apices. There is slightly increased\nsize of a spiculated 0.6 x 0.9 cm nodule in the right lung apex.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild degenerative changes of the cervical spine as above.\n3. Slightly increased size of a spiculated 0.9 cm nodule in the right lung\napex. Recommend follow-up per ___ criteria.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes most\nnotable at C5-6 with intervertebral disc height loss and uncovertebral joint\nhypertrophy resulting in mild right and moderate left foraminal narrowing. No\nsignificant canal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Atherosclerotic\ncalcifications seen at the carotid bulbs.", "output": "No cervical spine fracture or malalignment." }, { "input": "Spiculated 1.1 cm nodule right lung apex is is increased compared with 0.9 cm\non ___, and both increased and more solid compared with 7 mm ___. Findings are concerning for malignancy..\n\nAlignment is normal. No fracture. No prevertebral edema.\n\nMultilevel degenerative changes, disc space narrowing, disc osteophyte\ncomplexes, probably mild central canal narrowing, multilevel moderate severe\nforaminal narrowing. Centrilobular emphysema.", "output": "Increasing 1.1 cm spiculated nodule right lung apex, worrisome for malignancy.\nNo fracture.\nDegenerative changes.\n\nNOTIFICATION: The findings were discussed with ___ QA nurses, M.D. by ___\n___, M.D. on email on ___ at 8:32 am, 5 minutes after discovery of\nthe findings." }, { "input": "Alignment is normal. No fractures are identified.There is mild multilevel\nendplate and uncovertebral osteophytosis. Small posterior disc bulge and/or\nprotrusions result in mild multilevel spinal canal narrowing, worst at C5-C6. \nUncovertebral osteophytes result in mild multilevel neural foraminal\nnarrowing.There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm. Partially imaged paranasal sinus disease includes\naerosolized secretions. A partially imaged spiculated nodule at the right\nlung apex measures up to at least 1.0 cm. There is at least moderate\ncentrilobular pulmonary emphysema. There are mild bilateral carotid\nbifurcation calcifications. Moderate paranasal sinus disease.", "output": "1. No evidence of fracture or malalignment.\n2. Partially seen spiculated lung nodule right apex, may represent malignancy.\nChest CT recommended for more complete evaluation.\n3. Degenerative changes cervical spine.\n4. Paranasal sinus disease, consider acute sinusitis.\n\nRECOMMENDATION(S): Partially imaged spiculated pulmonary nodule measuring at\nleast 1 cm at the right lung apex concerning for malignancy. For incidentally\ndetected nodules bigger than 8mm or morphologically suspicious in the setting\nof an incomplete chest CT, follow-up with a nonemergent complete chest CT is\nrecommended." }, { "input": "Alignment is normal. No fractures are identified.The vertebral body heights\nare preserved. There is moderate loss of disc heights at C5-6 and C6-7. \nThere are anterior posterior osteophytes, worst at C5-6 and C6-7. Disc bulge\ncauses mild spinal canal stenosis at C5-6 and C6-7. No high-grade spinal\ncanal stenosis. Uncovertebral and facet osteophytes cause mild left neural\nforaminal narrowing at C4-5 and mild bilateral neural foraminal narrowing at\nC5-6.No prevertebral soft tissue swelling.The thyroid is unremarkable. There\nis a 1.1 x 1.0 cm right lung apex spiculated opacity which partially\nvisualized. The lesion is difficult to directly compared to most recent CT\ncervical spine from ___ given technique differences. However the\nlesion has increased in size compared to CT from ___.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine, worst at C5-6 and\nC6-7.\n3. Spiculated opacity in the right lung apex is incompletely characterized and\nhas increased in size compared to CT from ___. Dedicated\noutpatient chest CT is recommended for further evaluation.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "There are 5 lumbar-type vertebrae. Vertebral body heights are preserved. \nGrade 1 anterolisthesis of L4 on L5 measures 6 mm compared to 4 mm on the\nprior MRI, which may be either secondary to progression or dynamic\ninstability.\n\nT12-L1: Mild partially calcified disc bulge with overlying endplate\nosteophytes, and facet arthropathy. No significant spinal canal or neural\nforaminal narrowing.\n\nL1-L2: Mild partially calcified disc bulge with overlying endplate\nosteophytes, and facet arthropathy. No significant spinal canal or neural\nforaminal narrowing.\n\nL2-L3: Mild disc bulge and facet arthropathy. The ventral thecal sac is\nmildly indented, similar to the prior MRI. The neural foramina are mildly\nnarrowed, more conspicuous on the prior MRI, which may be secondary to\ndifferences in modalities.\n\nL3-L4: Mild disc bulge, mild right and moderate to severe left facet\narthropathy. Mild narrowing of the thecal sac, mild to moderate right and\nmoderate left neural foraminal narrowing, similar to the prior MRI.\n\nL4-L5: The disc is uncovered by the grade 1 anterolisthesis with a bulge. \nThere is thickening of the ligamentum flavum and severe bilateral facet\narthropathy. There is severe spinal canal narrowing, similar to the prior MRI\nallowing for differences in modalities. The neural foramina appear severely\nnarrowed, compared to moderate to severe narrowing on the prior MRI, which may\nbe due to the increased anterolisthesis versus differences in modalities.\n\nL5-S1: There is a disc bulge, right paracentral/foraminal disc protrusion\ncontacting the traversing right S1 nerve root in the subarticular zone\n(similar to prior MRI), and also severe right and moderate left facet\narthropathy. The neural foramina are foreshortened with mild-to-moderate\nnarrowing, similar to prior. No significant mass effect on the thecal sac.\n\nVisualized medial lung bases are clear. Visualized posterior right hepatic\nlobe demonstrates low density consistent with steatosis. Mild calcified\nplaque is seen in the visualized abdominal aorta. Nonenlarged retroperitoneal\nlymph nodes are noted.", "output": "1. Grade 1 anterolisthesis of L4 on L5 measures 6 mm compared to 4 mm on the\n___ MRI, which may be either secondary to progression or dynamic instability.\nThis may be better assessed by flexion-extension radiographs, if clinically\nwarranted.\n2. Severe spinal canal narrowing at L4-L5 is unchanged. The neural foramina\nappear severely narrowed, compared to moderate to severe narrowing on the\nprior MRI, which may be due to the increased anterolisthesis versus\ndifferences in modalities.\n3. Degenerative disease at other lumbar levels appear similar to the prior MRI\nallowing for differences in modalities, as detailed above.\n4. Visualized portion of the liver demonstrates steatosis." }, { "input": "Minimal anterolisthesis of C7 on T1 is chronic. No fractures are\nidentified.Multilevel moderate to severe degenerative changes including\nendplate sclerosis, intervertebral disc space narrowing, and osteophyte\nformation are present. Posterior disc osteophyte complexes at the C3-C4,\nC4-C5 and C5-C6 levels cause moderate narrowing of the spinal canal.Multilevel\nmoderate bilateral neural foraminal narrowing is also demonstrated, most\npronounced at C4-5, C5-6, and C6-7. There is no prevertebral soft tissue\nswelling.The patient has had a prior for left carotid endarterectomy. Tiny\nnodules in the thyroid gland appear unchanged. Mild septal thickening within\nthe lung apices suggests mild fluid overload.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Multilevel moderate to severe degenerative changes.\n3. Minimal chronic anterolisthesis of C7 on T1.\n4. Mild fluid overload." }, { "input": "Alignment is normal. No fractures are identified. Again seen are\npostoperative changes after C6 corpectomy and anterior fusion. The fusion\nhardware appears intact. Alignment at this level appears normal. No soft\ntissue abnormalities are demonstrated encroaching on the spinal canal or the\nparaspinal tissues. Note, the artifacts arising from the fusion hardware\nlimit evaluation in the immediate vicinity of the surgery. The remaining\nportion of the C6 vertebra as well as the pedicles, pars interarticularis and\nfacets R deeply infiltrated by tumor at C6.\nImaging of the remainder of the cervical spine demonstrates minimal\ndegenerative disease at C3-4, somewhat more prominent degenerative disease\nwith a small disc bulge at C4-5 and no areas of significant spinal canal or\nneural foraminal compromise. No other osseous lesions are identified.", "output": "1. Status post C6 corpectomy and anterior fusion with normal alignment and no\nevidence of spinal canal compromise." }, { "input": "Alignment is anatomic. No fractures are identified. As before, the patient\nis status post C6 corpectomy with anterior fusion of C5-C7. The fusion\nhardware appears intact and unchanged, with normal alignment at this level. \nPlease note that artifact limits evaluation immediately adjacent to the\nhardware. No definite soft tissue abnormalities are demonstrated in the\nepidural space or paraspinal soft tissues at this level. The C6 vertebral\nbody and pedicles demonstrate slightly increased sclerosis in comparison to\nthe previous study, however underlying residual tumor cannot be excluded.\nThere is no prevertebral soft tissue swelling. There is no abnormal\nenhancement on post contrast imaging.\n\nThere are mild multilevel degenerative changes of the cervical spine with\nendplate osteophytosis and facet arthropathy, most prominent at C4-C5. There\nis no evidence of spinal canal or neural foraminal stenosis.\n\nA few subcentimeter cervical lymph nodes are again seen with preserved fatty\nhila and lack of suspicious features, for example a right submandibular node\nmeasures 6 mm short axis.", "output": "1. Redemonstrated C6 corpectomy with anterior fusion from C5-C7 with intact\nappearing hardware and stable alignment.\n2. Artifact from the hardware limits evaluation of the adjacent structures.\nThe C6 vertebral body and pedicles demonstrate slightly increased sclerosis in\ncomparison to the previous study, however remaining underlying residual tumor\nis not excluded.\n3. No definite epidural or paraspinal soft tissue abnormalities are\ndemonstrated." }, { "input": "A fracture through the posterior arch of C1 is minimally displaced (02:14). A\ncomminuted fracture of the right aspect of the anterior arch of C1 is\nsubstantially displaced with asymmetric lateral displacement of the right\nlateral mass of C1 (2:13, 601:42). Fracture lucency through the right C1\ntransverse process is in close proximity to the right transverse foramina\n(2:18, 601:50).\n\nA transversely oriented fracture through the base of the dens extends into the\nbody suggestive of a type 3 dens injury with 2 mm of posterior displacement\n(602: 33, 601:40). Alignment is otherwise normal.\n\nThere is minimal if any adjacent soft tissue edema/hematoma. No other\nfractures are identified.\n\nMultilevel degenerative changes are mild causing mild spinal canal narrowing\nat multiple levels and severe left neural foraminal narrowing at C3-C4 the\nC4-C5, and C5-C6. There is no severe spinal canal or neural foraminal\nstenosis mild emphysema in the lung apices. Mild mucosal thickening in the\nsphenoid sinus.", "output": "1. Mildly displaced fracture of the posterior arch of C1.\n2. Comminuted displaced fracture of the right anterior arch of C1 with lateral\ndisplacement of the right lateral mass of C1.\n3. Right C1 transverse process fracture see comes in close proximity to the\ntransverse foramina. If there is clinical concern vertebral artery injury,\nCTA could be obtained.\n4. Type 3 dens fracture with 2 mm of posterior displacement. Otherwise normal\nalignment.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. in person on ___ at 9:08 pm, 3 minutes after discovery of\nthe findings." }, { "input": "Fracture through the C1 posterior arch is mildly displaced and appears similar\nin configuration to prior examination, although there does appear to be mild\ninterval osseous bridging. The comminuted fracture of the anterior arch of\nC1 appears demonstrates similar lateral 1.1 cm subluxation relative to the\nright lateral mass of C2.Type 3 odontoid fracture with mild posterior\ndisplacement of 2 mm is similar in position to prior examination, however\ndemonstrating increased lucency at the fracture site. There is no evidence of\nbony callous formation. There are multilevel degenerative changes, similar to\nprior examination..There is prevertebral soft tissue swelling from C1-C3.\nLarge pannus posterior to the dens, resulting in narrowing of the\ncraniocervical junction and remodeling of the craniocervical junction is\noverall similar to prior examination.", "output": "1. Alignment of the anterior and posterior C1 arch fractures are overall\nsimilar to prior examination, although does appear to be mild interval osseous\nbridging of the posterior fracture lucency. The degree of lateral subluxation\nof C1 on the right lateral mass of C2 is similar. No evidence of bony callus\nformation.\n2. Alignment of type 3 odontoid fracture with minimal posterior subluxation of\n2 mm is also similar in position to prior examination, with increased lucency\nat the fracture site. No evidence of bony callus formation.\n3. No additional fractures are identified.\n4. Prominent pannus posterior to the dens resulting in narrowing of the\ncraniocervical junction is overall similar to prior exam, with remodeling of\nthe cranial cervical junction." }, { "input": "Dental amalgam streak artifact limits study. Alignment is normal. No\nfractures are identified. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm. Scattered subcentimeter nonspecific lymph\nnodes are noted throughout the neck bilaterally, without definite enlargement\nby CT size criteria.", "output": "1. Dental amalgam streak artifact limits study.\n2. No fracture or malalignment of the cervical spine." }, { "input": "There is no evidence for acute fracture. Mild anterolisthesis of C3 on C4 is\nlikely degenerative in nature, more pronounced since the previous radiograph. \nNo abnormal prevertebral soft tissue swelling is identified. Moderate,\nmultilevel degenerative changes are noted throughout the cervical spine, most\nsevere at the levels of C4-C5 and C5-C6 with loss of intervertebral disc\nheight, endplate sclerosis, subchondral cyst formation, and osteophytosis.\nThere is no evidence of critical spinal canal stenosis.\n\nBiapical scarring is noted within the visualized lungs. In addition, region\nof ground-glass opacity is seen within the right upper lobe (3:76) measuring\nat least 2.2 cm, incompletely assessed on this examination. Bilateral 2-3 mm\napical nodules are also present (2: 62, 63, 66, 69). The thyroid is\nhomogeneous in attenuation. There is no evidence of pathologic cervical\nlymphadenopathy.", "output": "1. Moderate, multilevel degenerative changes of the cervical spine without\nevidence for acute fracture or substantial change in alignment.\n2. Ground-glass opacity within the right upper ___ represent\ninflammatory or infectious process, but malignancy cannot be excluded. \nAdditional multiple biapical sub 4 mm pulmonary nodules. Dedicated CT chest\nexamination is recommended for further evaluation.\n\nRECOMMENDATION(S): Dedicated CT chest examination is recommended for further\nevaluation." }, { "input": "THORACIC SPINE:\n\nThere are 12 rib-bearing vertebrae. T2, T3, T4, T8, and T9 demonstrate mild\nsuperior endplate deformities without fracture lines. T8 and T9 demonstrate\nmild associated loss of vertebral body height.\n\nT10 vertebral body demonstrates severe loss of height, greater than 90% in its\ncentral portion, with mild retropulsion at its posterior inferior corner. No\nacute fracture line is seen. There is only mild associated spinal canal\nnarrowing.\n\nT11 vertebral body demonstrates mild anterior wedging with approximately 20%\nloss of height. A fracture line is faintly visible parallel to the superior\nendplate, likely late subacute. There is no retropulsion and no posterior\nelement involvement.\n\nT12 vertebral body demonstrates severe loss of height in its central portion\nwith retropulsion of its superior posterior corner causing mild to moderate\nspinal canal narrowing. There is also kyphotic angulation at T11-12. There\nis no T12 posterior element involvement. No acute fracture line is seen.\n\nLUMBAR SPINE:\n\nThere are 5 lumbar-type vertebrae, which all demonstrate varying degrees of\nloss of vertebral body height, making it difficult to calculated the exact\npercentages for loss of height.\n\nL1 demonstrates mild anterior wedging without retropulsion, posterior element\ninvolvement, or acute fracture line.\n\nL2 demonstrates moderate loss of height with superior endplate and mild\nretropulsion of the posterior superior corner, which mildly narrows the spinal\ncanal. There is no acute fracture line or posterior element involvement.\n\nL3 demonstrates moderate loss of height with superior endplate deformity and\nmild retropulsion of the posterior superior corner, which mildly narrows the\nspinal canal. There is also severe bilateral L3-L4 neural foraminal\nnarrowing. There is no acute fracture line or posterior element involvement.\n\nL4 demonstrates mild superior endplate deformity with only minimal loss of\nheight and irregularity of the anterior superior corner, without clearly\nvisible acute fracture line. A linear lucency through the left lamina, images\n2:51 and 602b:42, likely represents a nutrient foramen. There is no\nretropulsion. Right L4-L5 neural foramen is mildly narrowed by disc bulge and\nfacet osteophytes.\n\nL5 demonstrates mild to moderate loss of height with superior endplate\ndeformity. There is no acute fracture line, retropulsion, or posterior\nelement involvement. There is moderate L5-S1 neural foraminal narrowing by\ndisc bulge and facet osteophytes.\n\nA sclerotic focus in the left ilium is nonspecific but compatible with a bone\nisland.\n\nOTHER:\n\nEvaluation of the partially included lungs is limited by respiratory motion\nartifact. Mild dependent atelectasis is noted bilaterally. There are\ncalcified granulomas in bilateral lower lobes, as well as right hilar\ncalcifications, consistent with sequela of prior granulomatous disease. \nPunctate nonobstructing calculi are noted in both kidneys.", "output": "1. Multiple thoracic and lumbar vertebral body fractures, as detailed above. \nSubacute fracture line is faintly visible within T11 vertebral body. Other\nfractures appear chronic.\n2. Retropulsion is present at several levels, with mild to moderate spinal\ncanal narrowing at T12, and mild spinal canal narrowing at several other\nlevels.\n3. Multilevel neural foraminal narrowing in the lumbar spine secondary to the\nloss of vertebral body height as well as degenerative disease, severe at\nL3-L4.\n4. Punctate nonobstructing calculi in both kidneys.\n5. Evidence of prior granulomatous disease with calcified granulomas in both\nlungs and right hilus." }, { "input": "THORACIC SPINE:\n\nThere are 12 rib-bearing vertebrae. T2, T3, T4, T8, and T9 demonstrate mild\nsuperior endplate deformities without fracture lines. T8 and T9 demonstrate\nmild associated loss of vertebral body height.\n\nT10 vertebral body demonstrates severe loss of height, greater than 90% in its\ncentral portion, with mild retropulsion at its posterior inferior corner. No\nacute fracture line is seen. There is only mild associated spinal canal\nnarrowing.\n\nT11 vertebral body demonstrates mild anterior wedging with approximately 20%\nloss of height. A fracture line is faintly visible parallel to the superior\nendplate, likely late subacute. There is no retropulsion and no posterior\nelement involvement.\n\nT12 vertebral body demonstrates severe loss of height in its central portion\nwith retropulsion of its superior posterior corner causing mild to moderate\nspinal canal narrowing. There is also kyphotic angulation at T11-12. There\nis no T12 posterior element involvement. No acute fracture line is seen.\n\nLUMBAR SPINE:\n\nThere are 5 lumbar-type vertebrae, which all demonstrate varying degrees of\nloss of vertebral body height, making it difficult to calculated the exact\npercentages for loss of height.\n\nL1 demonstrates mild anterior wedging without retropulsion, posterior element\ninvolvement, or acute fracture line.\n\nL2 demonstrates moderate loss of height with superior endplate and mild\nretropulsion of the posterior superior corner, which mildly narrows the spinal\ncanal. There is no acute fracture line or posterior element involvement.\n\nL3 demonstrates moderate loss of height with superior endplate deformity and\nmild retropulsion of the posterior superior corner, which mildly narrows the\nspinal canal. There is also severe bilateral L3-L4 neural foraminal\nnarrowing. There is no acute fracture line or posterior element involvement.\n\nL4 demonstrates mild superior endplate deformity with only minimal loss of\nheight and irregularity of the anterior superior corner, without clearly\nvisible acute fracture line. A linear lucency through the left lamina, images\n2:51 and 602b:42, likely represents a nutrient foramen. There is no\nretropulsion. Right L4-L5 neural foramen is mildly narrowed by disc bulge and\nfacet osteophytes.\n\nL5 demonstrates mild to moderate loss of height with superior endplate\ndeformity. There is no acute fracture line, retropulsion, or posterior\nelement involvement. There is moderate L5-S1 neural foraminal narrowing by\ndisc bulge and facet osteophytes.\n\nA sclerotic focus in the left ilium is nonspecific but compatible with a bone\nisland.\n\nOTHER:\n\nEvaluation of the partially included lungs is limited by respiratory motion\nartifact. Mild dependent atelectasis is noted bilaterally. There are\ncalcified granulomas in bilateral lower lobes, as well as right hilar\ncalcifications, consistent with sequela of prior granulomatous disease. \nPunctate nonobstructing calculi are noted in both kidneys.", "output": "1. Multiple thoracic and lumbar vertebral body fractures, as detailed above. \nSubacute fracture line is faintly visible within T11 vertebral body. Other\nfractures appear chronic.\n2. Retropulsion is present at several levels, with mild to moderate spinal\ncanal narrowing at T12, and mild spinal canal narrowing at several other\nlevels.\n3. Multilevel neural foraminal narrowing in the lumbar spine secondary to the\nloss of vertebral body height as well as degenerative disease, severe at\nL3-L4.\n4. Punctate nonobstructing calculi in both kidneys.\n5. Evidence of prior granulomatous disease with calcified granulomas in both\nlungs and right hilus." }, { "input": "There is minimal retrolisthesis of C5 on C6, unchanged.No fractures are\nidentified.Degenerative changes of the cervical spine are mild, with\nre-demonstration of moderately-sized osteophytes at C4-C5 and C5-C6. \nMultilevel disc bulges are seen, most notably at C5-6 which contributes to at\nleast mild canal narrowing effacing the ventral CSF. There is no severe\nspinal canal or neural foraminal narrowing.There is no prevertebral soft\ntissue swelling.\n\nThe thyroid is unremarkable. Imaged left lung apex is clear. Rounded\nmetallic densities noted in the left submandibular region and adjacent to the\nright mandibular condyle.", "output": "1. No cervical spinal fracture or traumatic malalignment.\n\n2. Mild degenerative changes of the cervical spine, as above." }, { "input": "Alignment of the cervical spine is normal. There is no acute fracture. Well\ncorticated ossific fragments anterior to the superior endplates of C4, C5 and\nC6 are likely chronic. No prevertebral soft tissue swelling. There are mild\ndegenerative changes throughout the cervical spine, with anterior/posterior\nosteophytes, uncovertebral hypertrophy and mild loss of intervertebral disc\nspace height, resulting in mild spinal canal narrowing at C5-C6. At C5-C6,\nthere is also mild bilateral neuroforaminal narrowing, left greater than\nright.\n\nThyroid is unremarkable in appearance. There is paraseptal emphysema in the\npartially imaged lung apices.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Paraseptal emphysema noted in the lung apices." }, { "input": "Alignment and vertebral body height is preserved. There is generalized\nosteoporosis. There are mild multilevel degenerative changes with anterior\nosteophyte formation, endplate irregularity, and multiple small Schmorl's\nnodes. There is loss of normal intervertebral disc height at L2-L3, and L4-L5.\nThere are vacuum disc phenomenon noted at L2-L3, L4-L5, and L5-S1.\n\nAt L1-L2, there is minimal disc bulge without significant spinal canal or\nneural foraminal narrowing.\n\nAt L2-L3, there is mild disc bulge and mild ligamentum flavum thickening\nresulting in mild spinal canal narrowing. A right-sided endplate osteophyte is\nagain noted to contribute to mild right neural foraminal narrowing.\n\nAt L3-L4, there is disc bulge asymmetric to the right which combined with\nbilateral mild facet and ligamentum flavum thickening is resulting in mild\nspinal canal stenosis. Disc material is also extending into the right\nforamen/ extra foraminal space and contacting the exiting right L3 nerve root.\n\nAt L4-L5, there is mild disc bulge, mild facet arthropathy, and mild\nthickening of the ligamentum flavum resulting in mild spinal canal narrowing\nand possible contacting of the bilateral traversing L5 nerve root. There is no\nsignificant neural foraminal stenosis.\n\nAt L5-S1, there is disc bulge and bilateral facet arthropathy. There is\npossible compression of the traversing left S1 nerve root between disc\nmaterial and facet osteophytes and mild left neural foraminal narrowing.\n\nThere is a large unchanged right renal cyst. Small renal calculi are again\nnoted in the left renal collecting system. There is heavy atherosclerotic\ncalcification of the infrarenal abdominal aorta which measures up to 2.8 cm\nand is unchanged. Diverticulosis is also incidentally noted in the included\nabdomen.", "output": "Multilevel degenerative changes with mild spinal canal and neural foraminal\nnarrowing at multiple levels. Nerve root compression is noted on the right at\nL3-L4 and on the left at L5-S1 as detailed above. Findings appear similar to\nprior study." }, { "input": "There is no evidence for acute fracture. There is mild anterolisthesis of C3\non C4, C4 on C5, and C6 on C7, findings which are likely degenerative in\nnature. No abnormal prevertebral soft tissue swelling is identified. \nModerate, multilevel degenerative changes of the cervical spine are noted,\nmost notable at the levels of C4-C5, C5-C6, and C6-C7 with subchondral cyst\nformation, loss of intervertebral disc height, and osteophytosis. Mild to\nmoderate central canal narrowing is noted at C4-5 and C5-6. Mild bilateral\nneural foraminal narrowing is most pronounced at C5-6.\n\nThe visualized lung apices are grossly clear bilaterally. The thyroid\ncontains multiple hypodense nodules, the largest of which measures 1.7 cm on\nthe right and contains calcifications. There is no evidence of pathologic\ncervical lymphadenopathy.", "output": "1. No evidence for acute fracture.\n2. Moderate multilevel degenerative changes of the cervical spine, including\nmultilevel anterolisthesis which is also likely degenerative in nature.\n3. Multinodular thyroid gland with a dominant 1.7 cm right thyroid nodule\ncontaining calcifications. Recommend dedicated thyroid ultrasound for further\nevaluation.\n\nRECOMMENDATION(S): Multinodular thyroid gland with a dominant 1.7 cm right\nthyroid nodule containing calcifications. Recommend dedicated thyroid\nultrasound for further evaluation." }, { "input": "There is no evidence of acute fracture throughout the visualized thoracic\nspine. Redemonstrated is mild anterolisthesis of C6 on C7, which is likely\ndegenerative in nature.\n\nModerate to severe, multilevel degenerative changes are seen throughout the\nvisualized thoracolumbar spine, with severe endplate sclerosis and osteophytic\nspurring. There is no evidence of critical spinal canal narrowing.\n\nThe imaged portions of the bilateral lungs demonstrates atelectasis without\npleural effusion or focal consolidation. There is a large paraesophageal\nhiatal hernia. Calcifications are seen within the visualized aorta and region\nof the mitral annulus. Cholelithiasis is incompletely imaged. Punctate\nnonobstructing calculus is seen in the interpolar aspect of the right kidney. \nA large peripelvic cyst on the right is incompletely imaged. Extrarenal\npelvises again noted on the left.", "output": "1. Moderate to severe, multilevel degenerative changes of the thoracolumbar\nspine without acute fracture or traumatic subluxation.\n2. Multiple additional incidental findings, as described above." }, { "input": "There is mild loss of the normal cervical lordosis. Mild anterior and\nposterior osteophyte formation and loss of disc and vertebral body height is\nworst at C5-6. No acute cervical spine fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.The lung apices are clear, the thyroid gland\nappears unremarkable. There is no evidence of infection or neoplasm.", "output": "No cervical spine acute fracture or traumatic subluxation. Moderate\ndegenerative changes identified at C5/C6 level as described above." }, { "input": "There is no acute fracture or subluxation involving the cervical spine. There\nis no abnormal prevertebral soft tissue swelling. No osseous lesion worrisome\nfor malignancy or infection is identified. The thyroid gland is homogeneous\nin attenuation without a focal lesion identified. There is no cervical\nadenopathy. Submandibular and imaged parotid glands are unremarkable.", "output": "No acute fracture or subluxation involving the cervical spine." }, { "input": "No evidence of traumatic malalignment. No fractures are identified.Multilevel\ndegenerative changes are seen, most extensive at C2-C3 and C4-C5 and notable\nfor anterior and posterior osteophytosis and mild loss of intervertebral disc\nheight which results in mild spinal canal narrowing..There is no prevertebral\nedema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is multilevel\ndegenerative changes including intervertebral disc space narrowing and\nendplate irregularity most prominent at the C4-C5, C5-C6 and C6-C7 levels. At\nthese levels, posterior disc protrusions and intervertebral osteophytes\nresults in mild to moderate spinal canal narrowing. There is severe bilateral\nneural foraminal narrowing at C4-C5. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nFluid is seen in the right mastoid tip. The visualized lung apices\ndemonstrate pleural parenchymal scarring without suspicious nodule.", "output": "1. No acute fracture or subluxation.\n\n2. Multilevel degenerative changes as described above, most severe at C4-C5\nlevel, where there is mild to moderate spinal canal narrowing and severe\nbilateral neural foraminal narrowing." }, { "input": "No acute fracture is seen..Moderate multilevel degenerative changes are seen,\nmost extensive at ___ and notable for intervertebral disc space narrowing\nat C4-5, C5-6, and C6-7, anterior and posterior osteophyte formation, and\nanterolisthesis of C3 on C4, which is stable from prior. There is mild spinal\ncanal narrowing and neural foraminal narrowing from C4 through C6.There is no\nprevertebral edema.\n\nThe thyroid is unremarkable.", "output": "No acute fracture or dislocation of the cervical spine. Stable multilevel\ndegenerative changes including anterolisthesis of C3 on C4." }, { "input": "No evidence for a fracture or prevertebral edema. Normal alignment. There\nare well corticated Schmorl's nodes in the C5 superior endplate. Disc space\nheights are preserved. No evidence for spinal canal narrowing. However,\nthere is moderate right C3-C4 neural foraminal narrowing by uncovertebral\nosteophytes.\n\nConcurrent head CT is reported separately. The thyroid is unremarkable. The\nlung apices are clear.", "output": "1. No fracture or subluxation.\n2. Well corticated Schmorl's nodes in the C5 superior endplate and moderate\nright C3-C4 neural foraminal narrowing by uncovertebral osteophytes, unusual\nfor the patient's young age." }, { "input": "No acute fractures are identified in the lumbar spine. There is mild anterior\nwedging of the T12 vertebral body, stable since the prior study.\n\nMultilevel moderate to severe degenerative changes are again noted throughout\nthe lumbar spine, most pronounced at the level of L2-L3, where there is\nmoderate central canal narrowing due to a disc-osteophyte complex. A posterior\ndisc bulge is noted at L1-L2 which also causes moderate central canal\nnarrowing. Grade I retrolisthesis of L1 on L2, and grade I anterolisthesis of\nL4 on L5 are unchanged. No pars defects are identified. Multilevel bilateral\nneural foraminal narrowing, mild to moderate in severity is also unchanged.\nThese changes are grossly unchanged compared to the prior study of ___.\n\nPostoperative changes with bilateral transpedicular screws and 2 posterior\nrods are noted at L4 and L5, with streak artifact limiting evaluation of the\ncentral canal at this level. A bone graft donor site is noted in the left\nposterior iliac crest.\n\nThe partially visualized intra-abdominal organs appear grossly unremarkable.\nDense atherosclerotic calcifications are seen in the abdominal aorta, at the\norigin of the left renal artery, and in the iliac branches bilaterally.", "output": "Status post L4/L5 posterior fusion without evidence of hardware complications\nor change in alignment. No acute fractures with unchanged mild wedging\nanteriorly of T12. Moderate to severe multilevel degenerative changes, most\npronounced at L2-L3 where there is moderate central canal narrowing, overall\nunchanged since the prior study." }, { "input": "There is no acute fracture or traumatic malalignment. Mild scoliosis of the\nthoracic spine is similar to prior. There are moderate multilevel degenerative\nchanges including anterior osteophytosis, disk space narrowing, endplate\nsclerosis, and vacuum phenomena at T10-11, T11-12, and T12-L1.Anterior wedging\nof T11 and T12 vertebral bodies is unchanged from prior. The remaining\nthoracic vertebral bodies are normal in height. To the extent that the\ncontents of the spinal canal can be evaluated, no high-grade canal stenosis\nis seen. No focal lytic or sclerotic osseous abnormality concerning for\nmalignancy is detected.\n\nThe included portions of the lungs are clear. There is no mediastinal\nlymphadenopathy. There is a 1.3 x 0.7 cm hypodensity in the body of the\npancreas that is similar in size to prior CT (3:106). Cholelithiasis is noted.", "output": "1. Unchanged moderate degenerative changes, worst in the lower thoracic spine\ncompared to ___. Mild anterior wedging at T11-12 is also unchanged. No acute\nfracture or traumatic malalignment. No osseous lesion suspicious for\nmetastasis.\n2. 1.3 cm pancreatic hypodensity is likely a side-branch IPMN. However,\nfurther evaluation with MRCP can be considered." }, { "input": "There are five lumbar-type vertebral bodies. Upper lumbar dextroscoliosis is\nagain noted. There is right lateral subluxation and retrolisthesis of L1 on\nL2, similar to prior. Anterolisthesis of L4 on L5 is similar compared to\nprior. Laminectomy changes and bilateral L4 and L5 pedicle screws are again\nin place without evidence of hardware related complication. Intervertebral\ndisc height loss is seen spanning T10-T11 through T12-L1 but also at L2-3. \nVacuum disc phenomenon again seated L1-L2. Findings are similar compared to\nprior noting that prior exam included up through the T11-T12 levels.\n\nAt T10-T11, scoliosis contributes to moderate to severe left foraminal\nnarrowing. There is mild right foraminal narrowing.\n\nAt T11-T12 there is moderate to severe left foraminal narrowing due to\nscoliosis in combination with endplate osteophytes. No canal or right\nforaminal narrowing.\n\nAt T12-L1, there is moderate to severe left and minimal right foraminal\nnarrowing. This is also due to the scoliosis in combination with endplate\nosteophytes.\n\nAt L1-L2 there is a disc bulge and endplate osteophytes as well as facet joint\nhypertrophic changes. There is at least mild canal narrowing and likely\nsubarticular recess narrowing. There is mild bilateral foraminal narrowing.\n\nAt L2-3, there is a disc bulge and facet joint hypertrophy. There is at least\nmild, likely mild canal narrowing and likely subarticular recess narrowing. \nThere is mild left and moderate right foraminal narrowing, similar to prior.\n\nAt L3-4, there is facet joint hypertrophy though without canal or foraminal\nnarrowing.\n\nAt L4-5, no obvious canal or foraminal narrowing noting artifacts limiting\ndetailed evaluation.\n\nAt L5-S1, there is no canal or foraminal narrowing.\n\nAtherosclerotic calcifications noted in the abdominal aorta. Stone seen\nlayering dependently within the gallbladder.", "output": "Overall, no significant change since prior exam from ___. Scoliosis and\ndegenerative changes as well as postop changes at L4-5. Overall alignment is\nsimilar compared to prior. Based on CT, most significant canal narrowing is\nnoted at L2-3 which is mild. There is moderate to severe left foraminal\nnarrowing at the lower thoracic levels spanning T10-T11 through T12-L1." }, { "input": "Alignment is normal. No acute fracture is identified. No concerning\nosteoblastic or lytic lesion is seen. Likely right paracentral disc\nprotrusion at L5/S1 significantly narrows the right aspect of the central\ncanal at this level. Mild broad-based disc bulge is seen at L4/L5.", "output": "No acute fracture or dislocation. Likely right paracentral disc protrusion at\nL5/S1 significantly narrows the right aspect of the central canal at this\nlevel.\n\nBroad-based disc bulge seen at L4/L5.\n\nNOTIFICATION: Findings discussed with Dr. ___ at 20:30 on ___\nvia telephone. Patient to undergo MRI." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Patient is status post L5-S1 laminectomy. There is stranding in the\nsubcutaneous tissue posterior to these levels likely postoperative. \nAdditionally, there are foci of air seen within postoperative bed at the level\nof L3. No discrete fluid collections seen. Alignment is anatomic. No acute\nfracture or traumatic dislocation. Multilevel degenerative changes with\nintervertebral disc space narrowing, osteophyte formation, and vacuum disc\nphenomenon, most prominent at L4-L5 and L5-S1. There is no evidence of\ncortical spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.There is a focus of increased sclerosis within the right\nsacral ala, similar to prior CT dated ___.\n\nThe visualized portion of the abdomen and pelvis is notable for moderate\natherosclerotic calcification and a partially visualized fibroid uterus. \nPresacral stranding is visualized and is similar to the CT L-spine dated ___.", "output": "1. Patient is status post L5-S1 laminectomy. Within the limitations of\nunenhanced scan, there is no discrete fluid collection." }, { "input": "No evidence of traumatic malalignment. Facet joints are well aligned. No\ndefinite acute fracture. There are extensive anterior osteophytes some of\nwhich demonstrate subtle internal linear lucencies however there is no\nassociated stranding or prevertebral edema to suggest acuity. Multilevel\ndegenerative changes have progressed in comparison to prior there is loss of\nintervertebral disc space at C5-C6. Ossification of the posterior\nlongitudinal ligament and/or posterior osteophytes contribute to very mild\nvertebral canal narrowing, most pronounced at C2 and C3. Multilevel\nuncovertebral hypertrophy and facet osteophytes contribute to mild neural\nforaminal narrowing at C5-6. Visualized thyroid gland and lung apices are\nunremarkable.", "output": "1. No evidence of traumatic malalignment or acute fracture. No prevertebral\nedema.\n2. Multilevel degenerative changes have progressed in comparison to ___ as described above." }, { "input": "No evidence of traumatic malalignment. No evidence of acute fracture. \nVertebral body heights appear well preserved. There is mild loss of\nintervertebral disc space at T12-L1. Anterior and left lateral osteophytes\nare noted. No significant vertebral canal narrowing. Multilevel facet\narthropathy contributes to neural foraminal narrowing. There are mild\ndegenerative changes of the bilateral sacroiliac joints.\n\nIncidental note is made of a 14 mm nodule in the medial limb of the left\nadrenal gland, similar in appearance to the prior CT abdomen/pelvis but\nincompletely evaluated (43 Hounsfield units). In addition, the bladder wall\nappears somewhat thickened. Mild atherosclerotic calcifications are seen in\nthe abdominal aorta.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Multilevel mild degenerative change.\n3. Nonspecific thickening of the bladder wall, incompletely evaluated but\ncorrelation with urinalysis for cystitis is recommended.\n4. 14 mm left adrenal nodule, incompletely evaluated, but unchanged from prior\nCT from ___, and presumably benign." }, { "input": "Alignment is normal. No fractures are identified. There are mild\ndegenerative changes seen in the cervical spine with small multiple level\nposterior disc bulges. There is no significant spinal canal stenosis. \nUncovertebral and facet hypertrophy cause mild left neural foraminal narrowing\nat C4-5. There is no prevertebral edema.\n\nThere is a 1 cm left thyroid nodule for which no follow-up is recommended. \nThe included lung apices are unremarkable. The esophagus is patulous and\ncontains debris. Paranasal sinus hemorrhage as detailed on the facial bone\nCT.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is minimal retrolisthesis of C4 on C5, unchanged. Otherwise, remaining\nalignment is normal. No acute fractures are identified.There are multilevel\ndegenerative changes which are mild with intervertebral disc space narrowing,\nendplate sclerosis and cysts, and osteophyte formation. There is mild central\ncanal narrowing at C4-5 and C5-6 as well as mild bilateral neural foraminal\nstenosis at C4-5. However, no significant or severe spinal canal or neural\nforaminal narrowing.There is no prevertebral edema.\n\nAgain demonstrated, is a 11 mm left isodense inferior thyroid lobe nodule. \nOtherwise, the remaining thyroid and included lung apices are unremarkable.\nThere are moderate bilateral carotid bulb calcifications, right greater than\nleft.", "output": "1. No acute fracture or traumatic malalignment.\n2. Redemonstration of 1.1 cm left thyroid lobe nodule. Please refer to\nrecommendations section below for further instructions.\n\nRECOMMENDATION(S): 1.1 cmThyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There are 5 lumbar-type vertebral bodies. Vertebral body heights are\nmaintained. There is mild facet arthropathy at the lumbosacral junction, but\nno compression fracture or paraspinal collection. Disc bulges are identified\nmost notably at L4-5 without significant canal or foraminal narrowing based on\nCT. Sacroiliac joints are symmetric and normal bilaterally.\n\nThe partially imaged retroperitoneum is normal with no hematoma, normal\nappearance of the kidneys bilaterally with no stones or hydronephrosis, and\nnormal caliber of the partially imaged bowel. No retroperitoneal\nlymphadenopathy. Atherosclerotic calcifications are noted in a normal caliber\nabdominal aorta and iliac vessels.", "output": "1. No evidence of fracture or malalignment in the lumbar spine.\n2. No evidence of retroperitoneal hematoma on the included images of the\nretroperitoneum." }, { "input": "Alignment is normal. No fractures are identified.There is asymmetry of the\nlateral masses about the dense with wider space seen laterally on the left\ncompared to the right. There is also slight asymmetry at the superior\narticular facets of C2 suggesting that this is likely not acute. The anterior\natlantodental interval is preserved. Degenerative changes include\nintervertebral disc height loss and uncovertebral joint hypertrophy. No\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nAtherosclerotic calcifications noted at the carotid bulbs. Lung apices are\nunremarkable. Included portion of the thyroid is within normal limits.", "output": "No fracture.\nAsymmetry of the dens between the lateral masses of C1. This is most likely a\nnormal variant however clinical correlation will be necessary. If clinical\nsuspicion for an acute injury, consider additional imaging by MRI. No\nprevertebral edema." }, { "input": "Alignment is unchanged with minimal anterolisthesis of C3 on C4. There is\nsimilar asymmetry of the lateral masses about the dens with left lateral\nwidening, unchanged. No fractures are identified. There are mild multilevel\ndegenerative changes as evidenced by loss of intervertebral disc space height,\nsubchondral cystic change and anterior and posterior osteophyte formation,\nmost pronounced at C4-5 and C6-7. There is mild multilevel neural foraminal\nnarrowing due to uncovertebral osteophytes and facet hypertrophy. There is\nmild canal narrowing at C4-5 due to a posterior osteophyte. There is no\nevidence of severe spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\nThe visualized lung apices demonstrate mild bilateral pleuroparenchymal\nscarring. The visualized thyroid gland is within normal limits.", "output": "1. No acute fracture or change in alignment.\n2. Mild multilevel degenerative disease, as above." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Multiple prominent\ncervical lymph nodes are noted, but are not enlarged by CT size criteria.", "output": "No acute fracture or malalignment." }, { "input": "Streak artifact from dental amalgam substantially limits evaluation at C2 and\nC3.\n\nThe bones are demineralized. No displaced fracture is identified. Vertebral\nbody heights are within normal limits. 2 mm anterolisthesis of C7 on T1. No\nevidence for prevertebral edema or disc space widening. No splaying of the\nposterior elements.\n\nProminent focal lucencies within multiple vertebral bodies may be secondary to\nloss of mineralization and degenerative cysts along the endplates, plus/minus\nhemangiomas. 2 mm sclerotic lesion in the right C5 vertebral body, along the\nmargin of lucent lesion, is nonspecific but may represent a sclerosing\nhemangioma or bone island.\n\nEvaluation of the spinal canal at C2-C3 and C3-C4 is limited by streak\nartifact from dental amalgam. Disc protrusions and endplate osteophytes\nmildly indent the ventral thecal sac from C4-C5 through C7-T1. Multilevel\nneural foraminal narrowing by uncovertebral and facet osteophytes is also\nnoted.\n\nThe partially visualized thyroid is enlarged with multiple nodules, extending\ninto the superior mediastinum, with multiple nodules. The right lobe has a\npartially visualized posterior exophytic component extending into the right\nparatracheal space. Visualized trachea is deviated to the left and minimally\nnarrowed. The dominant nodule on the right measures approximately 1.8 cm, on\nthe left 1.4 cm. The imaged lung apices are unremarkable. Concurrent head CT\nis reported separately.", "output": "1. Streak artifact from dental amalgam substantially limits evaluation at C2\nand C3.\n2. Otherwise, no displaced fracture is seen allowing for loss of bone\nmineralization.\n3. 2 mm anterolisthesis of C7 on T1 is almost certainly degenerative in\netiology, though there are no comparison exams to confirm chronicity.\n4. Multilevel degenerative disease.\n5. Partially visualized thyroid is enlarged with multiple nodules up to 1.8\ncm, extending into the superior mediastinum, right larger than left, with a\npartially visualized exophytic component of the right thyroid lobe insinuating\ninto the right upper paratracheal space. Visualized trachea is deviated to\nthe left and minimally narrowed.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: Electronic preliminary report was provided by Dr. ___ at\n01:13 on ___." }, { "input": "No evidence for a fracture or prevertebral edema. Alignment is normal. \nVertebral body heights are preserved. There is a 7 x 6 x 6 mm well-defined\nlucent lesion in the C7 vertebral body, most likely a hemangioma but not fully\ncharacterized. Allowing for differences in technique, it does not appear\nsignificantly changed compared to the head and neck CTA from approximately 4\nmonths earlier on ___. There is mild disc space narrowing at C5-C6\nand minimal disc space narrowing at C6-C7. Disc protrusions and endplate\nosteophytes mildly indent the ventral thecal sac at multiple levels. There is\nmultilevel neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nVisualized lung apices are grossly clear allowing for motion artifact. The\nthyroid gland is small with multiple calcifications; no evidence for thyroid\nnodule exceeding 15 mm. ACR guidelines do not recommend sonographic\nevaluation of incidentally discovered thyroid nodules smaller than 15 mm in\nthis age group. Concurrent head CT is reported separately.", "output": "1. No evidence for a fracture. Normal alignment.\n2. Multilevel degenerative disease.\n3. 7 mm well-defined lucent lesion within the C7 vertebral body, not\nsignificantly changed compared to head and neck CTA from approximately 4\nmonths earlier on ___, most likely represents a hemangioma but is\nnot fully characterized.\n4. The thyroid gland is small with multiple calcifications; no evidence for\nthyroid nodule exceeding 15 mm. ACR guidelines do not recommend sonographic\nevaluation of incidentally discovered thyroid nodules smaller than 15 mm in\nthis age group.\n\nRECOMMENDATION(S): If clinically warranted, outpatient cervical spine MRI\nwith and without contrast may be considered for more definitive\ncharacterization of the C7 vertebral body lesion.\n\nNOTIFICATION: The following preliminary report in PACS was provided by Dr.\n___ on ___ at 01:23: \"No acute fracture or traumatic malalignment\nof the cervical spine.\" Dr. ___ paged Dr. ___, who was\ntaking care of the patient on the inpatient service, about the impression item\n3 and the recommendation above at 10:45 on ___." }, { "input": "There is no prevertebral soft tissue swelling. . No the 3 fracture is\nidentified. There is no acute dislocation. Reversal of the normal cervical\nlordosis may be positional, and is similar to the prior exam. There are\nmoderate to severe multilevel degenerative changes. This is most marked at\nC4-5, where there is near complete obliteration of the disc space. At the\nother levels, there is severe disc space narrowing, endplate sclerosis,\nuncovertebral hypertrophy, and facet arthrosis. There is no evidence of severe\ncanal stenosis. Moderate multilevel neural foraminal narrowing is similar to\nthe prior exam. Overall, there is little change from the prior exam.\n\nThe thyroid gland is heterogeneous with multiple nodules. The largest is in\nthe right lobe, and measures 15 mm (3, 48). These are unchanged from the\nprior CT. A 3 mm right upper lobe pulmonary nodule (3, 55) is only partially\nimaged, though stable from the prior exam in ___. Given this stability, it is\nlikely benign. The apices of the lungs are otherwise clear.", "output": "1. No fracture or acute malalignment. Moderate to severe multi level\ndegenerative changes, similar to the prior exam from ___.\n2. No significant change in the multinodular thyroid by CT imaging. A thyroid\nultrasound in ___ demonstrated multiple nodules, one of which was biopsied.\nThere has been no repeat thyroid ultrasound since then in our PACS. If\nclinically indicated, these nodules could be re-evaluated by a nonemergent\nthyroid ultrasound." }, { "input": "The visualized elements of the posterior fossa and craniocervical junction are\nunremarkable, the alignment is normal. No fractures are identified throughout\nthe cervical spine.There is no significant canal or foraminal narrowing. There\nis no prevertebral edema.\n\nThe thyroid gland and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment in the cervical spine." }, { "input": "Alignment is anatomic.No fractures are identified.Multilevel degenerative\nchanges are mild. A posterior disc bulge causes mild canal narrowing at C3-4.\nNeural foraminal narrowing is mild bilaterally at C3-4.There is no\nprevertebral soft tissue swelling. There is no cervical lymphadenopathy by\nsize criteria.\n\nThe imaged thyroid gland is grossly unremarkable. Lung apices are clear.", "output": "No evidence of acute fracture or traumatic subluxation." }, { "input": "Alignment is anatomic.No acute fractures are identified. There is no evidence\nof high-grade spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.No suspicious osseous lesions.\n\n5 mm subpleural right upper lobe lung nodule (series 3, image 25). Mild\ndependent atelectasis within the lungs bilaterally. There is a prominent\nprevascular mediastinal lymph node measuring 8 mm in short axis (series 2,\nimage 33). No other abnormalities within the partially imaged chest.", "output": "1. No evidence of fracture. No suspicious osseous lesions, although MR is\nmore sensitive.\n2. 5 mm subpleural right upper lobe lung nodule, not visualized on the prior\nCT due to a pleural effusion, but may represent metastatic disease. Prominent\nprevascular lymph node has increased in size since ___, and may\nalso be metastatic. Attention on follow-up is recommended." }, { "input": "Alignment is anatomic.No acute fractures are identified.There is ankylosis of\nthe left T11 and T12 costovertebral junctions, likely secondary to chronic\nhealed fracture deformities. There is no evidence of high-grade spinal canal\nor neural foraminal stenosis. There is no prevertebral soft tissue swelling.No\nsuspicious osseous lesions.\n\nMultiple gallstones are visualized. Other than a large stool burden, no other\nabnormalities within the partially imaged abdomen and pelvis. Previously seen\ndiffuse ascites on examination of ___ is not visualized.", "output": "1. No evidence of acute fracture. No suspicious osseous lesions, although MR\nis more sensitive.\n2. Cholelithiasis.\n3. Additional findings as described above." }, { "input": "Alignment is anatomic.No fractures are identified.There is no prevertebral\nsoft tissue swelling.No suspicious osseous lesions are identified.\n\nMild degenerative disc disease throughout the cervical spine with prominent\nanterior osteophytes. Broad-based disc bulge at C5-6 causes mild narrowing of\nthe spinal canal. No high-grade spinal canal or neural foraminal stenosis.\n\nThe partially imaged lung apices are clear. No cervical lymphadenopathy. \nThyroid is unremarkable.", "output": "1. No evidence of fracture. No suspicious osseous lesions visualized,\nalthough MR is more sensitive.\n2. Mild degenerative disc disease with a broad-based disc bulge at C5-6, which\ncauses mild narrowing of the spinal canal." }, { "input": "Bones are osteopenic. There is minimal anterolisthesis of C3 on C4, likely\ndegenerative in nature. No fractures are identified.\n\nMultilevel degenerative changes are seen, most extensive at C4-5 and notable\nfor loss of intervertebral disc height, osteophytosis, uncovertebral joint\nhypertrophy, and facet arthrosis. There is fusion of the left C2 and C3 facet\njoints. There is no prevertebral edema.\n\nCalcification is seen at the left lung apex. The right thyroid lobe is\nenlarged with multiple nodules, the largest measures up to 1.1 cm. The left\nthyroid lobe is not visualized.", "output": "1. No acute fracture.\n2. Multilevel degenerative changes of the cervical spine. Minimal\nanterolisthesis of C3 on C4 is likely degenerative in nature.\n3. Multinodular right thyroid lobe.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm. No prevertebral soft tissue swelling is seen.\n\nThe included lung apices are clear.", "output": "No cervical spine fracture or malalignment." }, { "input": "No acute fracture is identified. There is anterolisthesis of C4 on C5 and\nretrolisthesis of C5 on C6 with apparent slight anterior subluxation of the\nright C4 facet. There is no prevertebral soft tissue swelling. At C2/C3\nlevel, there is a partially calcified cystic formation, apparently attached to\nligamentum flavum, measuring approximately 3.2 x 21 mm in sagittal projection\n(image 36, series 602b), probably consistent with a partially calcified\nsynovial cyst, correlation with MRI of the cervical spine in a non urgent\nbasis is advised. Multilevel, multifactorial degenerative changes are noted\nwith disc space narrowing, osteophyte formation, and subchondral sclerosis. \nThere is also uncovertebral and facet hypertrophy at multiple levels causing\nsevere bilateral neural foraminal narrowing at C5-C6 and C6-C7.\n\nEvaluation of the soft tissues in the neck demonstrate a soft tissue density\nin the right parapharyngeal space partially obliterating the parapharyngeal\nfat compatible with patient's known neck mass, although not fully evaluated\nwithout the administration of IV contrast. The right sternocleidomastoid\nmuscle is not visualized. There is extensive scarring at the lung apex common\nnot significantly changed since prior CT chest from ___.", "output": "1. No acute fracture. Anterolisthesis of C4 on C5 with retrolisthesis of C5\non C6 and apparent anterior subluxation of the right C4 facet. These findings\nmay be degenerative in nature, however given no direct prior comparison is\navailable, correlate with site of focal tenderness and MRI may be obtained for\nfurther evaluation if indicated.\n\n2. Soft tissue density in the right parapharyngeal space obliterating the\nright parapharyngeal fat consistent with patient's known neck mass, not fully\nevaluated on this study due to lack of IV contrast.\n\n3. Partially calcified lesion at C2-3 -C3 level, apparently attached to the\nligamentum flavum as described above, likely consistent with a synovial cyst,\ncorrelation with MRI is recommended.\n\nRECOMMENDATION(S): At C2/C3 level, there is a partially calcified cystic\nformation, apparently attached to ligamentum flavum, measuring approximately\n3.2 x 21 mm in sagittal projection (image 36, series 602b), probably\nconsistent with a partially calcified synovial cyst, correlation with MRI of\nthe cervical spine with and without contrast in a non urgent basis is advised." }, { "input": "No fractures are identified. Mild anterolisthesis of C4 on C5, and\nretrolisthesis of C5 on C6, is unchanged. The visualized osseous structures\nare osteopenic. No definite acute fractures are identified. Multilevel\ndegenerative changes, worst at C5-C6 and C6-C7, where facet arthropathy and\nuncovertebral hypertrophy results in up bilateral severe neural foraminal\nnarrowing, are not definitely changed from prior.There is no prevertebral\nedema.\n\nRight parapharyngeal soft tissue density in surgical clip (see 02:12) at site\nof patient's known mass resection is not significantly changed, and\nincompletely evaluated on this noncontrast study. Asymmetry of the vocal\nfolds compatible patient's known focal cord paralysis again noted.\n\nThe thyroid is unremarkable. Extensive biapical scarring and emphysematous\nchanges is not significantly changed from prior. Right sphenoid and maxillary\nsinus mucosal thickening is noted.", "output": "1. No fracture or traumatic malalignment.\n2. Nonspecific right cervical soft tissue density compatible with patient's\nknown right parapharyngeal differentiated carcinoma resection. If concern for\nrecurrent residual tumor, consider dedicated contrast neck MRI for further\nevaluation.\n3. Asymmetric vocal folds compatible patient's known vocal cord paralysis.\n4. Paranasal sinus disease as described.\n5. Grossly stable biapical scarring and emphysematous changes." }, { "input": "Alignment is normal. No fractures are identified.Mild degenerative changes\nwith intervertebral disc height loss, endplate sclerosis, and anterior and\nposterior osteophytes are seen at C5-6. Uncovertebral and facet osteophytes\ncause mild left neural foraminal narrowing at C3-4 and C5-6 and moderate right\nneural foraminal narrowing at C5-6. There is mild spinal canal stenosis at\nC5-6.There is no prevertebral soft tissue swelling.The thyroid is\nunremarkable. Mild paraseptal emphysema is seen at the right apex.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild degenerative changes of the cervical spine, most severe at C3-4 and\nC5-6." }, { "input": "There has been progression of a T12 compression fracture with retropulsion of\nthe superior posterior portion of the vertebral body into the spinal canal. \nThere is burst anatomy of the superior portion of the fractured T12 vertebral\nbody. The posterior elements appear intact. There are vacuum phenomena in\nthe intervertebral discs Re level from T11 through S1.\nThere is mild retrolisthesis of L2 upon L3.\nAt T12-L1 there is a mild bulge of the disc with no spinal canal or neural\nforaminal compromise.\nAt L1-2, intervertebral osteophytes mildly narrow the spinal canal. The\nneural foramina appear normal.\nAt L2-3, subluxation and posterior osteophytes combine with ligamentum flavum\nthickening to produce at least mild spinal canal narrowing. The neural\nforamina appear normal.\nAt L3-4, disc bulge and thickening of the ligamentum flavum mildly narrows the\nspinal canal. The neural foramina appear normal.\nAt L4-5, there is a right-sided protrusion extending into the lateral portion\nof the spinal canal and into the right neural foramen. The left neural\nforamina appears normal.\nAt L5-S1, intervertebral osteophytes encroach on the spinal canal. Facet\nosteophytes contribute to bilateral narrowing of the lateral recesses\ncompromising the S1 nerve roots, more severe on the left than right.", "output": "1. Progressing compression fracture at T12 with retropulsion of the\nposterosuperior portion of the vertebral body into the spinal canal.\n2. Degenerative changes at multiple other levels.\n\nNOTIFICATION: The finding of progression of the T12 compression fracture with\nretropulsion into the spinal canal was entered in the Radiology department\ncritical results reporting system 19:45 ___ immediately upon\nreviewing the images by Dr. ___." }, { "input": "There is again seen a burst compression fracture of T12 vertebral body. When\ncompared to the ___ CT torso, the degree of T12 vertebral body\nheight loss has progressed, now demonstrating a predominantly anterior wall\nwedge deformity. Additionally, a fracture fragment from the posterior aspect\nof the superior endplate is retropulsed into the vertebral canal by\napproximately 5.4 mm (602:39), previously retropulsed by 4 mm in ___.\nThe retropulsed fragment causes moderate narrowing of the vertebral canal and\ndeforms the ventral thecal sac this level. There has been interval\nprogression of degenerative disc disease at T11-T12 and T12-T1, likely\nsecondary to the old T12 fracture, demonstrating vacuum disc phenomenon. \nThere has also been interval worsening of bilateral T11-T12 and T12-L1 facet\narthropathy demonstrating periarticular heterotopic new bone, likely secondary\nto the prior fracture.\n\nThere are no other fractures identified. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.", "output": "1. When compared to the ___ CT torso, there has been interval\nprogression of T12 vertebral body height loss since the previously seen T12\nburst compression fracture. 5.4 mm bony retropulsion into the vertebral canal\ncauses moderate vertebral canal narrowing and deforms the ventral thecal sac\nat this level. There is also worsening intervertebral disc disease and\nbilateral facet arthropathy at T11-T12 and T12-T1, all likely secondary to the\nprior T12 fracture.\n2. No other fractures identified." }, { "input": "The bones are demineralized. Levoconvex scoliosis of the partially visualized\nthoracic spine with mild dextroconvex curvature of the cervical spine further\nlimit evaluation. No displaced fracture is identified. Vertebral body\nheights are within normal limits. There is minimal anterolisthesis of C3 on\nC4, mild anterolisthesis of C4 on C5, and minimal anterolisthesis of C5 on C6.\nThere is no evidence for prevertebral soft tissue swelling or disc space\nwidening. There is severe disc space narrowing from C4-C5 through C7-T1 with\nendplate osteophytes. Disc protrusions and endplate osteophytes indent the\nventral thecal sac at multiple levels with at least moderate spinal canal\nnarrowing at C4-C5 and C5-C6. There is multilevel neural foraminal narrowing\nby uncovertebral and facet osteophytes.\n\nConcurrent head CT and concurrent thoracic spine CT are reported separately.\nThere is mild emphysema at the included lung apices. The thyroid is grossly\nunremarkable. No enlarged lymph nodes by CT criteria.", "output": "1. No evidence for displaced fracture allowing for loss of bone\nmineralization.\n2. Minimal anterolisthesis at C3-C4, mild anterolisthesis at C4-C5, and\nminimal anterolisthesis at C5-C6 are almost certainly degenerative, though\nthere are no comparison exams to confirm chronicity.\n3. Multilevel degenerative disease with at least moderate spinal canal\nstenosis at C4-C5 and C5-C6." }, { "input": "There are 12 rib-bearing vertebrae. Loss of bone mineralization limits\ndetection of acute fractures. Moderate L1 compression deformity status post\nvertebroplasty similar to the ___ chest radiographs, except that the\nmild retropulsion cannot be compared to the chest radiographs due to\ndifferences in modalities. Mild to moderate T10 vertebral body loss of height\nwith superior endplate deformity and mild T11 loss of height with superior\nendplate deformity are grossly similar to the ___ chest radiographs,\nand minimally changed since the ___ chest CT. Mild anterior wedging of T5\nvertebral body with inferior endplate deformity are also similar to the ___\nchest CT. Overall, no acute displaced fracture is definitively identified.\n\nThere is disc space narrowing with vacuum phenomenon Schmorl's nodes at\nmultiple levels, as well as anterior endplate osteophytes at multiple levels. \nSmall posterior endplate osteophytes and disc bulges are also noted. \nEvaluation of spinal canal detail by CTs limited compared to MRI. However,\nmild spinal canal narrowing by the disc bulges, endplate osteophytes, and\nfacet osteophytes appears present at T10-T11 and T11-T12.\n\nEvaluation of the included lung parenchyma is limited by incomplete expansion\nand atelectasis. There is subpleural scarring with mild traction\nbronchiectasis in the medial portion of the posterior basal right lower lobe\nnear the spine, similar to the ___ chest CT allowing for differences in\nmodalities. There is mild emphysema. CABG related changes are partially\nvisualized. Vascular calcifications are noted. Partially visualized thyroid\nis grossly unremarkable.\n\nThis exam is not technically optimized for evaluation of the included upper\nabdomen. There is a small hiatal hernia. Peripherally calcified gallstone is\npartially imaged in the gallbladder, at least 1.5 cm. 2 cm cystic lesion in\nthe posterior mid right kidney on image 3:108 demonstrates density of simple\nfluid on noncontrast CT but is not fully evaluated. There are extensive\nvascular calcifications including within bilateral renal hila. In addition,\nthere is a 2 mm nonobstructing stone versus vascular calcification in the\nupper right kidney on image 3:104.", "output": "1. No evidence for an acute displaced fracture allowing for loss of bone\nmineralization.\n2. Chronic L1 compression fracture status post vertebroplasty appears grossly\nsimilar compared to the ___ chest radiographs allowing for differences\nin modality; mild retropulsion cannot be compared to the prior chest\nradiographs.\n3. Multiple mild chronic thoracic compression deformities.\n4. Multilevel degenerative disease. Mild spinal canal narrowing at T10-T11 and\nT11-T12.\n5. Mild emphysema.\n6. Partially visualized cholelithiasis.\n7. Possible 2 mm nonobstructing stone versus vascular calcification in the\nupper pole of the right kidney." }, { "input": "No definite acute fracture or traumatic malalignment. A lucency through the\nspinous process of T1 demonstrates corticated margins, and is felt to\nrepresent congenital variant versus sequela of prior trauma (602b:33, 2:76). \nThere is no significant canal or foraminal narrowing.There is no prevertebral\nedema.\n\nThe thyroid and included lung apices are unremarkable. There is no cervical\nlymphadenopathy by size criteria.", "output": "No definite acute fracture or traumatic malalignment. A lucency through the\nspinous process of T1 demonstrates corticated margins, and is felt to\nrepresent congenital variant versus sequelae of remote fracture." }, { "input": "Minimal anterolisthesis of C3-C4 is of indeterminate age and may be\ndegenerative in nature. No acute fracture or prevertebral soft tissue\nswelling is noted. There is no high-grade stenosis of the spinal canal. \nThere is no significant neural foraminal narrowing. The visualized lung\napices are clear. The thyroid gland is unremarkable. Medialization of the\ncarotid arteries is noted.", "output": "No acute fracture. Mild anterolisthesis of C3 on C4 of indeterminate age and\nmay be degenerative in nature.If clinical concern for ligamentous injury, MRI\nis more sensitive." }, { "input": "There is no evidence for prevertebral soft tissue edema. There is no fracture\nor subluxation. Disc space heights are preserved. Small central disc\nprotrusions at C4-5 and C5-6 minimally indent the ventral thecal sac. There\nare also small uncovertebral osteophytes at C4-5 with mild neural foraminal\nnarrowing.\n\n1.6 cm oval subcutaneous hypodense lesion in the left suboccipital region is\nsimilar to ___ but larger than on ___. It is most\ncompatible with a sebaceous cyst.\n\nBiapical scarring is noted at the lung apices.", "output": "1. No fracture or subluxation.\n2. Mild degenerative disease." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.The visualized lung apices are clear. There is no cervical\nlymphadenopathy by size criteria. The thyroid gland is unremarkable. The\nmajor salivary glands are also unremarkable. The aerodigestive tract\ndemonstrates no suspicious lesions within the confines of noncontrast enhanced\nexam.", "output": "No evidence of fracture or subluxation." }, { "input": "A previously seen nondisplaced fracture through the left aspect of the C2\nvertebral body demonstrates signs of interval healing since the prior study,\nalthough a lucent fracture line persists (02:14). The fracture line extends\nposteriorly to the central canal, and passes anterior to the transverse\nforamen\n.\nNo acute fracture is identified, and there is no malalignment of the cervical\nspine. The prevertebral soft tissues are unremarkable.\nMild sclerosis along the anterior aspect of the superior endplate of the T1\nvertebral body (602b:32) is new since the prior study from ___. There\nis no significant loss of height, retropulsion, or surrounding soft tissue\nswelling.\n\nMinimal multilevel degenerative changes are present throughout the cervical\nspine, including multilevel facet arthropathy and small anterior osteophytes\nat the C4-5 level.\n\nThere is no lymphadenopathy. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable.", "output": "1. Mild interval healing of a nondisplaced fracture through the left aspect of\nthe C2 vertebral body since the prior study from ___, although a\nlucent fracture line persists.\n2. No acute cervical spine fracture or malalignment is detected.\n3. Mild sclerosis of the anterior superior endplate of the T1 vertebral body\nnew since recent prior may be due to degenerative change or reflect the\nsequelae of prior injury/endplate compression.\n\nNOTIFICATION: The findings and change from the original WET READ were\ndiscussed by Dr. ___ with Dr. ___ resident) on ___ at 10:41 ___,\n3 minutes after discovery of the findings." }, { "input": "Alignment is normal. No acute fractures are identified. Mild vertebral body\nheight loss of T1 and T2 is unchanged.There are mild multilevel degenerative\nchanges including anterior, posterior, and uncovertebral osteophytosis worst\nat C4-C5. There is no significant osseous vertebral canal or neural foraminal\nnarrowing. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nA round rim calcified lesion in the right parotid gland is unchanged. Dense\ncavernous carotid and vertebral artery calcifications are again seen. Imaged\nthyroid gland remains somewhat nodular without discrete focal lesion. Imaged\nlung apices are clear.", "output": "1. No acute traumatic abnormality.\n2. T1 and T2 vertebral body height loss is chronic and unchanged." }, { "input": "Alignment is normal. No acute fractures are identified.Mild vertebral body\nheight loss at T1 and T2 is unchanged compared to prior. There are mild\nmultilevel degenerative changes including anterior, posterior, and\nuncovertebral osteophytosis. Mild left-sided neural foraminal narrowing is\nmost pronounced at C3-4 and C4-5. There is no significant osseous vertebral\ncanal narrowing. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nA round rim calcified lesion in the right parotid gland is unchanged,\npotentially a node. Dense internal carotid and vertebral artery\ncalcifications are again seen. Imaged thyroid gland remains somewhat\nheterogeneous without dominant nodule. Imaged lung apices are clear.", "output": "1. No acute fracture or traumatic subluxation.\n2. T1 and T2 vertebral body height loss is chronic and unchanged." }, { "input": "There is no acute fracture. There is right lateral subluxation of L3 on L4. \nVertebral bodies are otherwise preserved in alignment. There is straightening\nof the normal lumbar lordosis. Intervertebral disc height loss is seen\nspanning L2-3 through L5-S1 with associated vacuum disc phenomenon at these\nlevels. Congenitally short pedicles contribute to the degree of canal\nnarrowing detailed below.\n\nAt L1-2, there is a small disc bulge without significant canal or foraminal\nnarrowing.\n\nAt L2-3, there is disc bulge and endplate osteophytes. In combination with\nfacet joint hypertrophy, thickening of the ligamentum flavum, and congenitally\nshort pedicles, there is moderate to severe canal narrowing and moderate to\nsevere bilateral foraminal narrowing.\n\nAt L3-4, there is diffuse disc bulge and endplate osteophytes. In combination\nof facet joint hypertrophy, ligamentum flavum thickening, and congenitally\nshort pedicles there is moderate canal narrowing, moderate to severe left\nforaminal narrowing and moderate right foraminal narrowing.\n\nAt L4-5, there is diffuse disc bulge, endplate osteophytes which in\ncombination with congenitally short pedicles results in moderate canal\nnarrowing. Moderate to severe bilateral foraminal narrowing is noted.\n\nAt L5-S1, there is a disc bulge and endplate osteophytes without significant\ncanal narrowing although there is moderate to severe right and moderate left\nforaminal narrowing.\n\nLimited evaluation of the abdomen reveals diverticulosis without wall\nthickening or adjacent fat stranding and a left renal cyst measuring up to 4.0\nx 2.7 cm. Atherosclerosis of the abdominal aorta is noted without aneurysm.", "output": "1. No fracture or traumatic malalignment.\n2. Multilevel degenerative changes in combination with congenitally short\npedicles results in up to moderate to severe canal narrowing at L2-3. \nModerate to severe foraminal narrowing bilaterally at L2-3 and L4-5, on the\nleft at L3-4, and on the right at L5-S1." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "No evidence of fracture or subluxation." }, { "input": "Alignment of the cervical spine is normal. There is no acute fracture or\nprevertebral soft tissue swelling. There are mild multilevel degenerative\nchanges including anterior and posterior osteophytes with uncovertebral joint\nosteophytes C5-C6 and C6-C7. Disc protrusion seen at C4-C5. In combination\nwith a congenitally narrow canal, these changes result in moderate canal\nnarrowing and probable flattening of the cord at the C4-C5 level. Large right\nuncovertebral joint osteophyte on the right at C5-6 likely contacts the cord. \nThere is also mild bilateral neural foraminal narrowing at C5-C6.\n\nAn endotracheal tube is in position, and a nasoenteric tube is looped within\nthe oropharynx and continues to course inferiorly in the esophagus. The\nvisualized lung apices are clear, and there is no cervical lymphadenopathy.", "output": "1. Degenerative changes without acute fracture or traumatic malalignment.\n2. Nasoenteric tube is looped in the oropharynx and continues inferiorly into\nthe esophagus." }, { "input": "Alignment is normal. No fractures are identified. Moderate degenerative\nchanges at the level of C5-6 and C6-7 with endplate sclerosis, intervertebral\ndisc height loss, osteophytes and cyst formation. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.Patient is status post thyroidectomy. The lung apices\nare unremarkable. There is mucosal thickening in the left maxillary sinus\nwith a small mucous retention cyst. There is a 4 mm nodule at the right lung\napex, unchanged from chest CT dated ___.", "output": "1. No evidence of fracture or traumatic subluxation.\n2. Moderate degenerative changes at the level of C5-6 C6-7." }, { "input": "There is no acute fracture or traumatic malalignment. Mild degenerative\nchanges are seen throughout the thoracic spine with anterior osteophyte\nformation and intervertebral disc space narrowing. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm.\n\nScarring and atelectasis is seen in both lower lobes. The esophagus appears\npatulous. Again demonstrated is a left adrenal nodule measuring approximately\n2.5 x 2.2 cm, as seen on the recent CT abdomen and pelvis, which is\nincompletely characterized on the current exam.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is mild anterolisthesis of C4 on C5, likely degenerative in etiology, as\nthere is no prevertebral soft tissue swelling. No evidence of acute cervical\nspinal fracture. Incidental note is made of calcification of the transverse\nligament at C1-C2 and mild calcification of the disc at C4-C5 and C5-6. \nModerate multilevel degenerative changes of the cervical spine are most\npronounced at C5-C6, with osteophytosis and disc space narrowing. No severe\nspinal canal narrowing. Mild neural foraminal narrowing is noted bilaterally\nat C5-6.\n\nIncidental note is made of a 2 mm left upper lobe pulmonary nodule (3:64). \nMultinodular goiter thyroid is also noted, with a 5 mm right hypodense nodule\n(3:55).", "output": "1. No evidence of acute cervical spinal fracture or traumatic malalignment.\n\n2. Incidental note of a 2 mm left upper lobe pulmonary nodule. By ___\nsociety guidelines, if the patient is high risk for malignancy (history of\nsmoking), then follow-up chest CT is recommended in ___ year. Otherwise, no\nspecific radiologic follow-up recommended.\n\n3. Multinodular thyroid. The largest conspicuous nodule measures 5 mm.\n\nRECOMMENDATION(S): By ___ society guidelines, if the patient is high\nrisk for malignancy (history of smoking), then follow-up chest CT is\nrecommended in ___ year. Otherwise, no specific radiologic follow-up\nrecommended.\n\nNOTIFICATION: The above findings and recommendation were communicated via\ntelephone by Dr. ___ to Dr. ___ at 16:46 on ___, 5 min after\ndiscovery." }, { "input": "Patient is status post anterior fusion of C4 through C7 with intervertebral\nspacers with unchanged alignment. Streak artifact from hardware limits\nevaluation at those levels. No fractures are identified.There is mild spinal\ncanal narrowing at C4-C5. No significant neural foraminal narrowing.There is\nno prevertebral soft tissue swelling.Visualized thyroid and bilateral lung\napices appear unremarkable.", "output": "Status post anterior fusion of C4 through C7 with unchanged alignment. No\nevidence of perihardware complications. No cervical spine fractures are\nidentified." }, { "input": "Alignment is maintained. No fractures are identified. There is no\nprevertebral soft tissue swelling. Extensive degenerative changes are seen in\nthe cervical spine with loss of intervertebral disc height, subchondral\nsclerosis, and extensive osteophyte formation.\n\nThere is multilevel moderate vertebral canal narrowing due to posterior\nosteophytes and disc bulges with resultant deformation of the spinal cord,\nparticularly at the C4-C5 vertebral level which is also notable for moderate\ncanal narrowing. Extensive uncovertebral and facet joint hypertrophy is seen\ncausing severe neural foraminal stenosis bilaterally at C4-C5.\n\nThe lung apices appear grossly clear. There is a calcified hypodensity in the\nleft thyroid lobe measuring up to 9 mm. There is no evidence of infection or\nneoplasm.", "output": "1. No acute fracture or traumatic malalignment in the cervical spine.\n2. Extensive degenerative changes in the cervical spine with multilevel\nmoderate canal narrowing and neural foraminal stenosis, notably at C4-C5 as\nabove." }, { "input": "Mild anterolisthesis of C3 over C4 is likely degenerative and similar to prior\nexam.No fractures are identified.Multilevel moderate degenerative changes are\npresent in the cervical spine, most notable for disc height loss and anterior\nand posterior osteophytes at C4-7. Posterior disc bulges with posterior\nosteophytes at C4-5 and C5-6 cause effacement of anterior spinal canal and\nmoderate spinal canal narrowing. Moderate to severe neural foraminal\nnarrowing is most pronounced at the right C3-4 and C4-5 levels. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nVisualized lung apices and thyroid gland are unremarkable.", "output": "1. No fracture or traumatic malalignment.\n2. Multilevel moderate degenerative changes are most notable for moderate\nspinal canal narrowing at C4-5 and C5-6." }, { "input": "Alignment is normal. No acute fractures are identified. There is no critical\nspinal canal stenosis. There is no prevertebral soft tissue swelling.\nMultilevel degenerative changes are seen sound, including disc space narrowing\nthroughout the cervical spine with multilevel small anterior and posterior\nosteophytes causing mild central canal narrowing C3 through C6. Endotracheal\nand enteric tubes are partially imaged. Secretions in the nasopharynx likely\nrelate to intubation. Imaged lung apices demonstrate smooth interlobular\nseptal thickening, suggesting pulmonary edema.", "output": "No acute fracture or traumatic malalignment. Multilevel degenerative changes\nwith mild central canal narrowing from C3 through C6.\n\nPartially imaged lung apices suggest pulmonary edema." }, { "input": "Alignment is normal. No fractures are identified.There is a disc bulge at C5-6\nthat encroaches on the spinal canal and may contact the anterior surface of\nthe spinal cord. There is no other spinal canal narrowing. The neural\nforamina appear normal. There is no prevertebral soft tissue swelling. There\nis no evidence of infection or neoplasm.\n\nThere is moderate centrilobular emphysema in the bilateral lung apices. The\nthyroid gland is diffusely enlarged and appears somewhat inhomogeneous,\nalthough no nodules are identified. The appearance is similar to the neck CT\nof ___.", "output": "No evidence of fracture or subluxation." }, { "input": "Dental amalgam streak artifact and mild motion limits study. There is\nstraightening of cervical lordosis. No fractures are identified. Disc\nosteophyte complex at C5-6 results in mild spinal canal narrowing. There is\nno prevertebral soft tissue swelling. Within the limits of this noncontrast\nstudy, there is no evidence of infection or neoplasm within the limits of a\nnoncontrast study. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", "output": "1. Dental amalgam streak artifact and mild motion limits study.\n2. No evidence of acute fracture or traumatic malalignment.\n3. Disc osteophyte complex at C5-6 results in mild spinal canal narrowing." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. No soft tissue abnormalities are seen within the regions of\nthe carotid spaces bilaterally.\n\nThe visualized thyroid is unremarkable. The lung apices are clear.", "output": "No evidence of traumatic malalignment or acute fractures. No soft tissue\nabnormalities." }, { "input": "Alignment is normal. No fractures are identified.There may be a very small\nposterior disc bulge at C2-C3 (602b:23). However, there is no spinal canal\nnarrowing. No neural foraminal stenosis. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nThe imaged thyroid and lung apices are unremarkable.", "output": "1. No evidence of fracture or malalignment.\n\n2. There may be a very small posterior disc bulge at C2-C3, although without\nspinal canal or neural foraminal narrowing." }, { "input": "There is no evidence of fracture or prevertebral soft tissue swelling. There\nis mild retrolisthesis of C4 on C5, likely degenerative in etiology.\n\nMultilevel, multifactorial severe degenerative changes are seen throughout the\ncervical spine, with evidence of anterior and posterior osteophytosis worst at\nC5/C6 and C6/C7. There is also evidence of multilevel intervertebral disk\nherniation, resulting in moderate to severe thecal sac compression, worst at\nC3/C4, and C4/C5. Multilevel bilateral severe neural foraminal narrowing it\nis also demonstrated due to uncovertebral and facet hypertrophy.\n\nNote is made of mild mucosal thickening along the right maxillary sinus. The\nthyroid is unremarkable. The visualized apices of the lungs are clear. There\nis no cervical lymphadenopathy.", "output": "1. No acute cervical spine fractures identified.\n\n2. Multilevel severe degenerative changes, resulting in moderate to severe\nthecal sac compression and spinal stenosis. Recommend clinical correlation\nfor neurological symptoms as patient may be prone to spinal cord injury with\nminimal trauma and MRI can be obtained for further assessment." }, { "input": "Mild retrolisthesis of C4 on 5 is unchanged from prior, likely degenerative.\nNo acute fractures are identified.There are multilevel degenerative changes\nwith anterior and posterior osteophytes worse at C5- C6 and C6- C7. There is\nmultilevel intervertebral disc herniation resulting in moderate to severe\nthecal sac compression worst at through C3-C4 and C4-C5. Multilevel bilateral\nsevere neural foraminal narrowing is similar compared to prior. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "1. No acute fracture.\n2. Multilevel severe degenerative changes with disc bulges at C3-4 and C4-5\ncausing moderate to severe thecal sac compression, unchanged from prior" }, { "input": "Alignment is normal. No fractures are identified.Mild multilevel degenerative\nchanges of the cervical spine with small anterior/posterior osteophytes,\nendplate sclerosis, and disc space narrowing. Mild spinal canal narrowing at\nC3-C4 from small posterior disc bulge and C5-C6 from small posterior\nosteophyte. No neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Partially\nvisualized left humeral neck fracture on scout images. Limited evaluation of\nlung apices notable for moderate centrilobular emphysema.", "output": "1. No acute fracture or acute malalignment.\n2. Mild degenerative changes of cervical spine with mild spinal canal\nnarrowing at C3-C4 and C5-C6.\n3. Partially visualized left humeral neck fracture.\n4. Moderate centrilobular emphysema." }, { "input": "Dental amalgam streak artifact limits study. Minimal anterolisthesis of T1 on\nT2, unchanged, likely degenerative in nature. The visualized osseous\nstructures are osteopenic. No fractures are identified.There is no\nprevertebral soft tissue swelling. Within the limits of this noncontrast\nstudy, there is no evidence of infection or neoplasm.\n\nMild-to-moderate degenerative disc disease, most prominent at C7-T1. Small\nposterior intervertebral osteophytes cause mild narrowing of the spinal canal\nmost prominent at C3-4 and C4-5. Multilevel degenerative changes including\nloss of intervertebral disc height, Schmorl's nodes, endplate sclerosis, and\nfacet joint arthropathy again noted.\n\nLimited imaging of lungs again demonstrate emphysematous changes. The thyroid\nis within normal limits. No cervical lymphadenopathy. A left humeral neck\nfracture is re- demonstrated on the scouts, unchanged in alignment compared to\n___ (see 1b:2). Atherosclerotic vascular calcifications are seen\nin bilateral carotid bifurcations.", "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of fracture or traumatic malalignment.\n3. Chronic left humeral neck fracture, unchanged in alignment.\n4. Multilevel degenerative changes as described." }, { "input": "The imaged bones are diffusely osteopenic. The alignment is normal. No\nfractures are identified. Mild-to-moderate multilevel degenerative changes of\nthe cervical spine, including anterior and posterior osteophyte formation and\nintervertebral disc height narrowing, are most prominent at C6-C7. Mild\nspinal canal narrowing at C3-C4 and C4-C5, secondary to posterior osteophytes\nand ligamentum flavum hypertrophy. There is no significant neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nEmphysema in the imaged lung apices appears unchanged. A left humeral neck\nfracture is redemonstrated on the scout image, similar to prior. \nAtherosclerotic calcifications of the bilateral carotid bifurcations are\nsimilar to prior.", "output": "1. No acute cervical spine fracture. Normal alignment.\n2. Mild-to-moderate multilevel degenerative changes of the cervical spine,\nincluding mild spinal canal narrowing at C3-C4 and C4-C5." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is mild endplate sclerosis\nin intervertebral disc space narrowing C5-C6 There is no prevertebral soft\ntissue swelling. Focal calcification of the nuchal ligament is noted. There\nis no evidence of infection or neoplasm.", "output": "1. No fracture or malalignment.\n2. Mild degenerative changes at C5-C6. Otherwise no significant degeneration." }, { "input": "There has been little significant change since the prior study. Again\nidentified is a compression fracture involving the anterior and posterior\ncortex of the T9 vertebral body. There are healing fractures of the T7, T8\nand T9 spinous processes. The facet joints appear intact. CT is limited in\nfurther characterizing the posterior ligamentous complex. There is a mild\nfocal kyphosis at T9 with no evidence of translation or rotation. There is\nmild retropulsion of the posterior T9 cortex into the spinal canal. The\nrelationship to the spinal cord is poorly displayed on CT imaging. There is\nthickening of the ligamentum flavum and small facet osteophytes contributing\nto spinal canal narrowing at this level.\n\nAgain seen is a compression fracture of the superior endplate of the T12 body.\nThis appears unchanged since the previous study.\n\nAgain seen is a focus of sclerosis in the left inferior portion of the L1\nvertebral body, likely a bone island. There is a small focus of\nhyperintensity in the T5 vertebral body that may represent a second bone\nisland. This level was not included on the prior examination.\n\nNo fracture is identified at the T2 level.\n\nThere is a mild compression fracture of indeterminate age involving the C7\nvertebral body.\n\nThere is generalized demineralization of the skeleton with prominent vertical\ntrabeculae, suggesting osteoporosis. There is mild atelectasis and extensive\nemphysematous change at the lung bases bilaterally.", "output": "1. Unchanged appearance of T9 compression fracture with retropulsion of the\nposterior margin of the vertebral body.\n2. Unchanged compression fracture of the superior endplate of T12.\n3. Healing fractures of the T7 through T9 spinous processes.\n4. Likely bone islands in the T5 and L1 vertebral bodies." }, { "input": "Alignment is normal.Multilevel degenerative changes are mild. For example, at\nL4-5, there is a right-sided disc bulge more prominent on the right causes\nmild canal narrowing and mild neural foraminal narrowing on the right.There is\nno prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "No acute fracture or alignment abnormality. Mild degenerative changes as\nstated." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. Thyroid gland appears normal. Partially imaged\nis opacification of the right maxillary sinus.", "output": "No acute fracture or alignment abnormality." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\ncritical spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.\n\nThere is a 0.5 cm area of coarse calcification in the right lobe of the\nthyroid. No additional hypodense thyroid nodules are seen.", "output": "No fracture or subluxation." }, { "input": "Study is moderately degraded by motion. Within these confines: There is\nstraightening of the cervical lordosis.Question minimally displaced left C7\ntransverse process fracture (see 601:28; 602:42). Finding is not definitely\nseen on axial imaging.\n\n There is no evidence of bony spinal canal stenosis. C5 vertebral body limbus\nvertebra is noted (see 602: 30). There is no prevertebral soft tissue\nswelling. Within the limits of this noncontrast study, there is no evidence of\ninfection or neoplasm. A 4 mm right thyroid nodule is noted. Mild scarring\nat the left lung apex. Low lying cerebellar tonsils are again noted. \nAtherosclerotic vascular calcifications are seen in bilateral carotid\nbifurcations.", "output": "1. Study is moderately degraded by motion.\n2. Question left C7 minimally displaced transverse process fracture versus\nnutrient vessel or artifact. If clinically indicated, consider cervical spine\nMRI for further evaluation.\n3. No traumatic malalignment in the cervical spine.\n4. 4 mm right thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended.\n5. Redemonstration of patient's known Chiari 1 malformation.\n\nNOTIFICATION: Impression #2 findings emailed to the ED QA nurses by ___\n___, M.D. at 1106 on ___." }, { "input": "Dental amalgam streak artifact and patient body habitus limits study.\n\nThere is minimal anterolisthesis of C2-C3 and C3-C4 levels, likely\ndegenerative in etiology.A lucency extends through a left-sided bridging\nosteophyte at C5-C6 and anterior superior endplate of C6 vertebral body, which\nis not associated with definite prevertebral edema (602:32-36), likely\ndegenerative. Otherwise, vertebral body heights are grossly preserved.\n\nModerate degenerative changes are seen along the cervical spine with\nintervertebral disc space narrowing and multiple osteophytes. There is\nmultilevel mild vertebral canal narrowing due to posterior osteophytes and\ndisc bulges with flattening of the spinal cord. Multilevel uncovertebral and\nfacet joint arthropathy results in mild multilevel neural foraminal stenosis.\n\n OTHER:\nKnown 13 mm cerebellar tonsillar descent is better seen on the dedicated CT\nhead exam.\n\nLimited imaging lung apices demonstrates approximately 1.5 mm left upper lobe\npulmonary nodule (601:49; 02:57) and biapical scarring. There is an enlarged\nheterogeneous thyroid compatible with goiter. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria. Small foci of probable intravenous\nair are noted within the left C5 foramina transversarium (see 602: 40-42; 2:\n36-40). There is no definite evidence of adjacent fracture or prevertebral\nsoft tissue swelling.", "output": "1. Dental amalgam streak artifact and patient body habitus limits study.\n2. Lucency through left-sided bridging osteophyte at C5-C6 as well as anterior\nsuperior endplate of C6 vertebral body with no definite prevertebral edema,\nsuggestive of degenerative change. If concern for fracture, consider cervical\nspine MRI for further evaluation.\n3. Otherwise, no definite evidence of cervical spine fracture. Please note\nMRI of the cervical spine is more sensitive for the evaluation of ligamentous\ninjury.\n4. Moderate cervical spondylosis with multilevel mild spinal canal and neural\nforaminal stenoses, as above.\n5. 1.5 mm left upper lobe pulmonary nodule. Please see recommendation section\nbelow.\n6. Nonspecific cervical subcentimeter lymph nodes as described, which may be\nreactive.\n7. Nonspecific heterogeneously enlarged thyroid. If clinically indicated,\nconsider thyroid ultrasound for further evaluation.\n8. Please see concurrently obtained noncontrast head CT for description of\ncranial structures.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:53 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes notable\nfor right-sided facet joint hypertrophy spanning C2-3 through C4-5.There is no\nprevertebral edema.\n\nThere is mild height loss the T3 vertebral body level without CT findings to\nsuggest acuity.\n\nThe thyroid is not visualized. Included lung apices are unremarkable. \nAtherosclerotic calcifications noted at the carotid bulbs bilaterally.\n\nDegenerative changes noted at the right temporomandibular joint.", "output": "No cervical spine fracture or malalignment.\nMild height loss of the T3 vertebral body without CT findings to suggest\nacuity." }, { "input": "Again seen and unchanged is diffuse demineralization of the bones compatible\nwith a history of myeloma. Again seen is severe thoracic kyphosis, unchanged\nsince the prior study. Otherwise, alignment is normal.Again seen are\ncompression fractures of essentially every imaged thoracic vertebral body. The\nT6 through T8 bodies are the most severely affected. The degree of\ncompression of these bodies appears unchanged since the prior study.\n\n\nThere has been further loss of height of the T10 vertebral body, accompanied\nby a acute fracture lines along the anterior margin of the body. There is an\nintraosseous vacuum phenomenon in the T10 vertebral body. In a patient such\nas this, with expected slow healing, it is unclear exactly how old a fracture\ncould be and present this constellation of findings. The finding is clearly\nnew since the study of ___.\n\nVertebral augmentation cement is present in the T11 vertebral body. Vacuum\nphenomena are present in the intervertebral discs from T4 through T12. There\nis no evidence of osseous fragments encroaching on the spinal canal. A small\nintervertebral osteophyte arising from the superior endplate of T12 mildly\nencroaches on the anterior portion of the spinal canal. Although somewhat\nlimited on a CT scan, there is no evidence of soft tissue encroachment on the\nspinal canal. If this is a clinical concern, an MR examination would be far\nmore reliable.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection.", "output": "1. Slight compression of the T10 vertebral body, new since ___.\n2. Severe demineralization of all vertebral bodies compatible with a history\nof myeloma.\n3. Numerous compression fractures of other levels, unchanged since the prior\nexamination." }, { "input": "There is a mild kyphosis at the thoracolumbar junction. Otherwise, alignment\nis normal.\nSevere diffuse demineralization of the bones is again seen and unchanged,\ncompatible with the history of myeloma. There has been further loss of height\nof the L3 vertebral body since the study of ___. There are no\ndefinite acute fracture lines to indicate that this is an acute fracture. \nHowever, the demineralization of the bones limits the ability to age this\nfracture.\n\nThe overall heights of the L1 and L2 vertebral bodies, severely compressed on\nthe study of ___, appear similar. However, there are multiple vacuum\nphenomena on coursing through both vertebral bodies, worrisome for interval\ndevelopment of fractures. Retropulsed bone extends into the spinal canal at\nL1 and L2 unchanged since the prior study.\n\nAgain seen is a new fracture of the T10 vertebral body, described in detail in\nthe report of the thoracic spine.", "output": "1. Further compression of the L1, L2 and L3 vertebral bodies since the\ncomparison study of ___.\n2. Retropulsed bone encroaching on the spinal canal at L1 and L 2, unchanged\nin severity since ___.\n3. Acute compression fracture of T10, fully described in the report of the\nthoracic spine.\n4. Severe demineralization of all the visualized bones compatible with the\nhistory of myeloma.\n\nNOTIFICATION: The finding of multiple new compression fractures was discussed\nby telephone by Dr. ___ with Dr. ___ at 11:50 am ___\nimmediately after reviewing the study." }, { "input": "Again seen is extensive demineralization of all the visualized vertebral\nbodies with large areas of focal lucencies consistent with the diagnosis of\nmyeloma. There is a larger defect in the anterior portion of the T8 vertebral\nbody with destruction of the anterior cortex at this level. This is\ndefinitely new since the study of ___. The chest CT of ___ was\nnot performed with high-resolution bone technique. It is unclear whether this\nlesion was present at that time.\nAgain seen is a small amount of retropulsion of the posterosuperior endplate\nof the T6 vertebral body, unchanged.\nThere is compression of every vertebral body from T1 through T11. The loss of\nheight of vertebral bodies appears unchanged since ___. Again seen are\nvacuum phenomena in the intervertebral discs at every level from T3 through T8\nand T9 through T12. Unchanged since the chest CT of ___ is a\nfracture through the superior endplate of the T10 vertebral body with a vacuum\nphenomenon that extends through the vertebral body and joins the vacuum\nphenomenon in the T9-10 interspace.\nNoncontrast CT is limited for intraspinal soft tissue abnormalities. None are\ndetected but if this is a clinical concern, MR would be far more sensitive. \nThere is no evidence of significant osseous encroachment on the spinal canal. \nThere is no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "1. Severe demineralization all vertebral bodies with numerous focal lucencies\ncompatible with the history of myeloma.\n2. A lytic lesion in the anterior portion of the T7 vertebral body with\ndestruction of the anterior cortex. This is new since ___ but may\nhave been present on ___.\n3. Fracture through the superior endplate of the T10 vertebral body, new since\n___ but present in ___.\n4. Small amount of bone retropulsed into the spinal canal from the\nposterosuperior endplate of T6 without significant canal narrowing, unchanged." }, { "input": "Again seen is diffuse hypodensity of all visualized osseous structures with\nnumerous focal lucencies and an overall coarse appearance of the bones\ncompatible with the history of myeloma. Numerous compression fractures are\nagain seen with severe loss of height of the T12, L1 and L2 vertebral bodies\nbut some degree of compression fracture involving every vertebral body from\nT11 through L5. Again seen at L1 and L2 is retropulsion of bone into the\nspinal canal, unchanged since ___. There is a fracture of the\nsuperior endplate of the T11 vertebral body with a vacuum phenomenon that\nextends through the vertebral body and into the T10-11 intervertebral disc. \nThe superior endplate fracture appears new since the study of ___ but\nnot since the study of ___.\nThe sacrum demonstrates the same pattern of diffuse extreme hypodensity with\nareas of focal lytic lesions. As compared to the study of ___, there\nis an increase in sclerosis in the left side of the sacrum.\nThe patient is status post a T12 vertebroplasty, unchanged.", "output": "1. Diffuse changes of multiple myeloma with extensive compression fractures.\n2. Retropulsed bone at L1 and L2.\n3. The superior endplate of T11 fracture new since ___ but present on\n___.\n4. Status post T12 vertebroplasty." }, { "input": "Alignment is normal. Again seen are compression fractures of T3, T4, T5 and\nT10 vertebral bodies with severe compression fractures of T6, T7, T8, T9, T11\nand L1 vertebral bodies. At L1 the retropulsed bone narrows the spinal canal\nand may contact the conus medullaris. Patient is status post vertebroplasty\nof T11 which is unchanged since prior examination. No prevertebral soft\ntissue swelling.\n\nT1-T5: No significant spinal canal or neural foraminal narrowing.\nT5-T6: Stable 3 mm retropulsion at T6 vertebral body causing mild spinal\ncanal narrowing. No significant neural foraminal narrowing.\nT6-T7: No significant spinal canal or neural foraminal narrowing.\nT7-T8: Small posterior osteophyte without significant spinal canal or neural\nforaminal narrowing.\nT8-T10: No significant spinal canal or neural foraminal narrowing.\nT10-T11: The right uncovertebral hypertrophy is causing mild right neural\nforaminal narrowing. No significant spinal canal or left neural foraminal\nnarrowing\nT11-T12: Small posterior osteophyte without significant spinal canal or\nneural foraminal narrowing.\n\nParaspinal soft tissues and visualized solid organs are unremarkable. \nVisualized lungs are notable for mild bibasilar atelectasis.", "output": "1. Severe compression fracture of the L1 vertebral body with retropulsed bone\nnarrowing the spinal canal and potentially contacting the conus medullaris.\n2. Unchanged multiple T3-5 and T10 compression fractures without retropulsion.\n3. Unchanged severe compression fractures of T6-9 and T11 with unchanged 3 mm\nT6 retropulsion causing mild spinal canal narrowing at this level.\n4. Status post T11 vertebroplasty with associated post treatment changes.\n5. Please refer to same-day CT lumbar spine for dedicated lumbar findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:33 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "There is progression of now severe L1 compression fracture with subtle\nincreased sclerosis and new 6 mm of retropulsion of an osseous fragment. This\ninvolves the superior endplate of L1 and may contact the distal conus\nmedullaris.\n\nThere is new 4 mm anterolisthesis of L2 on L3. No significant change in grade\n1 L4 on L5 retrolisthesis by 4 mm. Alignment is otherwise normal. Moderate\nmultilevel degenerative changes of lumbar spine with anterior and posterior\nosteophytes, disc space narrowing, and subchondral sclerosis most notable at\nT11 through L1 and L4 through S1. No prevertebral soft tissue swelling. There\nis no evidence of infection or neoplasm.\n\nT12-L1: There is spinal canal narrowing due to 6 mm retropulsion of L1\nposterior fracture fragments into the spinal canal. No significant neural\nforaminal narrowing.\nL1-L2: No significant spinal canal or neural foraminal narrowing.\nL2-L3: Mild spinal canal narrowing likely due to uncovering of disc from\ngrade 1 anterolisthesis at this level. No significant neural foraminal\nnarrowing.\nL3-L4: No significant spinal canal or neural foraminal narrowing.\nL4-L5: Bilateral uncovertebral hypertrophy causing mild bilateral neural\nforaminal narrowing. No significant spinal canal narrowing.\nL5-S1: Small posterior osteophyte with bilateral uncovertebral hypertrophy\ncausing mild spinal canal and neural foraminal narrowing.\n\nThe visualized solid organs and soft tissues are unremarkable. Visualized\nlungs are notable for mild bibasilar atelectasis.", "output": "1. Progression of severe L1 compression fracture with 6 mm of retropulsion of\nthe superior endplate causing spinal canal narrowing at this level. This may\ncontact the distal conus medullaris\n2. New grade 1 anterolisthesis of L2 on L3 by 4mm\n3. Stable grade 1 L4 on L5 retrolisthesis by 4mm.\n4. Moderate multilevel degenerative changes of lumbar spine with mild spinal\ncanal narrowing at L2-L3, mild bilateral neural foraminal narrowing at L4-L5,\nand mild spinal canal and neural foraminal narrowing at L5-S1.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:33 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "Alignment of the cervical spine is normal. No acute fractures identified. No\nprevertebral soft tissue swelling. Multilevel multifactorial degenerative\nchanges and noted throughout the cervical spine including anterior/posterior\nosteophytes, loss of intervertebral disc space height and uncovertebral\nhypertrophy that results in up to mild spinal canal narrowing at C5-C6, and\nmoderate right neuroforaminal narrowing at this level (602b:25). There is\nalso severe left neuroforaminal narrowing C6-C7 on the left (602b:38).\n\nAn endotracheal and enteric tube are partially visualized along their course. \nThyroid gland is unremarkable. Minimal centrilobular emphysema it is seen in\nthe visualized portions of the lung apices.\n\nKnown intracranial hemorrhages and right temporal bone fracture are as\npreviously detailed. Near complete opacification of the mastoids is also\nnoted.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel multifactorial degenerative changes in the cervical spine as\ndescribed above." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. There is mild\ndegenerative disease in the mid to lower cervical spine evidenced by loss of\nintervertebral body disc space at C4 through C7. No critical spinal canal or\nneural foraminal stenosis. Carotid bulb calcification is notable bilaterally.\nNo prevertebral soft tissue swelling. The aerodigestive tract appears patent.\nLung apices are clear. Thyroid gland appears normal.", "output": "No fracture or malalignment. Mild degenerative changes." }, { "input": "There is reverse cervical lordosis centered at C4-5. Otherwise the alignment\nis unremarkable.No fractures are identified.There are multilevel anterior\nposterior osteophytes, most severe at from C3-4 to C5-6. There is severe loss\nof disc heights from C4-5 to C6-7. There is moderate loss of disc heights at\nC3-4. The vertebral body heights are preserved. Uncovertebral and facet\nosteophytes cause mild to moderate neural foraminal narrowing on the left at\nC3-4, C5-6, and C6-7 and bilaterally at C4-5. Disc bulge and posterior\nosteophytes cause mild spinal canal stenosis at C4-5 and C5-6.There is no\nprevertebral soft tissue swelling.The thyroid is heterogeneous without\ndiscrete nodule. The bilateral lung apices are unremarkable. Right\nmandibular molar periapical lucencies are noted. There is sclerosis of the\nmandibular body bilaterally likely from chronic inflammation.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine as described in the\nbody of the report." }, { "input": "Mild anterolisthesis of C2 over C3, C3 over C4, and C7 over T1 appears\nunchanged from prior. No fractures are identified.Moderate multilevel\ndegenerative changes with intervertebral disc space narrowing, endplate\nsclerosis and cysts, and anterior and posterior osteophyte formation are most\npronounced from C3-4 through C5-6. Mild multilevel central canal and\nbilateral neural foraminal narrowing is seen, most pronounced at C4-5, but no\nevidence of high-grade spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. The visualized apical lung fields demonstrate bilateral scarring. \nThyroid gland is atrophic.", "output": "No acute fracture or change in alignment." }, { "input": "Straightening of the cervical lordosis. No fractures or traumatic\nmalalignment identified. Multilevel degenerative changes resulting in at\nleast moderate spinal canal narrowing from C4-C7. There is severe neural\nforaminal narrowing at the right C6-C7 and left C5-C6 level. There is no\nprevertebral edema. Thyroid is unremarkable. Paraseptal emphysema noted at\nthe lung apices.", "output": "1. No evidence of cervical spine fracture or malalignment.\n2. Multilevel cervical spondylosis as described above." }, { "input": "There is mild cervical kyphosis with its apex at C5-6, due to degenerative\ndisease. Alignment is otherwise normal. No fractures are identified.There is\nossification of the anterior longitudinal ligament at C3. There is\nossification of the posterior longitudinal ligament at every level from C3\nthrough C6. At C6, this contributes to to severe spinal canal narrowing.\n\nThere are multiple levels of degenerative disease. At C2-3, there is mild\nbulging of the disc with no spinal canal or neural foraminal narrowing.\nAt C3-4, there is a midline disc protrusion flattening the anterior surface of\nthe spinal cord. The neural foramina appear normal.\nAt C4-5 there are intervertebral osteophytes and a large midline disc\nprotrusion. These flatten the anterior surface of the spinal cord. The\nneural foramina appear normal.\nAt C5-6, there are large intervertebral osteophytes narrowing the spinal canal\nand flattening the spinal cord. Uncovertebral osteophytes produce severe\nbilateral neural foraminal narrowing.\nAt C6-7, intervertebral osteophytes narrow the spinal canal. Uncovertebral\nosteophytes narrow the neural foramina.\nAt C7-T1 there is mild bulging of the disc with no spinal canal or neural\nforaminal compromise.\nThe included portions of the upper thoracic spine demonstrate no spinal canal\nor neural foraminal narrowing. There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm.", "output": "1. No fracture is identified.\n2. Multilevel degenerative changes spinal canal and neural foraminal narrowing\nat multiple levels." }, { "input": "Minimal anterolisthesis of C3 on C4 is unchanged from prior exam. There is no\nacute malalignment. There is no fracture. There is no prevertebral edema. \nDegenerative changes are notable for intervertebral disc height loss,\nposterior osteophytes and uncovertebral joint hypertrophy which are most\nextensive spanning C4-5 through C6-7. The bilateral C2-3 facet joints are\nfused. There is no critical canal narrowing. Moderate to severe foraminal\nnarrowing noted on the left at at C6-7.\n\nThe thyroid is unremarkable.", "output": "Degenerative changes without fracture or acute malalignment." }, { "input": "Mild dextro convex scoliosis of the upper thoracic spine. Minimal\nanterolisthesis of T1 on T2, and T2 on T3, likely degenerative in nature. \nOtherwise, alignment is normal. No acute fractures are identified.There is a\nchronic appearing fracture through the spinous process of T5 (series 602,\nimage 26). There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nMild dependent atelectasis. A 5 mm solid nodule within the left lower lobe\nhas increased in size since ___. Mild atherosclerotic calcifications of the\naortic arch and at the origin of the head and neck vessels.", "output": "1. No evidence of acute fracture or malalignment.\n2. Minimal anterolisthesis of T1 on T2 and T2 on T3, likely degenerative in\nnature.\n3. Chronic appearing T5 spinous process fracture.\n4. 5 mm left lower lobe solid nodule, which has increased in size since ___. \nThe ___ Society guidelines for pulmonary nodule guidelines suggest for\npulmonary nodules greater than 4 mm or less than 6mm, 12 month follow-up in\nlow-risk patients, and ___ month follow-up in high risk patients.\n\nRECOMMENDATION(S): The ___ Society guidelines for pulmonary nodule\nguidelines suggest for pulmonary nodules greater than 4 mm or less than 6mm,\n12 month follow-up in low-risk patients, and ___ month follow-up in high risk\npatients." }, { "input": "Alignment is normal. No fractures are identified. Moderate multilevel\ndegenerative change is noted, including multilevel disc space narrowing,\nanterior and posterior osteophytosis, and endplate sclerosis. Mild canal\nnarrowing at C2-C3, and moderate canal narrowing involving C4-C5, C5-C6, and\nC6-C7, secondary to posterior disc protrusion and uncovertebral osteophytes. \nMild left-sided neural foraminal narrowing at C3-C4, severe bilateral neural\nforaminal narrowing at C4-C5, moderate bilateral neural foraminal narrowing at\nC5-C6, and severe left neural foraminal narrowing at C6-C7, secondary to\nuncovertebral osteophytes. There is no prevertebral soft tissue\nswelling.There is a nodule in the right thyroid lobe measuring 2.4 x 1.9 x 1.6\ncm. Partially visualized lung apices are within normal limits.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Moderate multilevel degenerative change of the cervical spine, most severe\nspanning from C4-C5 through C6-C7, as described above.\n3. 2.4 cm right thyroid nodule. Recommend further evaluation with dedicated\nthyroid ultrasound on a nonemergent basis as an outpatient.\n\nRECOMMENDATION(S): Nonemergent thyroid ultrasound." }, { "input": "2-3 mm retrolisthesis of C4 on C5 is unchanged from prior radiograph of ___. \nOtherwise, cervical alignment is anatomic. No acute fractures are\nidentified.Multilevel degenerative changes are seen, most extensive at C3-4\nand notable for anterior and posterior osteophytosis, uncovertebral\nhypertrophy and facet hypertrophy contributing to mild spinal canal narrowing\nand moderate to severe left and moderate right neural foraminal narrowing at\nthis level. There is partial fusion of C3-4. Mild anterior wedge deformity\nat C4 is similar when compared to prior radiograph. There is also severe\nbilateral neural foraminal narrowing at C4-C5 and C6-C7. There is no\nprevertebral edema. There is no cervical lymphadenopathy by size criteria. \nThe visualized aerodigestive track is grossly unremarkable, noting\nretropharyngeal course of the bilateral internal carotid arteries and palatine\ntonsilliths.\n\nAllowing for respiratory motion artifact, the visualized lungs are grossly\nclear allowing for bilateral mild pleuroparenchymal scarring. The motion\nartifact obscures portions of the thyroid which demonstrates a coarse\ncalcification in the left lobe without discernible nodule.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Multilevel degenerative changes, as described above.\n3. Additional findings described above." }, { "input": "There is no fracture or subluxation. There is no evidence for prevertebral\nedema. Disc protrusions and endplate osteophytes indent the ventral thecal\nsac from C3-C4 through C6-C7 with at least moderate spinal canal stenosis at\nC5-C6 and C6-C7. There is multilevel neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nFluid in the partially visualized paranasal sinuses is likely secondary to\nendotracheal and orogastric intubation. There also mucous retention cysts in\nthe partially visualized maxillary sinuses. The brain parenchyma is better\nassessed on the concurrent head CT.\n\nThe thyroid gland is grossly unremarkable.\n\nVisualized lung apices are clear.", "output": "1. No fracture or subluxation.\n2. Multilevel degenerative disease." }, { "input": "Alignment is normal. No acute fractures are identified.\n\nThere is irregularity of the inferior endplates of the C6 and C7 vertebral\nbodies which is of indeterminate age given lack of priors for comparison, but\ncould be chronic. There is also mild loss of height of the superior endplate\nof C5 and anterior superior endplates of T1 -T4. There is loss of normal\nintervertebral disc height, anterior posterior osteophyte formation, and\nendplate irregularity at multiple levels of the cervical spine. There is mild\nspinal canal narrowing at C3-C4 in C4-C5. There is mild right-sided neural\nforaminal narrowing at C3-C4. There is no prevertebral edema.", "output": "1. Mild loss of height of the superior endplates of C4 through T4, of\nindeterminate age given lack of priors for comparison. Findings may be\nchronic, but acute compression component is not excluded. If acute injury is\nof high clinical concern, MRI is more sensitive and would further assess.\n2. No dislocation.\n3. Mild central canal narrowing at C3/C4, C4/C5, and C5/C6 due to disc bulge.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 3:34 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "There is ___ evidence of pathological or compression fracture or traumatic\nmalalignment. Minimal anterolisthesis of C4 on C5 is likely degenerative in\nnature. Slightly increased relative sclerosis of T1 is compatible with\ninfiltrative metastatic disease better assessed on recent MR. ___ prevertebral\nsoft tissue swelling is identified. The paraspinal soft tissues are\nunremarkable. Moderate degenerative disc disease is more prominent from C4-C5\nthrough C7-T1, with loss of intervertebral disc height, anterior and posterior\nspondylophytic changes and facet joint arthropathy, resulting in multilevel\nneural foraminal narrowing described in detail in the recent MRI of the\nC-spine from ___. Please refer to that study for detailed\ndescription of the degenerative changes and impact on the spinal canal as CT\nis not able to provide intrathecal detail compared to MRI.\n\nThe visualized aerodigestive tract is unremarkable. ___ lymphadenopathy is\npresent by CT size criteria. Numerous spiculated opacities in the right lung\napex are better seen in recent chest CT and are compatible with known\nneoplastic disease.", "output": "1. ___ evidence of compression fracture. Slightly increased relative\nsclerosis of T1 is compatible with infiltrative metastatic disease better\nassessed on recent MRI of the C-spine.\n\n2. Numerous spiculated opacities in the right lung apex are better seen in\nrecent chest CT and are compatible with known neoplastic disease.\n\n3. Moderate degenerative disc disease is not significantly changed from\nrecent C spine MR from ___ allowing for technical differences." }, { "input": "No evidence of acute fracture is seen. There is no dislocation. Multilevel\ndegenerative changes are seen. These include disc space narrowing at C2/C3\nand C6/C7. Anterior osteophytes at C5, C6 and C7, similar to prior. \nSclerosis of the left C4 facet and possibly the right C4 facet, may be\nslightly more conspicuous as compared to the prior study the prior study,\ncould relate to underlying metastatic disease. Increased density of the T1\nvertebra, similar to prior, with infiltrative metastatic disease better\nassessed on prior MRI.. No prevertebral soft tissue swelling is seen.\nThe thyroid gland isgrossly homogeneous..", "output": "No acute fracture or dislocation of the cervical spine.\n\nMulti-level degenerative changes again seen. Sclerosis of the left and\npossibly right C4 facets may relate to metastatic disease, possibly slight\nmore conspicuous as compared the prior study. Increased density of T1,\nsimilar to prior seen to represent metastatic disease." }, { "input": "Study is limited by motion artifact. Alignment is stable from the prior\nstudy. No acute fracture. No traumatic malalignment. Multilevel\ndegenerative changes are unchanged with disc space narrowing at C2-3 and C6-7\nand sclerosis of the left C4 facet. This could relate to underlying\nmetastatic disease. No prevertebral soft tissue swelling.", "output": "1. Motion degraded exam.\n2. No evidence of acute traumatic injury.\n3. Sclerosis of the left C4 facet may relate underlying metastatic disease,\nhowever is not well assessed on CT." }, { "input": "Alignment is unchanged since the prior study. No traumatic malalignment\nidentified.No acute fracture identified.Moderate multilevel degenerative\nchanges of the cervical spine are again seen, with disc space narrowing and\nC2-C3 and C6-C7. Facet hypertrophy at C2-C3 of particularly on the right, is\nunchanged. Sclerosis of the left C4 facet (602b:55), the C2 and C6 spinous\nprocesses and the T1 vertebral body are compatible with metastases. There is\nno prevertebral soft tissue swelling. Incidentally noted is bilateral\ncervical ribs.\n\nImaged thyroid is unremarkable.", "output": "1. No acute cervical spinal fracture or traumatic malalignment.\n\n2. Sclerosis of the left C4 facet, C2 and C6 spinous processes, and T1\nvertebral body compatible with metastatic disease, as seen on prior exams." }, { "input": "Alignment is normal. No acute fractures are identified. There is no\nprevertebral edema. Multilevel moderate to severe degenerative changes are\npresent worst from C3 through C6 with intervertebral disc space narrowing,\nanterior and posterior osteophyte formation, and endplate irregularity. \nPosterior disc osteophyte complexes result in moderate to severe bilateral\nneuroforaminal narrowing at C3-C4, C4-C5 and C5-C6. There is mild to moderate\nspinal canal narrowing, most pronounced at C5-C6.\n\nThe included thyroid gland and lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "CERVICAL SPINE:\n\nPatient is status post anterior fusion of C4-C7. Hardware appears intact, and\nthere is no evidence of hardware related complication. There is extensive\nmultilevel degenerative change, with moderate canal narrowing related to\nosteophytes from C3 through C6. Neural foraminal narrowing is also moderate\non the left and mild on the right at C3-4. Overall, degenerative changes are\nmore severe compared to ___. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nThe imaged lung apices are clear. The imaged thyroid gland is unremarkable. \nCervical lymph nodes are not enlarged.\n\nTHORACIC SPINE:\n\nThere is mild dextrocurvature of the thoracic spine. Mild anterior wedging of\nT11 appears chronic. A small posterior osteophyte at C5-6 results in mild\ncanal narrowing. A large posterior osteophyte at T8 results in moderate canal\nnarrowing. A disc bulge and posterior osteophyte results in mild to moderate\ncanal narrowing at T10. A disc bulge results in moderate canal narrowing at\nT11. There is mild neural foraminal narrowing at T10-11 bilaterally. There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThere is bibasilar dependent atelectasis. Multiple nonobstructing right renal\ncalculi versus vascular calcifications are noted.\n\nLUMBAR SPINE:\n\nL1-2 posterior fusion hardware veins. Near fusion hardware from L3 through S1\nhas been removed. Multiple anterior fixation screws are demonstrated in the\nL2 through S1 vertebral bodies.\n\nThere are extensive degenerative changes of the lumbar spine, with moderate\ncanal narrowing at L2-3, and moderate to severe narrowing at L3-4, and\nmoderate canal narrowing at L4-5 which appears to be present despite\nlaminectomy, as there is still bone over the posterior thecal sac. There is\nprobably moderate to severe neural foraminal narrowing at L1-2 bilaterally.\n\nThere is a large fluid collection along the subcutaneous soft tissues\noverlying the lumbar spine, which measures 2.4 x 12.1 x 17.8 cm. A component\nof this fluid collection extends into the deep paraspinous soft tissues and\npossibly the epidural space at L3-4 and L5 (301:67, 82).\n\nColonic diverticulosis is noted.", "output": "1. No acute findings in the cervical or thoracic spine. Degenerative changes\nas described above.\n2. Status post revision of lumbar laminectomy infusion. There is a large\nfluid collection in the posterior soft tissues overlying the lumbar spine,\nwhich appears to extend into the deep paraspinous soft tissues, and possibly\nepidural space at L3-4 and L5. While this could be postoperative seroma,\nsuperimposed infection or CSF leak cannot be excluded." }, { "input": "CERVICAL SPINE:\n\nPatient is status post anterior fusion of C4-C7. Hardware appears intact, and\nthere is no evidence of hardware related complication. There is extensive\nmultilevel degenerative change, with moderate canal narrowing related to\nosteophytes from C3 through C6. Neural foraminal narrowing is also moderate\non the left and mild on the right at C3-4. Overall, degenerative changes are\nmore severe compared to ___. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nThe imaged lung apices are clear. The imaged thyroid gland is unremarkable. \nCervical lymph nodes are not enlarged.\n\nTHORACIC SPINE:\n\nThere is mild dextrocurvature of the thoracic spine. Mild anterior wedging of\nT11 appears chronic. A small posterior osteophyte at C5-6 results in mild\ncanal narrowing. A large posterior osteophyte at T8 results in moderate canal\nnarrowing. A disc bulge and posterior osteophyte results in mild to moderate\ncanal narrowing at T10. A disc bulge results in moderate canal narrowing at\nT11. There is mild neural foraminal narrowing at T10-11 bilaterally. There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThere is bibasilar dependent atelectasis. Multiple nonobstructing right renal\ncalculi versus vascular calcifications are noted.\n\nLUMBAR SPINE:\n\nL1-2 posterior fusion hardware veins. Near fusion hardware from L3 through S1\nhas been removed. Multiple anterior fixation screws are demonstrated in the\nL2 through S1 vertebral bodies.\n\nThere are extensive degenerative changes of the lumbar spine, with moderate\ncanal narrowing at L2-3, and moderate to severe narrowing at L3-4, and\nmoderate canal narrowing at L4-5 which appears to be present despite\nlaminectomy, as there is still bone over the posterior thecal sac. There is\nprobably moderate to severe neural foraminal narrowing at L1-2 bilaterally.\n\nThere is a large fluid collection along the subcutaneous soft tissues\noverlying the lumbar spine, which measures 2.4 x 12.1 x 17.8 cm. A component\nof this fluid collection extends into the deep paraspinous soft tissues and\npossibly the epidural space at L3-4 and L5 (301:67, 82).\n\nColonic diverticulosis is noted.", "output": "1. No acute findings in the cervical or thoracic spine. Degenerative changes\nas described above.\n2. Status post revision of lumbar laminectomy infusion. There is a large\nfluid collection in the posterior soft tissues overlying the lumbar spine,\nwhich appears to extend into the deep paraspinous soft tissues, and possibly\nepidural space at L3-4 and L5. While this could be postoperative seroma,\nsuperimposed infection or CSF leak cannot be excluded." }, { "input": "Again seen is long-term instrumented fusion of L1 through S1 vertebral bodies\nwith intervertebral graft as well as screws at multiple levels. There are\nlaminectomies/laminotomies throughout the lumbar spine. There is long-term\ninstrumented posterior fusion of L1 and L2 with bilateral pedicle screws. \nThere also appears to be bone graft mediated posterior element fusion from L1\nthrough S1. No evidence for hardware related complications. No evidence for\na fracture. Alignment is anatomic allowing for posterior osteophyte ridges at\nL2-L3, L3-L4, and L4-L5.\n\nThe thecal sac and neural foramina are better assessed on the recent MRI from\n___, as evaluation CT is substantially limited by hardware related\nartifacts. There is a new lumbar drain entering the spinal canal at the level\nof left L4 laminectomy, coursing superiorly in the right aspect of the thecal\nsac, and terminating at the level of T12-L1. Fluid collection in the L4\nlaminectomy bed is difficult to reassess on noncontrast CT but appears grossly\nsimilar to the prior MRI, 4.8 x 4.5 cm on image 301:64. Overlying\nsubcutaneous fluid collection appears slightly decreased, 11.1 x 1.9 cm\n(transverse, AP) on image 301:63 compared to 11.7 x 2.8 cm on the prior MRI. \nA subcutaneous collection extends superiorly to the L1-L2 level, as before.\n\nThere is mild degenerative change and vacuum phenomenon in the bilateral\nsacroiliac joints and mild osteoarthritis of the partially included bilateral\nfemoroacetabular joints.\n\nFatty replacement of the included pancreatic parenchyma is again noted. \nMultiple nonobstructing stones are again seen in the right kidney. Also again\nseen is a nonspecific calcification medial to the right kidney on image\n301:31. Atherosclerotic calcifications are again noted. Diverticulosis of\nthe partially included sigmoid colon is again seen.", "output": "1. Instrumented anterior fusion L1-S1, instrumented posterior fusion at L1-L2,\nand bone graft mediated fusion at L1-L5 is again demonstrated, without\nevidence for hardware related complications.\n2. New lumbar drain enters the spinal canal at the level of left L4\nlaminectomy and terminates in the right anterior thecal sac at T12-L1.\n3. Fluid collections in the L4 laminectomy bed appears stable compared to the\n___ MRI allowing for differences in modalities. Subcutaneous\ncollection centered at this level and extending superiorly to L1-L2 appears\nslightly decreased in size.\n4. Stable nonobstructing stones in the right kidney." }, { "input": "FLUOROSCOPIC MYELOGRAM:\nFluoroscopic imaging demonstrates patient's known lumbar drain with contrast\nnoted to opacify the thecal sac and then transit inferiorly to opacify the\ninferior thecal sac, with communication noted into patient's known lumbar\ndorsal soft tissue fluid collection (see series ___.\n\nTHORACIC AND LUMBAR MYELOGRAM CT:\n\nAnterior cervical spinal and lumbar spinal fusion hardware streak artifact\nlimits examination.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nThe indwelling spinal drain enters the thecal sac at the level of L4 with\ndistal tip situated anteriorly at the Level of L1-L2.\n\nIntrathecal contrast outlines the thoracic and lumbar thecal sac. There is\nmild reverse S shaped scoliosis of the upper thoracic spine. Otherwise,\nthoracic spinal alignment appears intact. There is multilevel thoracic spine\nintervertebral disc space narrowing with endplate sclerosis and disc\nosteophyte complexes causing mild osseous stenosis of the spinal canal at the\nT5-T6, T8-T9, T10-T11 and T11-T12 levels. No definite osseous neural\nforaminal narrowing is noted throughout the thoracic spine.\n\nAs before, the patient is status post anterior spinal fusion from L2 through\nS1 and posterior spinal fusion at L1-L2, with intervertebral disc spacers at\nL1-L2 through L5-S1 and laminectomies/laminotomies extending from L1-L5. There\nis osseous bridging across the lumbar spine constructs. There appears to be\nbone graft mediated fusion of the posterior elements from L1 through S1. The\nhardware appears intact without evidence for loosening, failure or\nperiprosthetic fracture. Alignment appears unchanged.\n\nAt multiple levels throughout the lumbar spine, there is metallic artifact\nfrom hardware, which limits evaluation of adjacent structures. The patient is\nstatus post laminectomy/laminotomy from L1 through S1. At L2-L3, there is\nmild-to-moderate osseous narrowing of the spinal canal with slight indentation\nof the anterior thecal sac. From L3-L4 through L5-S1, there is mild\ndeformation of the thecal sac without significant stenosis, likely reflecting\na combination of postoperative changes including granulation tissue as well as\nendplate osteophytes, however the thecal sac is not effaced.\n\nCentered at the Level of L5, there is a collection of contrast in the\nposterior spine soft tissues measuring 1.5 cm AP by 1.8 cm TRV by 7.4 cm SI\nwith a thin connection to the thecal sac at this Level, indicating CSF leak. \nAt the superior aspect of this collection (see series 2, image 158) there is a\nthin connection of contrast to an additional more posterior fluid collection\nwithin the overlying subcutaneous fat measuring approximately 1.7 cm AP by\n10.9 cm TRV by 11.3 cm SI, extending from approximately the level of L1\nthrough L5. Within this more superficial collection, a small amount of\ncontrast is noted layering dependently (for example on series 2, image 172),\nindicating connection with the deeper paraspinal collection and therefore the\nthecal sac.\n\nPartially imaged, there is anterior spinal fusion from C4-C7, which is\nsuboptimally assessed. There are degenerative changes of the bilateral\nsacroiliac joints with vacuum disc phenomena as well as degenerative changes\nof the partially imaged femoroacetabular joints.\n\nThere are patchy atelectatic changes in the bilateral lungs dependently. \nPartially imaged, the heart appears enlarged. Several nonobstructing right\nrenal calculi are noted. The pancreas demonstrates diffuse fatty atrophic\nchanges.", "output": "1. Fluoroscopic imaging obtained during injection of contrast agent into\npatient's existing lumbar drain by Dr. ___ the neurosurgery service,\nas described.\n2. Anterior cervical spinal and lumbar spinal fusion hardware streak artifact\nlimits examination.\n3. CT myelogram demonstrates communication between the thecal sac and a\nposterior spinal soft tissue collection centered at the level of L5 measuring\n1.5 cm AP by 1.8 cm TRV by 7.4 cm SI, indicating CSF leak. A connection of\ncontrast is seen at the L4-L5 level (series 2, images 167-173).\n4. At the superior aspect of the above-mentioned collection there is an\nadditional thin connection of contrast to another more superficial fluid\ncollection within the subcutaneous fat measuring 1.7 cm AP by 10.9 cm TRV by\n11.3 cm SI, extending from approximately the level of L1 through L5. This\nsuperficial collection demonstrates dependent layering contrast, indicating\nconnection with the deeper paraspinal collection and therefore the thecal sac.\n5. Extensive lumbar spine fusion hardware and partially imaged lower cervical\nspine fusion hardware without definite evidence for loosening, failure or\nperiprosthetic fracture.\n6. Multilevel degenerative changes of the thoracolumbar spine and unchanged\nancillary findings, as described above and on multiple other recent studies.\n7. Additional findings as described.\nI, Dr. ___ supervised the trainee during the key components of\nthe above procedure and I reviewed and agree with the trainee's findings and\ndictation." }, { "input": "FLUOROSCOPIC MYELOGRAM:\nFluoroscopic imaging demonstrates patient's known lumbar drain with contrast\nnoted to opacify the thecal sac and then transit inferiorly to opacify the\ninferior thecal sac, with communication noted into patient's known lumbar\ndorsal soft tissue fluid collection (see series ___.\n\nTHORACIC AND LUMBAR MYELOGRAM CT:\n\nAnterior cervical spinal and lumbar spinal fusion hardware streak artifact\nlimits examination.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nThe indwelling spinal drain enters the thecal sac at the level of L4 with\ndistal tip situated anteriorly at the Level of L1-L2.\n\nIntrathecal contrast outlines the thoracic and lumbar thecal sac. There is\nmild reverse S shaped scoliosis of the upper thoracic spine. Otherwise,\nthoracic spinal alignment appears intact. There is multilevel thoracic spine\nintervertebral disc space narrowing with endplate sclerosis and disc\nosteophyte complexes causing mild osseous stenosis of the spinal canal at the\nT5-T6, T8-T9, T10-T11 and T11-T12 levels. No definite osseous neural\nforaminal narrowing is noted throughout the thoracic spine.\n\nAs before, the patient is status post anterior spinal fusion from L2 through\nS1 and posterior spinal fusion at L1-L2, with intervertebral disc spacers at\nL1-L2 through L5-S1 and laminectomies/laminotomies extending from L1-L5. There\nis osseous bridging across the lumbar spine constructs. There appears to be\nbone graft mediated fusion of the posterior elements from L1 through S1. The\nhardware appears intact without evidence for loosening, failure or\nperiprosthetic fracture. Alignment appears unchanged.\n\nAt multiple levels throughout the lumbar spine, there is metallic artifact\nfrom hardware, which limits evaluation of adjacent structures. The patient is\nstatus post laminectomy/laminotomy from L1 through S1. At L2-L3, there is\nmild-to-moderate osseous narrowing of the spinal canal with slight indentation\nof the anterior thecal sac. From L3-L4 through L5-S1, there is mild\ndeformation of the thecal sac without significant stenosis, likely reflecting\na combination of postoperative changes including granulation tissue as well as\nendplate osteophytes, however the thecal sac is not effaced.\n\nCentered at the Level of L5, there is a collection of contrast in the\nposterior spine soft tissues measuring 1.5 cm AP by 1.8 cm TRV by 7.4 cm SI\nwith a thin connection to the thecal sac at this Level, indicating CSF leak. \nAt the superior aspect of this collection (see series 2, image 158) there is a\nthin connection of contrast to an additional more posterior fluid collection\nwithin the overlying subcutaneous fat measuring approximately 1.7 cm AP by\n10.9 cm TRV by 11.3 cm SI, extending from approximately the level of L1\nthrough L5. Within this more superficial collection, a small amount of\ncontrast is noted layering dependently (for example on series 2, image 172),\nindicating connection with the deeper paraspinal collection and therefore the\nthecal sac.\n\nPartially imaged, there is anterior spinal fusion from C4-C7, which is\nsuboptimally assessed. There are degenerative changes of the bilateral\nsacroiliac joints with vacuum disc phenomena as well as degenerative changes\nof the partially imaged femoroacetabular joints.\n\nThere are patchy atelectatic changes in the bilateral lungs dependently. \nPartially imaged, the heart appears enlarged. Several nonobstructing right\nrenal calculi are noted. The pancreas demonstrates diffuse fatty atrophic\nchanges.", "output": "1. Fluoroscopic imaging obtained during injection of contrast agent into\npatient's existing lumbar drain by Dr. ___ the neurosurgery service,\nas described.\n2. Anterior cervical spinal and lumbar spinal fusion hardware streak artifact\nlimits examination.\n3. CT myelogram demonstrates communication between the thecal sac and a\nposterior spinal soft tissue collection centered at the level of L5 measuring\n1.5 cm AP by 1.8 cm TRV by 7.4 cm SI, indicating CSF leak. A connection of\ncontrast is seen at the L4-L5 level (series 2, images 167-173).\n4. At the superior aspect of the above-mentioned collection there is an\nadditional thin connection of contrast to another more superficial fluid\ncollection within the subcutaneous fat measuring 1.7 cm AP by 10.9 cm TRV by\n11.3 cm SI, extending from approximately the level of L1 through L5. This\nsuperficial collection demonstrates dependent layering contrast, indicating\nconnection with the deeper paraspinal collection and therefore the thecal sac.\n5. Extensive lumbar spine fusion hardware and partially imaged lower cervical\nspine fusion hardware without definite evidence for loosening, failure or\nperiprosthetic fracture.\n6. Multilevel degenerative changes of the thoracolumbar spine and unchanged\nancillary findings, as described above and on multiple other recent studies.\n7. Additional findings as described.\nI, Dr. ___ supervised the trainee during the key components of\nthe above procedure and I reviewed and agree with the trainee's findings and\ndictation." }, { "input": "Patient is status post fusion of the L1 through S1 vertebral bodies with\nintervertebral bone graft and screws seen at multiple levels. No obvious\nhardware related complications noted. Additionally, there is a lumbar drain\nseen coursing posteriorly and terminating at L3-L4. There is redemonstration\nof a fluid collection in the L4 laminectomy bed, which is difficult to assess\non noncontrast CT, but appears grossly similar to prior MRI dated ___, measuring approximately 4.6 x 3.0 x 7.5 cm on today's exam (series 301,\nimage 77). The overlying subcutaneous fluid collection measures approximately\n6.9 x 1.8 x 9.0 cm (series 301, image 85; series 602, image 44).\n\nNo acute fracture or traumatic dislocation. Multilevel degenerative changes\nwith intervertebral disc space narrowing, osteophyte formation, and\nsubchondral sclerosis, similar to prior.\n\nNonobstructing right renal calculi are partially visualized.", "output": "1. Patient is status post L1-S1 fusion with intervertebral bone graft and\nscrews again seen. No obvious hardware related complications noted.\n2. Redemonstration of a lumbar drain coursing through in terminating in the\nknown posterior paraspinal fluid collection. The fluid collection is\ndifficult to assess on a noncontrast CT; however, within these limitations,\nthe collection appears stable compared to MRI dated ___." }, { "input": "Patient is status post posterior fusion of L1-L2, anterior fusion of L2\nthrough S1, placement of L1-L2 through L5-S1 intervertebral disc spacers, and\nlaminectomy from L1 through L5. An epidural catheter is demonstrated in\nplace.\n\nExtensive artifact from posterior fusion hardware limits assessment of\nsurrounding tissues. Within these limitations, there is redemonstration of a\nposterior paraspinal surgical bed fluid collection in the region of L3 through\nS1 posteriorly, which is difficult to assess on noncontrast CT but appears\noverall similar in appearance to prior MRI from ___. Locules of\nair and fluid levels are again demonstrated.\n\nNo acute fracture or traumatic dislocation. Multilevel degenerative changes\ninclude intervertebral disc space narrowing, osteophyte formation, and\nsubchondral sclerosis. A nonobstructive right renal stone is again partially\nvisualized.", "output": "1. Extensive artifact from posterior fusion hardware limits assessment of\nsurrounding tissues. Within these limitations, there is redemonstration of a\nlarge posterior paraspinal fluid collection in the region of L3 through S1\nposteriorly, overall similar in appearance to prior MRI from ___.\nThis examination was not tailored for the evaluation of a spinal leak and if\nthis remains a clinical concern, a CT myelogram is recommended.\n2. Stable postsurgical changes status post posterior spinal fusion spanning L1\nthrough S1." }, { "input": "Patient is status post laminectomy from L1 through L5, posterior fusion of\nL1-L2 and anterior fusion from L2 to S1, placement of intervertebral spacers\nfrom L1-L2 through L5-S1. There has been interval removal of the epidural\ncatheter.\n\nEvaluation of the surrounding soft tissue is limited by beam hardening\nartifacts from the posterior fusion device. Furthermore, no intravenous\ncontrast was provided. Within the limits of the study, again seen is a\nposterior paraspinal surgical bed fluid collection spanning the level of L3 to\nS1, grossly similar in appearance from ___. There is mild\ninterval decrease subcutaneous emphysema in the postsurgical bed. No\ndefinitive evidence of a new fluid collection.\n\nNo acute fracture or traumatic subluxation. Mild degenerative changes are\nagain seen. Note is made of two 5 mm nonobstructive right renal calculi.", "output": "1. Evaluation of the soft tissue at the surgical bed is limited by beam\nhardening artifacts. Again seen is a large posterior paraspinal fluid\ncollection in the region from L3 through S1 posteriorly. Overall, similar\nappearance from prior study dated ___ aside from interval removal\nof the epidural catheter. No convincing evidence for a new fluid collection. \nCT myelogram may be considered for evaluation of CSF leak if clinically\nwarranted.\n2. Stable postsurgical appearance of posterior spinal fusion from L1 to S1\nlevels." }, { "input": "Dental amalgam streak artifact limits study.\n\nThere is reversal of the cervical lordosis. The visualized osseous structures\nare osteopenic. No definite acute fracture is identified. There is no\nprevertebral soft tissue abnormality. Multilevel degenerative changes are\nnoted, with mild multilevel spinal canal narrowing.\n\nThe thyroid is unremarkable. The visualized lung apices demonstrate 2 mm left\nupper lobe pulmonary nodule (see 601b:8, 2:70). Limited imaging of the\nsinuses suggests right ethmoid air cell mucosal thickening. Atherosclerotic\nvascular calcifications are seen in bilateral carotid bifurcations.", "output": "1. Dental amalgam streak artifact limits study.\n2. No acute cervical spine fracture identified.\n3. Multilevel degenerative changes as described.\n4. 2 mm left upper lobe pulmonary nodule. The ___ Society guidelines\nfor pulmonary nodule guidelines suggest for pulmonary nodules less than or\nequal to 4 mm, no follow-up needed in low-risk patients, and 12 month\nfollow-up in high risk patients." }, { "input": "There is trace 2 mm anterolisthesis of C5 on C6. Elsewhere, vertebral bodies\nare well aligned. No acute fractures are identified.Multilevel degenerative\nchanges are seen, with loss of intervertebral disc height, posterior, anterior\nand uncovertebral osteophytosis, and mild canal narrowing secondary to\nposterior osteophytes worse at C4-C5. Moderate to severe multilevel neural\nforaminal narrowing is noted, secondary to uncovertebral and facet\nosteophytes, worse at C4-C5 on the left and C3-4 on the right. There is no\nprevertebral edema.\n\nThere is an incompletely imaged 1.8 cm nodule off the inferior portion of the\nright lobe of the thyroid. The thyroid is otherwise unremarkable. Scarring\nis seen in the imaged right lung apex. The imaged left lung apex is\nunremarkable.", "output": "1. No evidence of acute fracture.\n2. Trace 2 mm anterolisthesis of C5 on C6 is most likely secondary to chronic\ndegenerative change.\n3. Moderate to severe multilevel degenerative changes of the cervical spine,\nas detailed above.\n4. 1.8 cm incompletely imaged thyroid nodule exit the lytic inferiorly of the\nright lobe. Recommend non-urgent thyroid ultrasound for further evaluation.\n\nRECOMMENDATION(S): Thyroid ultrasound for impression point 4.\n\nNOTIFICATION: Updated wet read discussed with ___, M.D. by ___,\nM.D. on the phone on ___ at 20:18." }, { "input": "No acute fracture or malalignment in the cervical spine is seen. There is\nmultilevel degenerative disease with prominent anterior and posterior\nosteophytes. Degenerative disease is most pronounced at C5-6 with loss of\ndisc space and anterior and posterior osteophytosis resulting in mild to\nmoderate left neural foraminal narrowing. There is mild left neural foraminal\nnarrowing at C3-4 level as well due to uncovertebral joint hypertrophy. \nPosterior osteophytes at C3-4 and C4-5 are associated with mild central spinal\ncanal stenosis.\n\nThere is no prevertebral edema. Bulky lymphadenopathy involves the entire\nneck, rate greater than left. Lymph nodes measure up to 2.4 cm in short axis.\nFindings are highly concerning for lymphoma. In addition, there is an\nexophytic mass in the oropharynx at the level of the right palatine tonsil\nmeasuring 2.4 x 3.1 x 4.0 cm. This finding is indeterminate though results in\nat least mild to moderate airway compromise at this level. Recommend direct\ninspection and biopsy. The left thyroid lobe is markedly enlarged and appears\nhypodense likely due to the presence of an underlying nodule measuring at\nleast 4.1 x 3.8 cm. Correlation with thyroid ultrasound is advised.", "output": "1. Degenerative disease in the cervical spine most pronounced at C5-6,\ndetailed above.\n2. Bulky lymphadenopathy throughout the neck, right greater than left is\nconcerning for lymphoma. Exophytic mass at the right palatine tonsil level\nmay be related and correlation with direct inspection and biopsy is advised.\n3. Left thyroidal enlargement with large left thyroid nodule for which\nultrasound is recommended to further assess." }, { "input": "The bones are somewhat demineralized. There is no acute fracture or\nmalalignment. A chronic mild superior endplate compression deformity of L2 is\nnoted. There is a prominent posterior osteophyte at L1-2 level which causes\nat least moderate central spinal canal narrowing at this level. Otherwise, no\ncritical stenosis.\n\nThere is a prominent pericaval lymph node best seen on series 3, image 17\nmeasuring 18 mm in short axis. Additional mildly enlarged lymph nodes are\nseen along the left retroperitoneal chain.\n\nThe abdominal aorta appears normal in caliber and course.", "output": "1. Posterior osteophyte at L1-2 causing moderate central spinal canal\nstenosis.\n2. Enlarged retroperitoneal lymph nodes. In this patient with bulky\nlymphadenopathy in the neck, findings are concerning for lymphoma." }, { "input": "There is no acute fracture or malalignment involving of the thoracic spine. \nDISH related changes of the T-spine noted without fractured osteophyte. No\nsignificant posterior protruding osteophytes. Bones are diffusely\ndemineralized.\n\nEnlarged lymph nodes in the base of neck are described on concurrent CT of the\ncervical spine. There is a hypodense nodule enlarging the left thyroid lobe\nalso better assessed on same-day CT of the cervical spine measuring at least\n3.9 x 4.0 cm. Enlarged mediastinal lymph nodes measure up to 1.3 cm in short\naxis. The imaged portion of the aorta appears within normal limits in size. \nBibasilar atelectasis is noted. A large pericaval lymph node measures up to 2\ncm in short axis. Otherwise the imaged portion of the upper abdomen is\nunrevealing.", "output": "1. DISH related changes of the T-spine without fracture or malalignment.\n2. Lymphadenopathy in the base of neck, mediastinum and upper abdomen. \nFindings are concerning for lymphoma.\n3. Large left thyroid nodule measuring at least 3.9 x 4.0 cm requires thyroid\nultrasound to further assess." }, { "input": "There is no acute fracture or traumatic malalignment in the cervical spine.\nThe visualized outline of the thecal sac is unremarkable. Mild multilevel\ndegenerative changes are present. No prevertebral edema. Lung apices are\nclear. Thyroid gland appears normal.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Prominent adenoidal tissue is within normal limits for this\npatient's age. Imaged thyroid gland and lung apices appear unremarkable.", "output": "Normal study." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema. A small well\ncorticated fragment adjacent to the anterior superior corner of the C5\nvertebral body (602:27) is compatible with a limbus vertebra.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture traumatic or malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nImaged lung apices are clear. Imaged thyroid is unremarkable. Right\nmandibular molar dental caries are noted with periapical lucencies and\nadjacent sclerosis suggesting chronic inflammation.", "output": "No fracture or traumatic subluxation." }, { "input": "Alignment is normal. No evidence for a fracture or prevertebral soft tissue\nswelling. Unchanged well corticated ossific density in the anterior C4-C5\ndisc space is consistent with annulus fibrosus ossification versus anterior\nlongitudinal ligament ossification. There is no significant canal or\nforaminal narrowing. Broad-based disc protrusion at C5-C6, right larger than\nleft, mildly indents the ventral thecal sac, unchanged. Small disc protrusion\nmildly indenting the ventral thecal sac is probably also present at C6-C7,\nsimilar to prior, though evaluation is limited by beam hardening artifact from\nthe shoulder girdles. There is mild to moderate, right greater than left\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nThe thyroid and included lung apices are unremarkable. No cervical\nlymphadenopathy by CT size criteria. Concurrent CT head is reported\nseparately.", "output": "1. No evidence for a fracture. Normal alignment.\n2. Disc protrusions are again seen mildly indenting the ventral thecal sac at\nC5-C6 and C6-C7." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. Limbus vertebrae are noted at C5 and C6.\nThe airway appears patent, the thyroid appears normal. Please note that there\nis an incidental 6.2 x 3.8 mm subpleural nodule in the left lung apex (image\n71, series 2), probably consistent with subpleural mucosal thickening, however\nfollow-up is recommended as recommended by the ___ Society\nrecommendations for follow up of small lung nodules detected incidentally\ndetected on CT.", "output": "1. No evidence of acute cervical spine fracture or cervical spine\nmalalignment.\n\n2. Incidental 6.2 x 3.8 mm left upper lobe subpleural nodule.\n\nRECOMMENDATION(S): According with the ___ Society recommendations for\nfollow-up of small lung nodules detected incidentally on CT. In low risk\npatient, CT is recommended in 12 months for nodules larger than 4-6 mm in size\nand at ___ months in high risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "Alignment is normal. No fractures are identified.Moderate to severe multilevel\ndegenerative changes are demonstrated with intervertebral disc space\nnarrowing, endplate sclerosis, and anterior and posterior osteophyte\nformation. Moderate central canal stenosis is demonstrated C3-4 and C5-6 due\nto posterior disc osteophyte complexes. Additionally, mild bilateral neural\nforaminal stenosis due to uncovertebral hypertrophy and facet arthropathy is\nmost pronounced on the right at C3-4. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nDense atherosclerotic calcifications are noted at the carotid bifurcations.\nThe visualized thyroid gland demonstrates heterogeneity without dominant\nnodule.", "output": "1. No acute fracture or malalignment.\n2. Moderate to severe cervical spondylosis, most profound at C3-4 and C5-6\nwhere there is moderate central canal narrowing." }, { "input": "Alignment is normal. No fractures are identified. Mild multilevel\ndegenerative change. There is no evidence of spinal canal stenosis. Mild\nneural foraminal narrowing on the right at C4-C5, C5-C6, and C6-C7 secondary\nto uncovertebral osteophytes. The thyroid is unremarkable.Partially\nvisualized lung apices are notable for scattered bilateral ground-glass\nopacities, better assessed on dedicated CT chest.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Scattered ground-glass opacities at the bilateral lung apices are better\nassessed on dedicated CT chest." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Coarse calcification adjacent to the right mandible is again\nseen similar in position and appearance. The thyroid is homogenous. The\nvisualized very superior lung apices are clear.", "output": "No acute cervical spine fracture or dislocation." }, { "input": "Alignment is anatomic.No acute fractures are identified.Mild multilevel\nanterior, posterior, uncovertebral, and facet osteophytosis. A combination of\nposterior osteophytes and a posterior disc bulge or protrusion results in mild\nspinal canal narrowing at C5-C6. A combination of uncovertebral and facet\nhypertrophy result in mild to moderate multilevel neural foraminal narrowing. \nThere is moderate to severe right C4-C5 and C5-C6 neural foraminal narrowing. \nThere is no prevertebral soft tissue swelling. Incidental left second\nmandibular molar dental ___ with a large periapical lucency eroding the\nadjacent medial mandibular cortex. Paranasal sinus findings are described on\nthe concurrent noncontrast head CT. Mild carotid bifurcation calcification. \nThe visualized lung apices are clear. No cervical lymphadenopathy by size\ncriteria.", "output": "1. No evidence of fracture or malalignment.\n2. Incidental left second mandibular molar dental caries with a large\nperiapical lucency eroding the adjacent medial mandibular cortex." }, { "input": "Alignment is unchanged compared to prior exam.No fractures are identified.Mild\nmultilevel degenerative changes cervical spine are worst at the C5-6 level\nwhere there is mild disc height loss and small posterior intervertebral\nosteophytes. Posterior intervertebral osteophytes C5-6 cause mild spinal\ncanal narrowing. Uncovertebral and facet hypertrophy cause mild to moderate\nneural foraminal narrowing at several levels, worst at the bilateral C5-6\nlevels.There is no prevertebral soft tissue swelling.Lung apices are clear. \nImaged thyroid gland is unremarkable. Mucous retention cyst is partially\nimaged in the left maxillary sinus. There is mild mucosal thickening in the\nright maxillary sinus.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild degenerative changes as described above." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Visualized\nlung apices and thyroid gland are unremarkable.", "output": "Normal study." }, { "input": "The cervical spine alignment is normal. No acute cervical spine acute\nfractures are identified. There is diffuse osteopenia. Moderate to severe\nmultilevel degenerative changes noted, including multilevel disc space\nnarrowing and anterior and posterior osteophytosis. Minimal canal narrowing\nat C4-C5 secondary to posterior osteophyte/disc complex. Mild bilateral\nneural foraminal narrowing at C3-C4, moderate bilateral neural foraminal\nnarrowing at C4-C5, mild left-sided neural foraminal narrowing at C5-C6, and\nmild bilateral neural foraminal narrowing at C6-C7, secondary to uncovertebral\nosteophytes. There is no prevertebral soft tissue swelling.Multinodular\nthyroid gland with multiple hypoenhancing nodules measuring up to 1.8 cm. \nPartially visualized lung apices are within normal limits.", "output": "1. No evidence of acute cervical spine fracture or traumatic malalignment.\n2. Moderate to severe multilevel degenerative change throughout the cervical\nspine, as described above.\n3. Multinodular thyroid gland with multiple hypoenhancing nodules measuring up\nto 1.8 cm. If no previous imaging has been obtained, then further evaluation\nwith ultrasound should be considered on a nonemergent basis as an outpatient." }, { "input": "There is minimal anterolisthesis of C3 on C4 and retrolisthesis of C6 on C7. \nNo fractures are identified. There are multilevel degenerative changes with\ndisc space narrowing and posterior disc osteophyte complexes, resulting in up\nto mild central canal narrowing, worst at C4-C5 and C5-C6. Facet arthropathy\nand uncovertebral hypertrophy results in up to moderate to severe bilateral\nneural foraminal narrowing, worst on the right at C3-C4, and bilaterally at\nC5-C6. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture.\n2. Minimal anterolisthesis of C3 on C4 and retrolisthesis of C6 on C7 is\nalmost certainly degenerative in nature given the degenerative changes at\nthose levels." }, { "input": "Alignment is normal. No definite acute fractures are identified.Mild\ndegenerative changes are present and most pronounced at C5-C6 and C7-T1, with\nmild disc space narrowing and osteophyte formation, with well corticated\nfracture of anterior inferior C5 vertebral body osteophyte with no associated\nprevertebral soft tissue swelling. There is no bony severe spinal canal\nstenosis. There is a small focus of nuchal ligament ossification between the\nspinous process ease of C6 and C7 (602b:44). There is no prevertebral soft\ntissue swelling. Within the limits of this noncontrast examination there is no\nevidence of infection or neoplasm.", "output": "1. No evidence of cervical spinal fracture or traumatic malalignment.\n2. Multilevel degenerative changes as described." }, { "input": "There is no evidence of cervical spine fracture or traumatic malalignment.\nThere is no prevertebral soft tissue swelling. The intervertebral disc spaces\nand vertebral body heights are preserved. The thyroid is normal. Lung apices\nare clear. Left pectoral pacemaker is imaged on scout views.", "output": "No acute cervical spine fracture or traumatic malalignment." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. The lung apices are clear, the\nthyroid gland is unremarkable. There is no evidence of lymphadenopathy by\nradiological criteria.", "output": "No evidence of acute cervical spine fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nsevere spinal canal or neural foraminal stenosis. Mild degenerative changes,\nincluding disc space narrowing, are most pronounced at C5-C6 and C6-C7. There\nis no prevertebral soft tissue swelling.\n\nIncluded thyroid and lung apices are clear. Incidental note is made of a\npacemaker wire coursing through the left subclavian vein to the SVC, partially\nimaged, as well as mild mucosal thickening in the inferior left maxillary\nsinus.", "output": "No acute cervical spinal fracture or traumatic malalignment." }, { "input": "Alignment is anatomic.No fractures are identified.Well corticated ossific\ndensities posterior to the C7 and T1 transverse processes are unchanged,\nlikely the sequela of prior trauma or tendinous calcification. Minimal\nanterior, uncovertebral, and facet osteophytosis. Small multilevel disc\nbulges or protrusions result in as much as mild spinal canal narrowing,\nprobably worst at C3-C4. No significant neural foraminal narrowing. There is\nno prevertebral soft tissue swelling. Mild bilateral maxillary sinus mucosal\nthickening is partially imaged. Small left palatine tonsilliths are\nincidentally noted. No cervical lymphadenopathy by size criteria. The\nvisualized lung apices are grossly clear.", "output": "No evidence of fracture or malalignment.\n\nPlease note, this examination was ordered as a cervical spine CT without\ncontrast and was therefore not reviewed by a radiologist before scanning, per\ninstitutional protocol. Unable to assess for vascular dissection in the\nabsence of intravenous contrast." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Small mucous retention\ncyst noted in the left maxillary sinus.", "output": "No cervical spine fracture. No prevertebral edema." }, { "input": "Alignment is normal. No fractures are identified.Flowing anterior osteophytes\nspan C4 through T1 with preservation of the intervertebral disc. Findings are\ncompatible with diffuse idiopathic skeletal hyperostosis. No significant\ncanal narrowing. Uncovertebral joint hypertrophy and facet joint osteophytes\ncontribute to mild-to-moderate bilateral C3-C4 foraminal narrowing. There is\nno prevertebral edema.\n\nAtherosclerotic calcifications noted in the common carotid arteries and\ncarotid bulbs. The thyroid and lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment.\nFindings compatible with diffuse idiopathic skeletal hyperostosis." }, { "input": "Alignment is maintained.No acute fractures are identified. There are again\nmultiple flowing anterior osteophytes spanning C4-T1 levels, compatible with\ndiffuse idiopathic skeletal hyperostosis. There is no evidence of significant\nspinal canal narrowing. Multilevel uncovertebral and facet joint arthropathy\nagain results in mild-to-moderate C3-C4 neural foraminal stenosis, unchanged. \nThere is no prevertebral soft tissue swelling.The thyroid gland is\nunremarkable. No focal consolidation is seen in the visualized lung apices.", "output": "1. No acute fracture or traumatic malalignment.\n2. Redemonstration of diffuse idiopathic skeletal hyperostosis" }, { "input": "There is no acute fracture or malalignment. Anterior flowing osteophytes span\nC4 through T1.There is no prevertebral soft tissue swelling. Nuchal ligament\ncalcification noted. Aerosolized material within the upper esophagus noted. \nCarotid calcification is notable. Lung apices grossly clear. Thyroid gland\nappears normal.", "output": "No acute fracture or malalignment." }, { "input": "There are 12 rib-bearing vertebrae. There is a mild dextroconvex curvature of\nthe thoracic spine which appears exaggerated by patient positioning within the\nscanner. There is no evidence of a fracture. Vertebral body heights are\npreserved. There is a 5 mm sclerotic lesion in the T8 vertebral body on image\n400b:31, nonspecific but compatible with a bone island.\n\nThere are endplate degenerative changes and anterior endplate osteophytes at\nmultiple thoracic levels, the latter of little clinical significance. \nPosterior longitudinal ligament ossification mildly to moderately narrows the\nspinal canal at C7-T1 (see series 2, image 10 and 400b, 29). Small calcified\ndisc protrusions and ossification of the posterior longitudinal ligament also\nmildly narrow the spinal canal at T6-T7, T7-T8, T8-T9, and T9-T10. There is a\nlarge indeterminate oval ossification in the spinal canal at T10-T11,\nmeasuring 7 mm transverse, 7 mm AP, and 10 mm craniocaudad on images 2:91 and\n400b:26, and a calcified disc bulge with moderately bulky posterior\nlongitudinal ligament ossification at T11-T12. However, the spinal canal is\ndecompressed by laminectomies at T10-T11 and T11-T12. Endplate and facet\nosteophytes cause mild bilateral neural foraminal narrowing from T8-T9 through\nT10-T11. There is also moderate left T11-T12 neural foraminal narrowing by a\ncalcified disc bulge.\n\nThe spinal nerve stimulator electrode lead enters the spinal canal at T11-T12.\nThe electrode is located at T9 through T11 levels.\n\nLinear opacities in the visualized medial posterior right lower lobe on images\n02:43 and 2:84 nonspecific but compatible with atelectasis or scarring. The\nleft adrenal gland appears mildly thickened.\n\nConcurrent lumbar spine CT is reported separately.", "output": "1. Posterior longitudinal ligament ossification mildly to moderately narrows\nthe spinal canal at C7-T1.\n2. Calcified disc protrusions and ossification of the posterior longitudinal\nligament mildly narrow the spinal canal from T6-T7 through T9-T10. There is a\nlarge indeterminate oval ossification in the spinal canal at T10-T11, and a\ncalcified disc bulge with moderately bulky posterior longitudinal ligament\nossification at T11-T12, but the spinal canal is decompressed by laminectomies\nat these 2 levels.\n3. The spinal stimulator electrode is located at T9 through T11 levels.\n4. Mild thickening of the left adrenal gland." }, { "input": "There are 5 lumbar-type vertebrae. There is approximately 8 mm\nanterolisthesis of L3 on L4, likely related to severe facet arthropathy,\nwithout a pars defect. There is also approximately 2 mm anterolisthesis of L4\non L5. There is a mild levoconvex curvature of the lumbar spine.\n\nThere is a fracture of the L5 superior and anterior endplates with\ntransversely and coronal a oriented components. Visible fracture lines are\npresent. Anterior loss of height is approximately 25%. There is no\ninvolvement of the posterior cortex, and no retropulsion. No other fractures\nare identified.\n\nT11-T12 level is described in the concurrent thoracic spine CT report.\n\nT12-L1: Mild disc bulge and moderate facet arthropathy. No significant spinal\ncanal narrowing. Some degree of bilateral neural foraminal narrowing is\npresent.\n\nL1-L2: Mild disc bulge and moderate facet arthropathy. No significant spinal\ncanal narrowing. Some degree of bilateral neural foraminal narrowing is\npresent.\n\nL2-L3: Disc bulge, advanced facet arthropathy, and thickening of the\nligamentum flavum causes at least mild spinal canal stenosis and at least\nmoderate bilateral neural foraminal narrowing.\n\nL3-L4: There is anterolisthesis with an uncovered and bulging disc and severe\nfacet arthropathy. There is an interspinous spacer, with associated streak\nartifact limiting evaluation of the spinal canal and neural foramina. At\nleast moderate spinal canal narrowing is present. There is also at least\nmoderate bilateral neural foraminal narrowing. There is bone graft in the\nposterior elements.\n\nL4-L5: There is mild anterolisthesis with an uncovered and bulging disc, as\nwell as advanced facet arthropathy. There is left laminotomy defect and bone\ngraft in the posterior elements bilaterally. Subarticular zones appear\nnarrowed, but the thecal sac is not significantly narrowed. There is at least\nmoderate bilateral neural foraminal narrowing.\n\nL5-S1: There is a disc bulge, right paracentral and foraminal endplate\nosteophytes, severe facet arthropathy, and possibly also bone graft in the\nposterior elements. Traversing right S1 nerve root is displaced in the\nsubarticular zone. The thecal sac is at least mildly narrowed. There is at\nleast moderate bilateral neural foraminal narrowing.\n\nVisualized lung bases are grossly unremarkable. Calcifications are noted in\nthe aorta and its visualized branches, including extensive calcification in\nthe region of the left renal artery origin. The left adrenal gland appears\ndiffusely thickened.", "output": "1. fracture of the anterior and superior endplates of L5 approximately 25%\nloss of height and no retropulsion. Visible fracture lines indicate acute or\nsubacute fracture.\n2. Approximately 8 mm anterolisthesis of L3 on L4. Approximately 2 mm\nanterolisthesis of L4 on L5.\n3. S/p left L4 laminotomy with an interspinous spacer at L3-L4 and bone graft\nin the posterior elements at L3-L4, L4-L5, and possibly also L5-S1.\n4. Multilevel degenerative disease. At least moderate spinal canal stenosis\nat L3-L4. At least moderate neural foraminal narrowing at multiple levels, as\ndetailed above.\n5. Mild diffuse left adrenal gland thickening.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:25 am, 15 minutes\nafter discovery of the findings." }, { "input": "MYELOGRAM:\n\nFluoroscopic images demonstrate intrathecal needle access at approximately\nL4-5 level, with subsequent installation of intrathecal contrast, with caudal\nopacification of contrast stopping abruptly at approximately the T11-12 level.\n\nPOSTMYELOGRAM CT:\n\nSpine stimulator streak artifact limits examination.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nTHORACIC SPINE MYELOGRAM:\n\nRedemonstrated are spinal stimulator leads in the posterior epidural space\ncentered at T10. There is mild dextroscoliosis of the thoracic spine. \nAlignment is otherwise maintained. Vertebral body heights are preserved. A\nsmall sclerotic focus in the T8 vertebral body is unchanged and may represent\na bone island. The visualized osseous structures are osteopenic.\n\nThere is abrupt cut off of intrathecal contrast at T10-11 with trace contrast\nalong the posterior aspect of the thecal sac reaching up to mid T7. \nTherefore, assessment of the cord and intrathecal structures can only be\nreliably performed below T10-11.\n\nAt T10-11, there is severe right for displacement and external compression of\nthe thecal sac and the cord by partially calcified structure in the anterior\nepidural space suggestive of disc fragment (series 301, images 98-102).\n\nAt T11-12, a calcified disc bulge contacts the spinal cord and moderately\nnarrows the spinal canal and moderately narrows the left neural foramen.\n\nMultilevel degenerative changes at the remaining thoracic levels are described\nin detail on the thoracic spine CT from one day prior and remain unchanged.\n\nLimited imaging of the larynx not included on previous day thoracic spine CT\nstudy suggests nonspecific soft tissue density within the left laryngeal\nventricle (see 301:3).\n\nLUMBAR SPINE MYELOGRAM:\n\nThere is approximately 7 mm anterolisthesis of L3 on L4, similar to the prior\nexamination. Levoscoliosis also again noted. Fracture of the superior\nendplate of L5 with mild loss of height anteriorly is unchanged. There is no\nbony retropulsion. The visualized osseous structures are osteopenic.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is a disc bulge with mild narrowing of the spinal canal.\n\nAt L2-L3, disc bulge and ligamentum flavum thickening results in moderate\nnarrowing of the spinal canal with trace contrast separating the nerve roots\n(series 2, image 41). Moderate to severe degenerative changes of the facet\njoints contributes to moderate bilateral neural foraminal narrowing.\n\nAt L3-L4, there is severe loss of disc height and vacuum disc phenomena with\nanterolisthesis resulting in uncovering of the intervertebral disc\nposteriorly. There is severe bilateral facet arthropathy with an interest\nspinous fixation device. The spinal canal narrowing is moderate with trace\ncontrast in the thecal sac at this level. There is moderate bilateral neural\nforaminal narrowing although evaluation is somewhat limited by streak artifact\nfrom the hardware.\n\nAt L4-5, a disc bulge results in mild narrowing of the spinal canal. \nBilateral facet degenerative changes are severe. There is moderate bilateral\nneural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge and severe bilateral facet degenerative\nchanges. There is mild narrowing of the spinal canal. There is moderate\nbilateral neural foraminal stenosis.\n\nThe conus medullaris terminates at L1-2. There is clumping of the cauda\nequina nerve roots distal to L3-4 concerning for arachnoiditis.\n\nVascular calcifications are noted in the aorta and branch vessels.", "output": "1. Myelogram imaging demonstrating L4-5 level intrathecal access, with\nintrathecal installation of contrast which progresses caudally, and abruptly\nstops at approximately T11-T12 level.\n2. CT examination is limited by streak artifact from a spinal stimulator\ndevice centered at T10 and interspinous fusion device at L3-4.\n3. There is a myelographic block with trace contrast past the T10-11 level, as\na result of rightward displacement and severe compression of the thecal sac by\nsoft tissue density in the anterior epidural space, which may represent a\ncalcified disc fragment.\n4. Clumping of the cauda equina nerve roots distal to L3-4 concerning for\narachnoiditis.\n5. Additional thoracolumbar spondylosis, as described. Degenerative changes\nof the thoracic spine are fully described on the thoracic spine CT from one\nday prior.\n6. Limited imaging larynx suggests nonspecific opacification of left laryngeal\nventricle, which may be secondary to secretions. If concern for mass,\nconsider correlation with direct examination.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:17 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "MYELOGRAM:\n\nFluoroscopic images demonstrate intrathecal needle access at approximately\nL4-5 level, with subsequent installation of intrathecal contrast, with caudal\nopacification of contrast stopping abruptly at approximately the T11-12 level.\n\nPOSTMYELOGRAM CT:\n\nSpine stimulator streak artifact limits examination.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nTHORACIC SPINE MYELOGRAM:\n\nRedemonstrated are spinal stimulator leads in the posterior epidural space\ncentered at T10. There is mild dextroscoliosis of the thoracic spine. \nAlignment is otherwise maintained. Vertebral body heights are preserved. A\nsmall sclerotic focus in the T8 vertebral body is unchanged and may represent\na bone island. The visualized osseous structures are osteopenic.\n\nThere is abrupt cut off of intrathecal contrast at T10-11 with trace contrast\nalong the posterior aspect of the thecal sac reaching up to mid T7. \nTherefore, assessment of the cord and intrathecal structures can only be\nreliably performed below T10-11.\n\nAt T10-11, there is severe right for displacement and external compression of\nthe thecal sac and the cord by partially calcified structure in the anterior\nepidural space suggestive of disc fragment (series 301, images 98-102).\n\nAt T11-12, a calcified disc bulge contacts the spinal cord and moderately\nnarrows the spinal canal and moderately narrows the left neural foramen.\n\nMultilevel degenerative changes at the remaining thoracic levels are described\nin detail on the thoracic spine CT from one day prior and remain unchanged.\n\nLimited imaging of the larynx not included on previous day thoracic spine CT\nstudy suggests nonspecific soft tissue density within the left laryngeal\nventricle (see 301:3).\n\nLUMBAR SPINE MYELOGRAM:\n\nThere is approximately 7 mm anterolisthesis of L3 on L4, similar to the prior\nexamination. Levoscoliosis also again noted. Fracture of the superior\nendplate of L5 with mild loss of height anteriorly is unchanged. There is no\nbony retropulsion. The visualized osseous structures are osteopenic.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is a disc bulge with mild narrowing of the spinal canal.\n\nAt L2-L3, disc bulge and ligamentum flavum thickening results in moderate\nnarrowing of the spinal canal with trace contrast separating the nerve roots\n(series 2, image 41). Moderate to severe degenerative changes of the facet\njoints contributes to moderate bilateral neural foraminal narrowing.\n\nAt L3-L4, there is severe loss of disc height and vacuum disc phenomena with\nanterolisthesis resulting in uncovering of the intervertebral disc\nposteriorly. There is severe bilateral facet arthropathy with an interest\nspinous fixation device. The spinal canal narrowing is moderate with trace\ncontrast in the thecal sac at this level. There is moderate bilateral neural\nforaminal narrowing although evaluation is somewhat limited by streak artifact\nfrom the hardware.\n\nAt L4-5, a disc bulge results in mild narrowing of the spinal canal. \nBilateral facet degenerative changes are severe. There is moderate bilateral\nneural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge and severe bilateral facet degenerative\nchanges. There is mild narrowing of the spinal canal. There is moderate\nbilateral neural foraminal stenosis.\n\nThe conus medullaris terminates at L1-2. There is clumping of the cauda\nequina nerve roots distal to L3-4 concerning for arachnoiditis.\n\nVascular calcifications are noted in the aorta and branch vessels.", "output": "1. Myelogram imaging demonstrating L4-5 level intrathecal access, with\nintrathecal installation of contrast which progresses caudally, and abruptly\nstops at approximately T11-T12 level.\n2. CT examination is limited by streak artifact from a spinal stimulator\ndevice centered at T10 and interspinous fusion device at L3-4.\n3. There is a myelographic block with trace contrast past the T10-11 level, as\na result of rightward displacement and severe compression of the thecal sac by\nsoft tissue density in the anterior epidural space, which may represent a\ncalcified disc fragment.\n4. Clumping of the cauda equina nerve roots distal to L3-4 concerning for\narachnoiditis.\n5. Additional thoracolumbar spondylosis, as described. Degenerative changes\nof the thoracic spine are fully described on the thoracic spine CT from one\nday prior.\n6. Limited imaging larynx suggests nonspecific opacification of left laryngeal\nventricle, which may be secondary to secretions. If concern for mass,\nconsider correlation with direct examination.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:17 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "MYELOGRAM:\n\nFluoroscopic images demonstrate intrathecal needle access at approximately\nL4-5 level, with subsequent installation of intrathecal contrast, with caudal\nopacification of contrast stopping abruptly at approximately the T11-12 level.\n\nPOSTMYELOGRAM CT:\n\nSpine stimulator streak artifact limits examination.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nTHORACIC SPINE MYELOGRAM:\n\nRedemonstrated are spinal stimulator leads in the posterior epidural space\ncentered at T10. There is mild dextroscoliosis of the thoracic spine. \nAlignment is otherwise maintained. Vertebral body heights are preserved. A\nsmall sclerotic focus in the T8 vertebral body is unchanged and may represent\na bone island. The visualized osseous structures are osteopenic.\n\nThere is abrupt cut off of intrathecal contrast at T10-11 with trace contrast\nalong the posterior aspect of the thecal sac reaching up to mid T7. \nTherefore, assessment of the cord and intrathecal structures can only be\nreliably performed below T10-11.\n\nAt T10-11, there is severe right for displacement and external compression of\nthe thecal sac and the cord by partially calcified structure in the anterior\nepidural space suggestive of disc fragment (series 301, images 98-102).\n\nAt T11-12, a calcified disc bulge contacts the spinal cord and moderately\nnarrows the spinal canal and moderately narrows the left neural foramen.\n\nMultilevel degenerative changes at the remaining thoracic levels are described\nin detail on the thoracic spine CT from one day prior and remain unchanged.\n\nLimited imaging of the larynx not included on previous day thoracic spine CT\nstudy suggests nonspecific soft tissue density within the left laryngeal\nventricle (see 301:3).\n\nLUMBAR SPINE MYELOGRAM:\n\nThere is approximately 7 mm anterolisthesis of L3 on L4, similar to the prior\nexamination. Levoscoliosis also again noted. Fracture of the superior\nendplate of L5 with mild loss of height anteriorly is unchanged. There is no\nbony retropulsion. The visualized osseous structures are osteopenic.\n\nAt T12-L1, there is no spinal canal or neural foraminal narrowing.\n\nAt L1-L2, there is a disc bulge with mild narrowing of the spinal canal.\n\nAt L2-L3, disc bulge and ligamentum flavum thickening results in moderate\nnarrowing of the spinal canal with trace contrast separating the nerve roots\n(series 2, image 41). Moderate to severe degenerative changes of the facet\njoints contributes to moderate bilateral neural foraminal narrowing.\n\nAt L3-L4, there is severe loss of disc height and vacuum disc phenomena with\nanterolisthesis resulting in uncovering of the intervertebral disc\nposteriorly. There is severe bilateral facet arthropathy with an interest\nspinous fixation device. The spinal canal narrowing is moderate with trace\ncontrast in the thecal sac at this level. There is moderate bilateral neural\nforaminal narrowing although evaluation is somewhat limited by streak artifact\nfrom the hardware.\n\nAt L4-5, a disc bulge results in mild narrowing of the spinal canal. \nBilateral facet degenerative changes are severe. There is moderate bilateral\nneural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge and severe bilateral facet degenerative\nchanges. There is mild narrowing of the spinal canal. There is moderate\nbilateral neural foraminal stenosis.\n\nThe conus medullaris terminates at L1-2. There is clumping of the cauda\nequina nerve roots distal to L3-4 concerning for arachnoiditis.\n\nVascular calcifications are noted in the aorta and branch vessels.", "output": "1. Myelogram imaging demonstrating L4-5 level intrathecal access, with\nintrathecal installation of contrast which progresses caudally, and abruptly\nstops at approximately T11-T12 level.\n2. CT examination is limited by streak artifact from a spinal stimulator\ndevice centered at T10 and interspinous fusion device at L3-4.\n3. There is a myelographic block with trace contrast past the T10-11 level, as\na result of rightward displacement and severe compression of the thecal sac by\nsoft tissue density in the anterior epidural space, which may represent a\ncalcified disc fragment.\n4. Clumping of the cauda equina nerve roots distal to L3-4 concerning for\narachnoiditis.\n5. Additional thoracolumbar spondylosis, as described. Degenerative changes\nof the thoracic spine are fully described on the thoracic spine CT from one\nday prior.\n6. Limited imaging larynx suggests nonspecific opacification of left laryngeal\nventricle, which may be secondary to secretions. If concern for mass,\nconsider correlation with direct examination.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 5:17 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "Spinal stimulator is noted. Patient is status post laminectomy and fusion\nfrom T9-T12.\n\nThere is grade 1 anterolisthesis of L3 over L4, unchanged from CT lumbar spine\n___. Posterior surgical hardware at L3-L4 is again noted, unchanged\nfrom ___. There is no fracture.\n\nEvaluation for fluid collection intradurally or in the paraspinal muscles of\nlower thoracic spine is extremely limited given streak artifact from spinal\nhardware and spinal stimulators. There is fluid and foci of air adjacent to\nthe spinous processes at the level of T7 and T8 (3:63, 68). There is also\nfluid with suggestion of a collection and small foci of air in the\nsubcutaneous tissues spanning from T6 to L1.\n\nBilateral extrarenal pelvises are noted. There is dilatation of the common\nbile duct measuring 1.3 cm (3:122)", "output": "1. Evaluation for intradural fluid collection is severely limited due to\nstreak artifact from posterior fusion hardware and spinal stimulator.\n2. Foci of air and fluid adjacent to the spinous processes ofT7-T8 likely\npostoperative.\n3. Fluid in subcutaneous tissues tracking from T6-L1, likely postoperative. \nThere is some suggestion of a possible evolving thin-walled collection,\npossibly representing seroma, but superinfection is not excluded.\n4. Dilatation of the common bile duct measuring 1.3 cm. This likely\nrepresents a postcholecystectomy state." }, { "input": "Successful myelogram was performed with intrathecal administration of contrast\nat L4-L5. There is contrast opacification of the lumbar spine, with poor\ncontrast passage through the lower thoracic spine at the level of surgical\nhardware. Subsequent CT myelogram demonstrates contrast opacification to the\nlevel of the upper thoracic spine.\n\nThere are multilevel degenerative changes with disc bulge within the lumbar\nspine causing with moderate spinal canal stenosis at L3-L4 and mild spinal\ncanal stenosis at L1-L2 and L2-L3. Within the thoracic spine, there is a disc\nbulge at T9-T10 through T11-T12 levels causing moderate spinal canal stenosis.\nPlease refer to subsequent CT report of the thoracic and lumbar spine for\nadditional details.", "output": "1. Successful myelogram with intrathecal contrast administration at L4-L5. \nThere was initial poor contrast passage through the lower thoracic spine at\nT11-T12 level with the subsequent CT showing contrast opacification to the\nlevel of the upper thoracic spine, without high-grade spinal canal stenosis.\n2. Status post posterior spinal fusion at T10-T12 levels with disc bulge at\nthese levels causing moderate spinal canal stenosis.\n3. Multilevel degenerative changes of the lumbar spine with moderate spinal\ncanal stenosis at L3-L4 and mild spinal canal stenosis at L1-L2 and L2-L3.\n4. Please refer to subsequent CT report of the thoracic and lumbar spine for\nadditional details.\nI, Dr. ___ supervised the trainee during the key components of\nthe above procedure and I reviewed and agree with the trainee's findings and\ndictation." }, { "input": "Alignment of the thoracic spine is normal. The patient is status post\nposterior laminectomy from T9-T12 and posterior fusion spanning from T10-T12. \nAssociated bone graft material is noted along the posterior aspect. Streak\nartifact from the postsurgical hardware limits evaluation. A spinal\nstimulator is in place along the lower thoracic ___ around T10. In\ncomparison with the prior CT\nthoracolumbar myelogram, the current exam demonstrates distribution of the\nintrathecal contrast above the previously noted myelographic blockage at the\nlevel of T10/T11 level, with visualization of contrast along the thoracolumbar\nspine, the caliber and configuration of the thoracic spinal cord from T1\nthrough T8 levels appears unremarkable. At T8-T9, a disc bulge causes mild\nspinal canal narrowing.\n\nEvaluation of T9-T10 and T10-T11 is limited due to artifact from hardware with\npossible spinal canal narrowing.\n\nNo acute fracture or subluxation is noted. Diffuse osseous demineralization\nis noted.\n\nThere is no significant spinal canal or neural foramina narrowing from T1-T8.\n\nAt T11-T12, there is no significant spinal canal narrowing. There is possible\nmild bilateral neural foramina narrowing.\n\nLimited images of the lungs demonstrate bibasilar atelectasis.", "output": "1. In comparison with the prior CT thoracolumbar myelogram, the current exam\ndemonstrates distribution of the intrathecal contrast above the previously\nnoted myelographic blockage at the level of T10/T11 level, with visualization\nof contrast along the thoracolumbar spine.\n2. Status post posterior laminectomy and posterior fusion spanning from\nT10-T12. Associated surgical hardware limits evaluation.\n3. Mild spinal canal narrowing at T8-T9. Evaluation of the spinal canal from\nT9-T11 is severely limited due to surgical hardware artifact." }, { "input": "Limited examination due to patient habitus as well as presence of fixation\nhardware and nerve root stimulator in place. In comparison with the prior CT\nthoracolumbar myelogram the current exam demonstrates distribution of the\nintrathecal contrast above the previously noted myelographic blockage at the\nlevel of T10/T11 level, with visualization of contrast along the thoracolumbar\nspine, please refer to the dedicated report for thoracic spine for more\ndetails. In this exam again the alignment of the lumbar spine is grossly\nunchanged from ___. There is stable grade 1 anterolisthesis of L3\non L4 by approximately 6 mm (series 602:image 46). Mild levoscoliosis of the\nthoracolumbar spine is again noted. Fracture of the superior L5 endplate is\nagain noted with mild anterior height loss, grossly similar to ___. \nNo bony retropulsion into the spinal canal from the fracture is noted.\n\nThe conus medullaris terminates at L1-L2. There is similar clumping of the\nnerve roots at the level of L3-L4, possibly reflective of arachnoiditis.\n\nAt T11/T12 level, again there is narrowing of the intervertebral disc space,\nposterior spondylosis and disc bulging, causing anterior thecal sac deformity\nand moderate spinal canal narrowing, apparently contacting the ventral aspect\nof the spinal cord (image 42, series 602). Additionally there is disc\nprotrusion inferiorly extending towards the left lateral recess and impinging\nthe thecal sac on the left (image 25, series 2).\n\nAt T12-L1, there is no significant spinal canal narrowing or neural foraminal\nnarrowing.\n\nAt L1-L2, there is an eccentric disc protrusion which causes mild spinal canal\nnarrowing and left neural foraminal narrowing (series 2:image 35).\n\nAt L2-L3, a diffuse disc bulge and ligamentum flavum hypertrophy causes\nmoderate spinal canal narrowing, grossly similar to the ___ exam\n(series 2:image 45). Associated facet arthropathy also likely causes\nbilateral moderate neural foraminal narrowing.\n\nAt L3-L4, grade 1 anterolisthesis causes uncovering of the intervertebral disc\nposteriorly. There is also associated severe bilateral facet arthropathy. A\nspinous fixation device is noted between the L3 and L4 spinous processes. \nThere is stable moderate spinal canal narrowing due to associated changes\n(series 2:image 55). Evaluation of the neural foramina is limited; however,\nthere is likely moderate bilateral neural foraminal narrowing.\n\nAt L4-L5, there is a disc bulge with minimal spinal canal narrowing. \nBilateral facet arthropathy is again noted. Bilateral mild-moderate neural\nforaminal narrowing is noted.\n\nAt L5-S1, there is a mild disc bulge with minimal spinal canal narrowing. \nBilateral facet arthropathy is severe causing moderate canal narrowing.\n\nThe imaged retroperitoneal and pelvic organs are within normal limits. A\nFoley catheter is noted in the bladder. There is extensive atherosclerotic\ndisease involving the infrarenal abdominal aorta and iliac artery branches.", "output": "1. The patient is status post thoracolumbar fixation with transpedicular\nscrews from T10 through T12 levels, spine stimulator in place. Grossly there\nis no evidence of hardware complications.\n2. In comparison with the prior exam, the current CT myelogram exam\ndemonstrates distribution of the intrathecal contrast above the previously\nnoted myelographic blockage at the level of T10/T11 level, with visualization\nof contrast along the thoracolumbar spine, please refer to the dedicated\nreport for thoracic spine for more details. similar clumping of the cauda\nequina nerve roots distal to L3-L4 may reflect arachnoiditis.\n3. Similar lumbar spondylosis when compared to ___ as described\nabove with moderate to severe spinal canal narrowing at L3-L4 level.\n4. Stable appearance of a L5 compression fracture." }, { "input": "Dental amalgam streak artifact limits study. There is minimal reversal of\ncervical lordosis.No fractures are identified. The posterior arch of C1 is\nunfused, likely congenital. Multilevel degenerative changes of the cervical\nspine are noted, including loss of intervertebral disc height, endplate\nsclerosis, osteophyte formation, and facet joint hypertrophy. There is at\nleast mild vertebral canal narrowing at C3-4 through C6-7 secondary to disc\nosteophyte complexes. Multilevel moderate to severe degenerative change is\nworst at C3-4, where there is disc space narrowing, endplate sclerosis, and\nanterior and posterior osteophytes. There is multilevel mild to moderate\nspinal canal narrowing. There is no prevertebral soft tissue swelling. \nEnlarged multinodular goiter is again seen.", "output": "1. Dental amalgam streak artifact limits study.\n2. No definite acute fracture or traumatic malalignment.\n3. Enlarged multinodular goiter is again seen. Decision for follow-up should\nbe based on the overall clinical assessment, including prior ultrasound and\nbiopsies.\n4. Multilevel cervical spondylosis as described, with at least mild vertebral\ncanal narrowing at C3-4 through C6-7. If clinically indicated, consider\ncervical spine MRI for further evaluation." }, { "input": "There is mild anterolisthesis of C4 on C5 and C7 on T1. There is a fracture\nthrough the odontoid with approximately 2 mm of posterior displacement. \nAnteriorly, the fracture line runs through the superior aspect of the dens and\nthe fracture line extends obliquely through to the base of the odontoid\nposteriorly. The bones are demineralized.\n\nDegenerative changes are noted with extensive bilateral facet joint\nhypertrophy throughout, intervertebral disc height loss and uncovertebral\njoint hypertrophy with posterior osteophytes, most extensively at C6-C7.\n\nThyroid is grossly unremarkable. There is mild biapical scarring and\ncentrilobular emphysema. Endotracheal and enteric tubes are partially\nvisualized.", "output": "1. Fracture through the odontoid with approximately 2 mm of posterior\ndisplacement of the superior fracture fragment. Anteriorly, the fracture line\nruns through the upper portion of the dens but posteriorly the fracture line\nextends through the base.\n2. Mild anterolisthesis of C4 on C5 and C7 on T1 is likely degenerative but of\nindeterminate chronicity without priors for comparison. If there is clinical\nconcern for ligamentous injury, MRI C-spine should be considered." }, { "input": "There is complete fusion of C5 and C6 vertebral bodies which demonstrate\nsmaller AP dimension compared to other cervical vertebral bodies, and near\ncomplete fusion of the facet joints, consistent with congenital etiology. New\nevidence for an acute fracture or prevertebral soft tissue swelling. \nAsymmetric atlantoaxial distances are consistent with the patient's head tilt.\nOtherwise, no subluxation. Disc protrusions and endplate osteophytes cause\nmild-to-moderate C4-C5 and moderate C6-C7 spinal canal stenosis. Neural\nforaminal narrowing by uncovertebral and facet osteophytes is advanced at\nmultiple levels, with sparing of the congenitally fused C5-C6 level.\n\nConcurrent head CT is reported separately. Right palatine tonsilliths are\nconsistent with sequela of prior infection. Slightly medialized right\ninternal carotid artery indents the right pharyngeal wall. Partially\nvisualized thyroid is unremarkable. The lung apices are not imaged.", "output": "1. No evidence for a fracture or subluxation.\n2. Congenital appearing fusion of C5 and C6.\n3. Multilevel degenerative disease, with apparent moderate spinal stenosis at\nC6-C7, and advanced multilevel neural foraminal narrowing." }, { "input": "Alignment is normal. No acute fractures are identified.There is multilevel\nmild loss of disc height with multiple be a small to moderate osteophytes\nwhich result in mild anterior spinal canal narrowing at C3-4 and C5-6. There\nis mild neural foraminal narrowing at these levels on the left. Chronic\nnonunion of the spinous process of C6 is likely congenital. There is no\nprevertebral soft tissue swelling.Right tonsilliths are noted. Very partially\nimaged lung apices are clear. Thyroid gland is unremarkable.", "output": "1. No acute fracture or traumatic malalignment." }, { "input": "No acute fracture is seen. Mild anterolisthesis of C3 on C4, C4 on C5 likely\nreflect chronic degenerative disease. There is no prevertebral edema. \nDegenerative disc disease is most pronounced at C5-6, C6-7 and C7-T1 with\ncomplete loss of disc space and small endplate osteophytes. Extensive facet\narthropathy appears most pronounced on the left at at C4-5 level. There is\nalso significant loss of joint space at the right atlantoaxial joint. \nPartially visualized at the right lung apex is a pleural effusion. The imaged\nportion of the thyroid is unremarkable. The base of dens is intact.", "output": "No fracture. Subtle misalignments likely chronic. Degenerative changes as\ndescribed. Partially visualized right pleural effusion." }, { "input": "There is diffuse demineralization. Multilevel, multifactorial degenerative\nchanges are seen throughout the lower thoracic and lumbar spine. Disc height\nloss is seen at multiple levels, most severe at the level of L4-5, with there\nis also vacuum disc phenomenon. Vertebral body heights and alignment appear\nmaintained. No fractures are identified. No concerning lytic or sclerotic\nlesions are seen.\nThere is no significant spinal canal stenosis.\n\nThere is asymmetry of the left psoas muscle, with a mixed attenuation\ncollection seen within the left psoas muscle. Areas within this collection\nmeasure up to 72 Hounsfield units, consistent with acute hematoma. Precise\nmeasurement of this collection is difficult given its shape, but it measures\nat least 9.2 x 3.5 cm.\n\nThere is a small left pleural effusion with adjacent compressive atelectasis. \nEmphysematous changes are seen in the bilateral lung bases. Severe calcified\natherosclerotic disease is seen involving the abdominal aorta. There is\ndiverticulosis without evidence of diverticulitis. Note is made of a small\nhiatal hernia.", "output": "1. Mixed attenuation collection within the left psoas muscle, containing areas\nmeasuring up to 72 Hounsfield units, which is most consistent with a hematoma.\n2. Diffuse demineralization and multilevel, multifactorial degenerative change\nthroughout the lower thoracic and lumbar spine.\n3. Vertebral body heights and alignment appear maintained. No fracture\nidentified.\n\nNOTIFICATION: Wet read was discussed with Dr. ___ by Dr. ___\ntelephone at 18:58 on ___, 10 min after discovery." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid is unremarkable. The included lung apices are notable for\nmultiple cysts at the right apex.", "output": "Normal study." }, { "input": "There is no fracture or acute malalignment of the cervical spine. The\nprevertebral soft tissues are not thickened.\n\nNo significant degenerative change is detected.\n\nScattered bilateral cervical chain lymph nodes are noted but not\npathologically enlarged. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable.", "output": "No fracture or acute malalignment of the cervical spine." }, { "input": "There is no acute fracture. There is a mild loss of disc space with grade 1\nanterolisthesis of L4 on L5. Also noted at L4-5 level is posterior and left\nparacentral disc herniation which results in mild to moderate narrowing of the\ncentral spinal canal and severe narrowing of the left neural foramen. No\nassociated spondylolysis. There is a mild posterior disc bulge at L3-4 and\nL5-S1 without significant resultant spinal or neural foraminal stenosis. \nThere is facet arthropathy most pronounced at L4-5 and to a lesser extent at\nL5-S1. Also noted is ligamentum flavum hypertrophy at L4-5.\n\nWithin the imaged portion of the abdomen pelvis, no discrete abnormalities are\nseen. There is a normal appendix. Mild atherosclerotic calcification of the\nlower abdominal aorta noted.", "output": "Degenerative changes most pronounced at L4-5 with grade 1 anterolisthesis,\nposterior and left paracentral disc herniation resulting in mild-to-moderate\ncentral canal stenosis and severe left neural foraminal stenosis." }, { "input": "Alignment is normal. No fractures are identified.There are mild multilevel\ndegenerative changes with disc space narrowing and small posterior disc\nosteophyte complexes, worst at C4-C5 and C5-C6 where there is mild spinal\ncanal narrowing. Facet arthropathy and uncovertebral hypertrophy results in\nup to mild bilateral neural foraminal narrowing, worst at C5-C6. There is no\nprevertebral edema.\n\nThe thyroid is unremarkable. There is mild biapical scarring.", "output": "No fracture or traumatic malalignment. Mild degenerative disease as stated." }, { "input": "There is no traumatic malalignment. Mild straightening of the cervical spine\nis likely positional. No acute fracture is identified. There is no evidence\nof spinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "1. No acute fracture or traumatic malalignment." }, { "input": "Mild anterolisthesis of C2 on C3, C3 on C4, and C5 on C6, likely chronic and\nsecondary to degenerative change.No acute fractures are identified. Extensive\nmultilevel degenerative change is noted, including multilevel disc space\nnarrowing most severe at C3-C4 and C4-C5 and fusion of the facet joints at\nthese levels. Moderate multilevel anterior and posterior osteophytosis is\ndemonstrated. Extensive pannus formation with calcification at the\natlanto-axial region. A cyst is seen within the dens which is likely\ndegenerative in etiology. Mild multilevel canal narrowing secondary to\nposterior disc/osteophyte complexes, most notably at C3-C4 and C5-C6. Mild\nright-sided neural foraminal narrowing at C3-C4, severe bilateral neural\nforaminal narrowing at C4-C5, severe bilateral neural foraminal narrowing at\nC5-C6, and moderate bilateral neural foraminal narrowing at C6-C7, secondary\nto uncovertebral osteophytes. There is no prevertebral soft tissue swelling.\n\nThe thyroid gland is unremarkable. Partially visualized lung apices are\nnotable for a 3 mm pulmonary nodule at the right upper lobe.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Extensive multilevel degenerative change, most notably at C4-C5 and C5-C6. \nMultilevel subluxations likely degenerative in etiology.\n3. Solitary 3 mm pulmonary nodule at the right upper lobe. As per the\n___ society guidelines included below, no CT follow-up is recommended\nin a low-risk patient, and an optional CT in 12 months is recommended in a\nhigh-risk patient.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "There is normal alignment of the cervical spine. There is multilevel mild\nloss of vertebral disc height with mild anterior and posterior osteophytosis. \nThere is moderate facet hypertrophy on the left at C3-4 resulting in\nmild-to-moderate neural foraminal narrowing. No acute fracture.\n\nThe visualized lung apices are clear. Thyroid is unremarkable.", "output": "No fracture or traumatic malalignment." }, { "input": "No fractures or prevertebral soft tissue swelling is identified. Mild C2 on\nC3 and C4 on C5 anterolisthesis is likely degenerative in etiology. Moderate\nmultilevel degenerative changes are noted in the cervical spine most notably\nat the C6-C7 vertebral level with mild narrowing of the spinal canal at that\nlevel as well as endplate sclerosis and anterior and posterior osteophyte\nformation. No critical central canal stenosis is identified. There is mild\nto moderate neural foraminal narrowing, most pronounced on the left at C4-5\nand bilaterally at C5-6 due to uncovertebral spurring and facet hypertrophy.\n\nThe thyroid gland is normal. Smooth septal thickening in the lung apices\nsuggests mild pulmonary edema.", "output": "1. No evidence of cervical spine fracture.\n2. Moderate cervical spondylosis with mild C2 on C3 and C4 on C5\nanterolisthesis, likely degenerative in etiology.\n3. Mild pulmonary edema in the lung apices." }, { "input": "There is straightening of the cervical alignment. No fractures are identified.\nThere is no significant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. Within the limits of this noncontrast\nstudy, there is no evidence of infection or neoplasm. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. There are endotracheal\nand enteric tubes.", "output": "No acute cervical spine fracture" }, { "input": "Alignment of the cervical spine is normal. No acute fractures. There is no\nprevertebral soft tissue swelling. Small anterior osteophytes are noted at C5\nand C6. No significant spinal canal or neuroforaminal narrowing. Within the\nlimitations of this noncontrast study, there is no evidence of infection or\nneoplasm.\n\nThyroid gland is unremarkable. Partially visualized lung apices demonstrate\nparaseptal emphysema on the right. Scattered subcentimeter nonspecific lymph\nnodes are noted throughout the neck bilaterally.", "output": "1. No fracture or malalignment within the cervical spine.\n2. Right upper lobe partially visualize emphysematous changes versus pleural\nblebs." }, { "input": "Again seen are compression fractures of the T6 and T7 vertebral bodies. The\nfractures involve the inferior endplate of T6 and the superior endplate of T7.\nThese appear chronic at this point. There is a small vacuum phenomenon in the\nT6-T7 intervertebral disc. There is extensive sclerosis of the endplates at\nthis level, consistent with a chronic fracture. The small lesion in the\ninferior inferior portion of the T5 vertebral body, seen on the MR\nexamination, manifests on this CT examination as minimal sclerosis. There is\nno encroachment on the spinal canal and no evidence of associated soft tissue\nabnormality.\nAlignment is normal.The bones are diffusely osteopenic. The other included\nvertebral bodies, inferior C6 through superior L1, demonstrate no other\nabnormalities. There is no evidence of spinal canal or neural foraminal\nstenosis.\nThe patient is status post a right thyroidectomy with postoperative clips in\nplace and no evidence of residual right-sided thyroid tissue.\nAgain seen is a left lower lobe parenchymal and pleural lesion. Allowing for\nthe difference in technique, this appears similar to the spine MR findings.", "output": "1. Chronic-appearing compression fractures of the inferior endplate of T6 and\nsuperior endplate of T7.\n2. Minimal or oasis of the anterior, inferior portion of the T5 vertebral body\ncorresponding to the abnormality seen on the ___ MR study.\n3. Left lower lobe pleural and parenchymal palatine that may represent tumor,\ntreatment effect, or some combination of these factors." }, { "input": "Alignment is normal. No fractures are identified. There is mild spondylosis\nat C5/C6 level with bilateral uncovertebral hypertrophy, causing mild\nbilateral neural foraminal narrowing, otherwise, there is no evidence of\ncritical spinal canal or neural foraminal narrowing. There is no evidence of\ninfection or neoplasm. Scattered cervical lymph nodes are not pathologically\nenlarged. The thyroid is unremarkable. The lung apices are clear.", "output": "No evidence of cervical spine fracture. Mild degenerative changes identified\nat C5/C6 level as described above." }, { "input": "The patient has had anterior discectomy and interbody fusion at C3-4. There\nis mild anterior positioning of the interbody spacer.\n\nThe patient has also had multilevel laminectomies from C3 through T1, with\nposterior fusion. Vertical rods and pedicle screws with adjacent bone\ngrafting material extend from C3 through T3.\n\nNo signs of hardware failure or loosening is noted.\n\nThe spinal canal is decompressed. The thecal sac is poorly visualized.\n\nThe alignment is normal. Significant neural foraminal narrowing at C6-7 is\nredemonstrated.\n\nThe lung apices are degraded by respiratory motion. Inflammatory changes and\nsmall amount of soft tissue gas is noted in the posterior cervical neck soft\ntissue compatible with recent surgery. There is no discrete or drainable\ncollection.", "output": "Postsurgical changes, detailed above, spanning C3 through T3. The spinal\ncanal is decompressed. No evidence of acute hardware related complication." }, { "input": "Patient is status post multilevel laminectomies extending from C3 inferiorly\nto at least the T2 level. Posterior fixation hardware is seen with bilateral\nC3, C4, C6 and C7 lateral mass screws and right-sided C5 lateral mass screw\nwith transfixing rods. T2 pedicle screws are partially visualized. Anterior\ncervical fixation hardware seen at the C3-4 level including an intervertebral\ndisc spacer with anterior plate and transfixing screws. Previously removed\nanterior screw ghost tract seen at C5. The C3 through C6 vertebral bodies are\nfused. These postoperative changes are all similar compared to prior.\n\nThere is no fracture. No malalignment.\n\nThere is no prevertebral edema. Atherosclerotic calcifications noted at the\ncarotid bulbs. Scattered cervical lymph nodes are noted but not\npathologically enlarged by size criteria.", "output": "Postoperative changes in the cervicothoracic spine. No fracture or\nmalalignment." }, { "input": "Thoracic: Posterior fixation hardware is noted with bilateral T2 and T3\npedicle screws with transfixing rods extending superiorly and better evaluated\non cervical spine CT. There is no evidence of periprosthetic lucency.\n\nThoracic vertebral bodies are maintained in height and alignment. There is no\nfracture. No visualized canal or foraminal narrowing.\n\nDependent atelectasis noted in the right lung. More dense consolidation in\nthe dependent areas of the left lung may also represent atelectasis though\nsuperimposed infection would be possible. Endoluminal debris is noted in the\nleft mainstem bronchus. Coronary artery calcifications are noted.\n\nLumbar spine: There are five lumbar-type vertebral bodies which are preserved\nin alignment. There is no fracture. Mild retrolisthesis of L5 on S1 is\nnoted. Posterior fixation hardware seen with bilateral L1 through L4 pedicle\nscrews as well as a right-sided L5 pedicle screw with transfixing rods. Ghost\ntract from prior right L5 pedicle screw is noted. Intervertebral disc spacers\nnoted at the L2-3 and L3-4 levels. There is no evidence of perihardware\nlucency. Better seen on MRI from five days prior is a fluid collection in the\npost laminectomy bed, measuring approximately 3.0 cm AP x 3.9 cm TRV and\nspanning the postoperative levels.\n\nPartially calcified portacaval lymph nodes are noted.", "output": "1. Postoperative changes in the upper thoracic and lumbar spine as above. No\nfracture or acute malalignment. No periprosthetic lucency.\n2. Fluid collection in the postoperative bed at the lumbar levels, potentially\npostoperative, better evaluated on recent prior MR.\n3. Dependent atelectasis with more confluent opacity at the left lung\ndependently, potentially with superimposed infection or aspiration given\nendoluminal debris in the left mainstem bronchus." }, { "input": "Alignment is anatomic. No acute fractures are identified.Mild-to-moderate\nmultilevel degenerative changes are noted in the cervical spine, worse at\nC5-C6 and notable for loss of intervertebral disc space and anterior and\nposterior osteophytes. Mild to moderate multilevel central canal narrowing is\nworst at C4-5 and C5-6 due to posterior osteophytes. Additionally, mild\nbilateral neural foraminal narrowing is most pronounced C4-5 and C5-6.there is\nno prevertebral edema.\n\nThe thyroid demonstrates a heterogeneous appearance, without focal lesions\nidentified. The imaged lung apices are clear.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is anatomic. No acute fractures are identified.Multilevel\ndegenerative changes are seen, most extensive at C3-4 and notable for loss of\nintervertebral disc height, subchondral sclerosis, osteophytosis,\nuncovertebral hypertrophy.There is no prevertebral edema. Degenerative\nchanges at C3-C4 through C6-C7 include posterior disc protrusions and\nintervertebral osteophytes which results in mild to moderate spinal canal\nnarrowing most prominent at C5-C6 where there is flattening of the thecal sac.\nMultilevel moderate to severe neural foraminal narrowing bilaterally is also\nidentified.\n\nThe thyroid and included lung apices are unremarkable, allowing for\npleuroparenchymal scarring. Prominent cervical lymph nodes, nonpathologic by\nsize criteria.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine, most prominent at\nC5-C6 where there is at least moderate spinal canal narrowing flattening the\nthecal sac with multilevel bilateral moderate to severe neural foraminal\nnarrowing." }, { "input": "Alignment is normal. No acute fracture. No prevertebral swelling. Moderate\nmultilevel degenerative changes with intervertebral disc space narrowing,\nendplate irregularity and sclerosis, and anterior and posterior osteophyte\nformation are most pronounced from C4-5 through C7-T1. Tiny hyperdensity\nposterior to the C4-5 level likely reflects calcification of the disc annulus\n(602:32). There is multilevel mild central canal narrowing, most pronounced\nat C4-5, but no high-grade spinal canal stenosis. There is diffuse moderate\nneural foraminal stenosis throughout the cervical spine, most pronounced at\nC5-6.\n\nThe thyroid is unremarkable. There is scarring at the bilateral lung apices\nmore prominent on the right. Moderate atherosclerotic calcifications of the\ncarotid bifurcations. Esophagus is patulous proximally.", "output": "1. No acute fracture or traumatic subluxation.\n2. Moderate-severe background degenerative changes with mild multilevel\ncentral canal narrowing and moderate neural foraminal stenosis.\n\nNOTIFICATION: The updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 7:47 pm." }, { "input": "There is minimal anterolisthesis of C7 over T1, likely degenerative.No acute\nfracture is seen.Multilevel degenerative changes are seen, including disc\nspace narrowing C3 through C7. There also anterior posterior osteophytes at\nthese levels. Vacuum phenomenon seen at C5/C6.there is no prevertebral soft\ntissue swelling.", "output": "1. No acute fracture of the cervical spine. Minimal anterolisthesis of C7\nover T1 is of indeterminate age given lack of priors for comparison, but most\nlikely degenerative.\n2. Multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.There are multilevel\ndegenerative changes, worst at C5-C6 with endplate sclerosis, disc space\nnarrowing, intervertebral osteophyte, and facet and uncovertebral osteophyte. \nThere is mild vertebral canal narrowing and left neural foraminal narrowing at\nthis level.There is no prevertebral edema.\n\nThe thyroid is unremarkable. There is a 0.5 cm subpleural nodule in the left\nlung apex. There is biapical scar.", "output": "1. No fractures or dislocations.\n2. Multilevel degenerative changes.\n3. 0.5 cm subpleural nodule in the left lung apex.\n\nRECOMMENDATION(S):\nThe ___ society pulmonary nodule recommendations are intended as\nguidelines for follow-up and management of newly incidentally detected\npulmonary nodules smaller than 8 mm, in patients ___ years of age or older. Low\nrisk patients have minimal or absent history of smoking or other known risk\nfactors for primary lung neoplasm. High risk patients have a history of\nsmoking or other known risk factors for primary lung neoplasm.\n\n\nIn the case of nodule size >4 - 6 mm: For low risk patients, follow-up at 12\nmonths and if no change, no further imaging needed. For high risk patients,\ninitial follow-up CT at ___ months and then at ___ months if no change." }, { "input": "No evidence of acute fracture is seen. There is no dislocation. No\nprevertebral soft tissue swelling is seen. Some facet arthropathy is seen\nbilaterally from C2-C6.\nThe thyroid gland isgrossly homogeneous, but appears atrophic. The lung\napices are clear.", "output": "No acute fracture of the cervical spine." }, { "input": "There is congenital nonunion of the posterior arch of C1. There is no acute\nfracture or traumatic malalignment. Multilevel degenerative changes with mild\nloss of disc space at C5-C6 and multiple anterior osteophytes are noted, some\nof which fragmented but well corticated. No significant spinal canal or\nneural foraminal stenosis is noted. A focal calcification is present in the\nnuchal ligament.\nThere is prevertebral soft tissue swelling. Thyroid and lung apices are\nunremarkable.", "output": "1. No fracture or malalignment.\n2. Multilevel degenerative changes without significant spinal canal or neural\nforaminal stenosis." }, { "input": "Motion artifact limits evaluation at C4 and C5. No fracture is otherwise\nseen. There is mild retrolisthesis of C5 on C6. It is not clear whether the\nretrolisthesis was present on the ___ cervical spine radiographs due to\nslight rotation on the lateral view. There is a mild smooth kyphotic\ncurvature of the cervical spine compared to straightening of cervical lordosis\non the ___ radiographs. There is disc space narrowing with anterior and\nposterior endplate osteophytes from C4-C5 through C6-C7. There appears to be\nmoderate spinal canal narrowing at C6-C7. Evaluation at C4-C5 and C5-C6 is\nlimited by motion artifact. There is multilevel neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nConcurrent head CT is reported separately. There is mild emphysema at the\nright lung apex. The thyroid gland is grossly unremarkable.\n\nThere is no evidence of infection or neoplasm. The lung apices appear clear. \nThe thyroid gland is unremarkable.", "output": "1. Motion artifact limits evaluation at C4 and C5. Otherwise, no evidence for\na fracture.\n2. Mild retrolisthesis of C5 on C6 is almost certainly degenerative, though\nchronicity cannot be confirmed definitively.\n3. Multilevel degenerative disease.\n4. Emphysema at the right lung apex." }, { "input": "Alignment is normal. No fractures are identified.There are moderate multilevel\ndegenerative changes of the cervical spine with vertebral body osteophytosis,\nintervertebral disc space narrowing, and uncovertebral joint hypertrophy. \nThere is multilevel central spinal canal narrowing, most prominent at C3-C4\nwhere it is moderate secondary to a prominent posterior disc osteophyte\ncomplex (2:29). There is multilevel neural foraminal narrowing, most\nprominent at C3-C4 on the right where it is severe secondary to a prominent\nposterior disc osteophyte complex (2:29). There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nThere are large calcified stones measuring up to 2 cm within the right\nsubmandibular duct with chronic atrophy of the right submandibular gland. \nThere is mild fluid overload in the bilateral lung apices with smooth septal\nthickening. There are no suspicious thyroid nodules. There is no cervical\nlymphadenopathy.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Moderate multilevel degenerative changes of the cervical spine.\n3. Large calcified stones within the right submandibular duct with chronic\natrophy of the right submandibular gland.\n4. Findings suggestive of mild fluid overload in the lung apices." }, { "input": "Dental amalgam streak artifact limits study. Mild anterolisthesis of C7 on T1\nis unchanged since ___. The visualized osseous structures are\nosteopenic. No fractures are identified.A small bone island in the T2\nvertebral body is unchanged since ___. No osteolytic lesions detected\nin the cervical spine.\n\nMulti-level moderate degenerative changes with disc space narrowing and\nosteophytosis are most pronounced at from C3-C7, similarly to prior study. \nMild neuroforaminal narrowing at multiple levels this caused by uncovertebral\nand facet joint hypertrophy. There is no prevertebral soft tissue swelling. \nMultiple prominent inguinal are lymph nodes are visualized, 1 example which is\na 1.1 cm short axis left paratracheal lymph node (C3: 52).\n\nRedemonstration of a heterogeneous, enlarged thyroid gland with low-density\nareas, overall similar in appearance since ___.", "output": "1. Dental amalgam streak artifact limits study.\n2. No definite osteolytic lesions detected in the cervical spine. If\nclinically indicated, consider FDG PET-CT for evaluation of renal cell\ncarcinoma metastatic disease.\n3. Moderate degenerative changes, as above. Overall, these are unchanged to\nslightly progressed since ___.\n4. Partially visualized known bilateral pleural effusions.\n5. Prominent lymph nodes with at least 1 enlarged left paratracheal lymph node\nby CT size criteria, as described." }, { "input": "For the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nAt is dextroscoliosis with apex at T5-6 level. The visualized osseous\nstructures are osteopenic.\n\nA 9 mm rounded lucency in the T8 vertebral body is concerning for metastatic\ndisease, given history of renal cell carcinoma (602b:19). There is severe\ndegenerative change, particularly at T7-T8, with disc space narrowing,\nosteophyte formation, and endplate sclerosis. There is loss of height of the\nvertebral bodies involving T6 -T9. Moderate degenerative changes, including\ndisc space narrowing and osteophytosis, are also identified at T6-T7 and\nT8-T9. There is no severe bony spinal canal narrowing. There is no\nprevertebral soft tissue swelling.\n\nThere are bilateral nonhemorrhagic pleural effusions. The enlarged, nodular\nleft kidney, with a nodular conglomerate anterior to the left kidney (2:105)\nis identified, but poorly characterized on noncontrast CT. This was better\ncharacterized on the recent MRI.\n\nProminent and enlarged mediastinal, axillary and abdominal lymph nodes are\nagain noted. Additionally, left hilar calcified lymph nodes are noted (see\n2:50). Extensive atherosclerotic vascular calcifications are noted.", "output": "1. Study limited secondary to extensive osteopenia.\n2. 9 mm rounded lucency in the T8 vertebral body is concerning for metastatic\ndisease, given history of renal cell carcinoma, with differential\nconsideration of hemangioma. If concern for additional spinal metastatic\nlesions, consider FDG PET-CT for further evaluation.\n3. Severe degenerative changes at T7-T8.\n4. Age indeterminate anterior wedge compression deformities of T6 through T9\nvertebral bodies.\n5. No evidence of severe bony spinal canal narrowing.\n6. Enlarged, nodular left kidney, with anterior nodular soft tissue\nconglomerate better evaluated on recent renal MRI.\n7. Prominent and enlarged mediastinal, axillary, and abdominal lymph nodes\nagain noted." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is levoscoliosis of lumbar spine. The visualized osseous structures are\nosteopenic.\n\nThere is fusion of the L3 and L4 vertebral bodies.\n\nCompression deformities of the T12 and L5 vertebral bodies are age\nindeterminate.\n\nOsteolytic lesions involving the posterior L2 and L3-L4 vertebral bodies are\nconcerning for metastatic disease (601b:36).\n\nThere is mild bony spinal canal narrowing involving the entire lumbar spine. \nMultilevel degenerative changes are noted throughout the lumbar spine, with\nnumerous Schmorl's nodes, loss of inferior of disk height, and facet\narthropathy.\n\nHeavy atherosclerotic calcifications of the abdominal aorta and iliac vessels\nis noted. Limited imaging of the abdomen again partially demonstrates\npatient's known bilateral pleural effusions, left renal and retroperitoneal\nmass is, and abdominal and pelvic lymphadenopathy. The known left renal\nmasses with an adjacent large conglomerate mass are better characterized on\nprior MRI. Scout images demonstrate bilateral hip postsurgical changes.", "output": "1. Study limited secondary to extensive osteopenia.\n2. Compression deformities of the T12 and L5 vertebral bodies are of\nindeterminate age, given no priors for comparison. If concern for pathologic\nfracture, consider dedicated lumbar spine MRI for further evaluation.\n3. Lytic lesions involving the posterior L2 and L3-L4 vertebral bodies are\nconcerning for metastatic disease. If clinically indicated, consider FDG PET\nCT or lumbar spine MRI for further evaluation.\n4. Multilevel degenerative changes as described, with at least mild spinal\ncanal narrowing of entire lumbar spine." }, { "input": "Moderate multilevel degenerative changes of the cervical spine with\nintervertebral disc space narrowing, endplate cysts and sclerosis, and\nanterior and posterior osteophyte formation. Fusion of the right C4-5 facets.\nThere is minimal anterolisthesis of C4 on C5 and mild retrolisthesis of C5\nrelative to C6, likely degenerative in etiology.\n\nNo acute fractures are identified. There is diffuse central canal narrowing\ndue to congenitally short pedicles with more moderate narrowing at C2-3 and\nC3-4 due to posterior osteophytes. There is multilevel left-sided neural\nforaminal stenosis which is mild-to-moderate in degree, most pronounced at the\nC6-C7 level.There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm within the limits of this non-contrast\nenhanced study. The thyroid gland is unremarkable. Mild emphysematous\nchanges of the imaged lung apices with scarring.", "output": "1. No evidence of acute fracture or prevertebral soft tissue swelling.\n2. Moderate cervical spondylosis.\n3. Mild C4 on C5 anterolisthesis and C5 on C6 retrolisthesis, likely\ndegenerative in etiology." }, { "input": "Grade 1 C3 on C4 anterolisthesis and grade 1 C4 on C5 anterolisthesis are\nlikely chronic in the setting of multilevel degenerative changes.No fractures\nare identified.There is mild-to-moderate central canal stenosis at the C4-C5\nlevel associated with a midline disc extrusion. The C5-C6 and C6-C7\ninterspaces are moderately narrowed with small posterior osteophytic ridges. \nAt C3-C4 right-sided neural foraminal narrowing is moderate and associated\nwith uncovertebral and facet osteophytes. At C5-C6 bilateral neural foraminal\nnarrowing is mild and due to uncovertebral osteophytes. Very similar Findings\nare identified at C6-C7. There is no prevertebral soft tissue\nswelling.Partially imaged large right-sided pleural effusion, of low\nattenuation not consistent with hemorrhage, and patchy left apical lung\nground-glass opacities, which are nonspecific and better assessed on same day\nCT torso. Partially imaged endotracheal tube and enteric tubes noted.", "output": "No evidence of traumatic fractures or subluxation." }, { "input": "Dental amalgam streak artifact and mild motion limits study. Alignment is\nnormal. No fractures are identified.Multilevel degenerative changes are noted\nthroughout the cervical spine, including loss of intervertebral disc height,\ndisc osteophyte complexes, and facet joint arthropathy, most pronounced at\nC6-7, where there is at least mild vertebral canal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "1. Dental amalgam streak artifact and mild motion limits study.\n2. No consent acute cervical spine fracture.\n3. Multilevel degenerative changes as described.\n4. Please refer to concurrently obtained CT of the chest, abdomen and pelvis\nfor description of thoracic structures." }, { "input": "4 mm of C3 on C4 anterolisthesis is demonstrated as well as 1-2 mm of C5 on C6\nand C6 on C7 retrolisthesis, likely chronic and related to underlying\ndegenerative changes.No fractures are identified.Mild to moderate multilevel\ndegenerative changes with intervertebral disc space narrowing, endplate\nirregularity, and anterior and posterior osteophyte formation are most\npronounced at C4-5 and C5-6. Multilevel mild central canal narrowing is\ndemonstrated, most pronounced at C4-5, C5-6, and C6-7. Additionally,\nbilateral multilevel neural foraminal narrowing is most pronounced at C5-6\nwhere it is moderate in degree bilaterally. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Sclerotic\nfocus within the right posterior aspect of the C6 vertebral body may be a bone\nisland. Focal lucency within the C6 spinous process may be related to focal\nosteopenia.\n\nVisualized thyroid gland is unremarkable. Lung apices appear clear. Mild\natherosclerotic calcifications of the carotid bifurcations, more so on the\nleft, are noted.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Mild to moderate cervical spondylosis. Multilevel mild subluxations likely\nare chronic and related to degenerative changes.\n3. C6 vertebral body sclerotic focus, likely a bone island. Focal lucency\nwithin the C6 spinous process may be related to focal osteopenia. Please\ncorrelate however with any history of malignancy, and if there is continued\nconcern, consider bone scan for further assessment." }, { "input": "There is external spine stabilization hardware in place. There is re-\ndemonstration of an axial oblique fracture through the C2 vertebral body which\nis in near anatomic alignment. There is a 1 mm step-off of the posterior C2\ncortex. There is persistent visualization of the fracture lucency with\ninterval development of adjacent mild sclerosis. There is no visualized\nhealing callus formation or osseous ___.\n\nThe cervical spine demonstrates normal alignment. The vertebral body heights\nare preserved. There is no new fracture or osseous lesion. There is no\nsignificant neural foramina or spinal canal stenosis.\n\nThe paravertebral soft tissues are unremarkable. The lung apices are clear.", "output": "Redemonstration of a type 3 dens fracture in near anatomic alignment. \nPersistent fracture lucency with interval development of mild adjacent bony\nsclerosis. No significant bony callus formation or osseous ___." }, { "input": "Re-identified is a type 3 dens fracture, similar in appearance to prior\nexamination ___ with fracture lucency still visualized, in near\nanatomic alignment. As noted on the prior exam, there is increased sclerosis\nalong the fracture line. There appears to be mild intraosseous bridging. No\nextensive callus formation is identified.\n\nThe remainder the cervical spine is anatomic alignment. Vertebral body\nheights are preserved. No new fracture.\n\n There is no evidence of spinal canal or neural foraminal stenosis. There is\nno prevertebral soft tissue swelling.The visualized lung apices are clear.", "output": "1. Re- demonstration of a type 3 dens fracture in essentially anatomic\nalignment.\n2. Persistent fracture lucency with sclerosis along the fracture line and\nminimal inter osseous bridging." }, { "input": "Grade 1 anterolisthesis of L5 on S1 is noted, degenerative in etiology. Mild\nlumbar curve. No fractures are identified. No prevertebral edema.\nMultilevel degenerative changes. Significant narrowing L5-S1 disc space, with\ndegenerative disc disease, endplate hypertrophic changes. Lower lumbar facet\narthritis, most prominent L5-S1 facet joints. Multilevel diffuse disc bulges.\nEpidural mitosis L5, S1 level effacing thecal sac, worse at L5-S1 level. \nMultilevel foraminal narrowing, most prominent and moderate to severe at\nbilateral L5-S1 foramina.\n\nExtensive atherosclerotic calcification of the aorta and bilateral iliacs\nnoted. d indeterminate 2.3 cm left adrenal nodule, ___\nrepresent benign adenoma in the absence of history of malignancy. Consider\nMRI adrenal glands without contrast.", "output": "1. No fracture.\n2. Degenerative changes, grade 1 L5-S1 anterolisthesis.\n3. Moderate to severe bilateral L5-S1 foraminal narrowing.\n4. Epidural lipomatosis, effacing thecal sac at L5-S1 level.\n5. Left adrenal nodule, ___ represent benign adenoma,\ncomparison to prior scans or follow-up MRI abdomen without contrast would be\nhelpful." }, { "input": "No cervical spine fracture or acute malalignment. Vertebral body and disc\nheight are preserved. Pre and paravertebral soft tissues are normal.\nVisualized portions of the skullbase show no abnormalities.\n\nLimited assessment of the spinal canal is unremarkable.Visualized portions of\nthe aerodigestive tract are patent. Limited assessment of the lung apices are\nclear.", "output": "No cervical spine fracture or malalignment." }, { "input": "No evidence for a fracture or prevertebral soft tissue swelling. No\nsubluxation. Anterior endplate osteophytes and ossification of the anterior\nannulus fibrosis are again seen from C4-C5 through C6-C7.. Disc protrusions\nmildly indent the ventral thecal sac from C3-C4 through C6-C7. There is\nmoderate left C4-C5 neural foraminal narrowing by uncovertebral and facet\nosteophytes, and mild neural foraminal narrowing at several other levels.\n\nThere is a mucous retention cyst in the right maxillary sinus. There is a\nlarge periapical lucency of the last right maxillary molar with dehiscence of\nthe lingual cortex, image 2:15. There is periodontal lucency of the last left\nmaxillary molar. Otherwise, concurrent head CT is reported separately.\n\nEnlargement of the nasopharyngeal soft tissues is similar to the cervical\nspine MRIs from ___ and ___, which demonstrated an incompletely evaluated\ncystic nasopharyngeal lesion. There is a 3 mm calcification in the left\nthyroid lobe with a possible 4-5 mm underlying nodule; this does not warrant\nultrasound based on the ACR guidelines for this age group. Visualized lung\napices are clear.", "output": "1. No evidence for a fracture in the cervical spine. No subluxation.\n2. Large periapical lucency of the last right maxillary molar with dehiscence\nof the lingual cortex. Periodontal lucency of the last left maxillary molar. \nPlease correlate with dental exam regarding active inflammation.\n3. Grossly unchanged enlargement of the nasopharyngeal soft tissues compared\nto cervical spine MRIs from ___ and ___, which demonstrated an incompletely\nevaluated cystic nasopharyngeal lesion. Consider ENT evaluation if not\npreviously performed.\n\nRECOMMENDATION(S): Consider ENT evaluation if not previously performed." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Thyroid gland is unremarkable. The partially imaged upper\nlung apices are clear.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "Alignment is normal. No acute fractures are identified. Corticated calcific\ndensity posterior to the left L3-4 facet joint is likely degenerative. There\nis no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. The imaged paravertebral soft tissues are\ngrossly unremarkable.", "output": "No acute fracture or traumatic malalignment. Corticated calcific density\nabout the left L3-4 facet joint appears chronic, and is likely degenerative." }, { "input": "Comminuted anterior and bilateral posterior C1 fractures are acute with mild\ndisplacement. There is a type 2 fracture through the dens-body junction of\nthe C2 vertebral body with mild subluxation of the proximal fracture fragment\nposteriorly relative to the remainder of the C2 vertebral body. There is mild\nsubluxation posteriorly of C1 on C2 which could be related to traumatic injury\nin the setting of known C1 and C2 fractures, although the patient is rotated\nand could contribute to this appearance as well. There may be a fracture also\ninvolving the right transverse foramen at C1 (series 2, image 15). There is\nwidening of the anterior intervertebral disc space at C3-C4 with mild\nanterolisthesis of C3 on C4 and mild prevertebral soft tissue swelling,\nsuspicious for acute ligamentous injury. There is also mild anterolisthesis\nof C4 on C5 which could be degenerative in etiology rather than related to\nacute traumatic injury. Slight widening of the anterior disc space at C6-C7\nwith a small ossific fragment along the anterior inferior aspect of C6 could\nbe related to prior injury because the osseous fragment appears well\ncorticated, but in the setting of known injuries above, acute injury cannot be\nexcluded.\n\nBackground multilevel degenerative changes are extensive. Mild\nanterolisthesis of C7 on T1 is probably degenerative. Sclerotic focus in the\nleft posterior second rib is probably a bone island in the absence of any\nhistory of malignancy (series 2, image 43).", "output": "1. Unstable, acute mildly displaced fractures of the anterior and posterior\narches of C1, type 2 C2 vertebral body fracture, and right C1 transverse\nforamen with possible mild traumatic subluxation posteriorly of C1 on C2.\n\n2. Widening of the C3-C4 anterior disc space with mild anterolisthesis of C3\non C4 and prevertebral soft tissue swelling are highly suspicious for acute\nligamentous injury.\n\n3. Mild anterolisthesis of C4 on C5 could be degenerative or related to\ntraumatic injury.\n\n4. Slight widening of the anterior disc space at C6-C7 with a small anterior\nossific fragment is age indeterminate but could be also acute.\n\nRECOMMENDATION(S): 1. CTA neck to further evaluate the vertebral arteries.\n2. MR cervical spine to further evaluate for ligamentous injury.\n\nNOTIFICATION: The findings were discussed ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:20 ___, 10 minutes after discovery\nof the findings." }, { "input": "Again seen is a fracture of the odontoid as well as the posterior arch of C1\nbilaterally. The C1 fractures demonstrate widening of the fracture lines\nsince the prior study, but no displacement of the fragments. The odontoid\nfracture demonstrates widening of the fracture line and a slight increase in\ndistraction of the distal fragment. There is unchanged slight posterior\nangulation of this fragment. Again seen is bilateral facet fusion at C2-3 as\nwell as C4 through C6. Again seen are degenerative changes with loss of\nheight of the intervertebral discs and endplate sclerosis at every imaged\nlevel.\n\nAxial images posterior to the C2 body demonstrate mild soft tissue encroaching\non the spinal canal but without contact with the spinal cord.\n\nAt C2-3, there is again seen mild degenerative disease with left facet\nosteophyte formation but no canal or foraminal compromise.\n\nAt C3-4, large facet osteophytes combine with uncovertebral osteophytes to\nproduce severe bilateral neural foraminal narrowing. There is no canal\nnarrowing.\n\nAt C4-5, intervertebral osteophytes mildly narrow the spinal canal. Facet and\nuncovertebral osteophytes produce severe bilateral neural foraminal narrowing.\n\nAt C ___, facet and uncovertebral osteophytes produce severe bilateral neural\nforaminal narrowing. Intervertebral osteophytes narrow the spinal canal.\n\nAt C6-7, facet and uncovertebral osteophytes produce severe neural foraminal\nnarrowing. Small intervertebral osteophytes do not significantly encroach on\nthe spinal canal.\n\nThe C7-T1 and included portions of the upper thoracic spine demonstrate\ndegenerative disc disease but no canal or foraminal encroachment\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "1. Evolving C1 and C2 fractures with widening of the fracture lines and slight\nincreased distraction of the odontoid fracture.\n\n2. No new fracture is demonstrated." }, { "input": "Redemonstrated is a type 2 fracture of the odontoid process and bilateral\nfractures of the posterior arch of C1. Displacement and angulation of the\nodontoid fracture line is overall unchanged compared to the most recent\nexamination of ___. Multilevel degenerative changes are similar to\nthe recent study of ___.\n\nAt C2-3, there is again seen mild degenerative disease with left facet\nosteophyte formation but no canal or foraminal compromise.\n\nAt C3-4, large facet osteophytes combine with uncovertebral osteophytes to\nproduce severe bilateral neural foraminal narrowing. There is no canal\nnarrowing.\n\nAt C4-5, intervertebral osteophytes mildly narrow the spinal canal. Facet and\nuncovertebral osteophytes produce severe bilateral neural foraminal narrowing.\n\nAt C ___, facet and uncovertebral osteophytes produce severe bilateral neural\nforaminal narrowing. Intervertebral osteophytes narrow the spinal canal.\n\nAt C6-7, facet and uncovertebral osteophytes produce severe neural foraminal\nnarrowing. Small intervertebral osteophytes do not significantly encroach on\nthe spinal canal.\n\nThe C7-T1 and included portions of the upper thoracic spine demonstrate\ndegenerative disc disease but no canal or foraminal encroachment.\n\nThere is no prevertebral soft tissue swelling.", "output": "1. C1 and C2 fractures are stable compared to the most recent examination of\n___. The fracture lines remain visible.\n\n2. Severe multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "No acute fracture or change in overall alignment. There is severe\ndegenerative disc disease again noted at C3-4 with complete obliteration of\nthe disc space, notable endplate sclerosis and small endplate osteophytes. \nSubtle anterolisthesis of C4 relative to C5 appears similar to the prior exam.\nNo critical neural foraminal or central spinal canal stenosis is seen. The\nimaged apices of the lungs are clear. The thyroid is nodular and slightly\nenlarged, please correlate clinically and correlate with prior thyroid\nultrasound.", "output": "No acute fracture or traumatic malalignment. Degenerative changes as stated. \nThyroid nodular enlargement, please correlate with prior workup." }, { "input": "Multiple fractures are seen throughout the cervical spine:\n\n1. Fracture through the right lateral mass of C1 involving the right\ntransverse foramen (series 2, image 17).\n2. Spinous process fractures from C7 to T4 (series 602, image 31, 33).\n3. Right T2 -3 transverse process fractures (series 2, image 60.\n4. Fracture along the posterior aspect of right rib 1 through 3 (series 2,\nimage 60).\n\nThere is retrolisthesis of C3 on C4. Otherwise, alignment is normal. There\nis widening of the right see 3 4 facet joint without a fracture. This raises\na concern of injury to the joint capsule. Moderate severe degenerative\nchanges most prominent at the level of C 3 4 with loss of intervertebral disc\nheight, endplate sclerosis and osteophyte formation.\nThere is no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.", "output": "1. Multiple fractures seen throughout the cervical spine involving the spinous\nprocesses, and C1, as described above. Additional fractures through the right\nT2 -3 transverse process and the right ___ ribs. Fracture through the right\nlateral mass of C1 involving the right transverse foramen should be further\nevaluated with a CTA of the neck.\n2. Widening of the right C3-4 facet joint raising the possibility of injury to\nthe joint capsule.\n3. No evidence of traumatic malalignment.\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "There is 2 mm retrolisthesis of C3 on C4. Alignment is otherwise normal. \nThere is a minimally displaced fracture through right lateral aspect of the C1\nvertebra, which involves the right foramen transversarium. The fracture\ninvolves the right atlantooccipital joint. The C1 ring appears otherwise\nintact.\n\nThere are displaced fractures of the spinous processes of C7 and T1, and of\nthe posterior aspect of the right first and second ribs, and of the right\ntransverse process of T2.\n\nNote is again made of the widening of the right C3-C4 facet joint, without\nfracture, concerning for injury to the joint capsule.\n\nNo additional fractures are identified.\n\nThere is marked loss of intervertebral disc height at C3-C4, with adjacent\nendplate degenerative change. There is multilevel facet joint arthropathy.\n\nC3-C4: 2 mm retrolisthesis of C2 on C3, with posterior osteophytes, causing\nmild spinal canal narrowing. There is severe right neural foraminal narrowing\nand mild left neural foraminal narrowing. There is possible impingement of\nthe exiting right C3 nerve root.\n\nC5-C6: There are posterior osteophytes causing moderate left neural foraminal\nnarrowing.\n\nThere is no evidence of spinal canal or neural foraminal stenosis at the\nremaining imaged vertebral levels. There is no prevertebral soft tissue\nswelling overlying the cervical spine.There is no evidence of infection or\nneoplasm. Multinodular goiter noted. Cardiac pacing device.", "output": "1. Minimally displaced fracture through right lateral aspect of the C1\nvertebra, which involves the right foramen transversarium. The fracture\ninvolves the right atlantooccipital joint. The C1 ring appears otherwise\nintact.\n2. Displaced fractures of the spinous processes of C7 and T1, and of the\nposterior aspect of the right first and second ribs, and of the right\ntransverse process of T2.\n3. Unchanged widening of the right C3-C4 facet joint, without fracture,\nconcerning for injury to the joint capsule.\n4. 2 mm retrolisthesis of C3 on C4, with posterior osteophytes, causing mild\nspinal canal narrowing. There is severe right neural foraminal narrowing with\npossible impingement of the exiting right C3 nerve root.\n5. Multinodular goiter." }, { "input": "There is a healing fracture through the right lateral mass of C1 with\nextension into the transverse foramen and posterior tubercle of the transverse\nprocess. Displaced fractures of the C7 and T1 spinous processes demonstrate\nslightly increased sclerosis along the fracture lines. There are additional\nhealing fractures through the posterior aspects of the bilateral first and\nsecond ribs. Mild widening of the right C3-4 facet joint space is similar to\nprior study and may represent degenerative changes or joint capsule injury.\n\nVertebral alignment is unchanged with retrolisthesis of C3 on C4.\n\nMultilevel degenerative changes have not significantly progressed and are most\npronounced at the C3-4 level, where there is mild spinal canal stenosis and\nsevere right and mild left neural foraminal narrowing\n\nThere is no prevertebral soft tissue swelling. A multinodular thyroid goiter\nis noted. A 7 mm hypodense lesion in the subcutaneous fat of the right\nanterior neck which extends to the skin most likely represents a sebaceous\ncyst or epidermal inclusion cyst. The lung apices are clear.", "output": "1. Healing fractures through the right lateral mass of C1 with extension into\nthe right transverse foramen and posterior tubercle of the right transverse\nprocess; the spinous processes of C7 and T1; and the posterior aspects of the\nbilateral first and second ribs.\n2. Unchanged widening of the right C3-4 facet joint, which may represent joint\ncapsule injury or degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are notable for intervertebral disc height loss, posterior osteophytes\nand uncovertebral joint hypertrophy, most extensive at C4-5 where there is\nmoderate left foraminal narrowing and mild right foraminal narrowing. No\nsignificant overall canal narrowing.There is no prevertebral edema.\n\nThe thyroid is grossly unremarkable. Dense atherosclerotic calcifications\nnoted in the common and internal carotid arteries and at the carotid bulbs.", "output": "Degenerative changes without fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. No prevertebral soft\ntissue swelling is present. Multilevel severe degenerative changes are again\nseen characterized by large anterior osteophytes, posterior disc osteophyte\ncomplexes, and intervertebral disc space narrowing with endplate irregularity.\nThere is severe spinal canal narrowing from C3-C7 due to the presence of\nposterior disc osteophyte complexes in conjunction with congenitally short\npedicles. Mild neural foraminal narrowing is also noted at multiple levels due\nto facet hypertrophy.\nEnlarged and nodular thyroid gland is unchanged. No prevertebral soft tissue\nswelling. The included lung apices are unremarkable.", "output": "1. No fracture or traumatic malalignment.\n2. Degenerative changes are again seen with severe spinal canal narrowing from\nC3-C7. Severe spinal stenosis places the patient at increased risk for cord\ninjury.\n\nRECOMMENDATION(S): If neurologic symptoms correlate to any cervical spine\nlevel, consider MRI.\n\nNOTIFICATION: The findings and recommendation were discussed by Dr. ___\n___ with Dr. ___ on the telephone on ___ at 12:01 ___." }, { "input": "Straightening of cervical lordosis may be positional. There is minimal\nanterolisthesis of C2 on C3.No fractures are identified.Severe degenerative\nchanges of the cervical spine with prominent osteophytosis at the from C3-C6\nlevels. Redemonstration of moderate to severe spinal canal from the C3-C7\nlevel secondary to prominent posterior disc osteophyte complexes. There is no\ncritical neural foraminal narrowing. There is no prevertebral soft tissue\nswelling.The partially imaged lung apices are clear. The thyroid is\nunremarkable.", "output": "1. No acute fractures or traumatic malalignment of the cervical spine.\n2. Severe degenerative changes of the cervical spine, with moderate to severe\nspinal stenosis at the C3-C7 level." }, { "input": "Alignment is normal. No acute fractures are identified. There are multilevel\nminimal degenerative changes. There is no significant canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nThe included lung apices are unremarkable. The thyroid appears enlarged, with\na 1.2 cm hypodense lesion in the left thyroid lobe, and punctate\ncalcifications in the right thyroid lobe (3:60).", "output": "1. No fracture or traumatic dislocation.\n2. Enlarged thyroid, with a focal 1.2 cm hypodense left lobe lesion and\npunctate calcifications in the right lobe. Recommend correlation with thyroid\nfunction tests and outpatient ultrasound.\n\nRECOMMENDATION(S): Recommend correlation with thyroid function tests and\noutpatient thyroid ultrasound.\n\nNOTIFICATION: The updated findings recommendations were discussed by Dr.\n___ with Dr. ___ on the telephone on ___ at 1:24 ___, 15 minutes\nafter discovery of the findings." }, { "input": "There is slight reversal of the normal cervical lordosis, which could be due\nto patient positioning. Alignment is otherwise normal. No fractures are\nidentified. There is posterior disc bulge at C5-6 causing indentation of the\nanterior thecal sac without definite spinal cord contact. There is no\nprevertebral soft tissue swelling.", "output": "1. No acute fracture or traumatic malalignment.\n2. Posterior disc bulge at C5-6 causes indentation of the anterior thecal sac." }, { "input": "The cervical spine demonstrates multiple lucencies throughout the vertebral\nbodies, and spinous processes. The visualized portion of the left mandible\nalso demonstrates a diffuse infiltrative, permeative process. Mild\ncompression of the C5 vertebral body is likely chronic. There is no evidence\nof malalignment. There is no prevertebral soft tissue swelling.\n\nModerate degenerative changes are seen throughout the cervical spine, with\nevidence of anterior, and posterior osteophytosis. There is also mild to\nmoderate neural foraminal narrowing, the worst on the right from C5/C6.\n\nThe thyroid is normal. A moderate right pleural effusion is seen. There is no\ncervical lymphadenopathy.", "output": "1. No definite acute cervical spine fracture is identified. Mild compression\nof the C5 vertebral body is likely chronic, however incompletely evaluated\ngiven the absence of prior exams. Please correlate clinically.\n\n2. Multiple lucencies throughout the vertebral bodies and spinous processes. \nThis may be secondary to metastatic disease or multiple myeloma.\n\nNOTE ADDED AT ATTENDING REVIEW: These lucencies may be due to as benign a\nprocess as osteroporosis and certainly may be a consequence of the patient's\nknown end stage renal disease.\n\n3. Small right pleural effusion. A chest CT may be helpful for further\nevaluation of the thorax.\n\n4. Diffuse permeative, infiltrative process is seen in the visualized portion\nof the left mandible." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. No prevertebral soft tissue\nswelling is seen. A 1.1 x 0.9 x 0.5 cm soft tissue density is noted within\nthe subcutaneous tissues to the left of midline at the level of C3, this may\nrepresent a small sebaceous cyst or a subcutaneous hematoma.", "output": "No acute fracture or malalignment." }, { "input": "Alignment is normal. No acute fractures are identified. There is no evidence\nof spinal canal or neural foraminal stenosis. There is incidental finding of\nfenestration of the right transverse foramen at C4, C5, and C6. There is no\nprevertebral soft tissue swelling. The imaged portion of the lung apices are\nclear. The thyroid gland is normal.", "output": "1. No evidence of traumatic malalignment or acute fractures of the cervical\nspine." }, { "input": "Patient is status post posterior laminoplasty of C3, C4, C5 and C6, bilateral\nlaminotomy of C2 and medial facetectomy. There is no evidence of perihardware\nlucency or hardware related fracture. There is no prevertebral soft tissue\nswelling. A subtle lucency is seen along the left lamina of C6 (2;54).\n\nWhen compared to the most recent prior ___ cervical spine\nradiograph, there is a change in the alignment of the cervical spine which is\nlikely due to difference in patient positioning rather than an acute\nmalalignment.\n\nThere is mild anterolisthesis of C2 on C3 and moderate to severe bilateral\nneural foramina narrowing at C3-C4. There is unchanged mild anterolisthesis\nof C3 on C4. However the anterior bridging osteophytes between C4 and C5 is\nlarger and demonstrates a well corticated vertical fracture (new from the\n___ radiograph), likely chronic (602:37). Loss of the normal\ncervical lordosis at C3-C4 is again seen. Mild retrolisthesis of C5 on C6 is\nunchanged. There is no significant vertebral canal narrowing.\n\nThere is no evidence of infection or neoplasm.\n\nThe imaged portion of the thyroid gland and salivary glands are unremarkable. \nPartially visualized lung apices are also unremarkable.", "output": "1. Status post posterior laminoplasty of C3-C6, without evidence of\nperihardware lucency or hardware complications.\n2. A subtle lucency is seen along the left lamina of C6 (2;54) of\nindeterminate chronicity. No prevertebral soft tissue swelling.\nNOTE: If there is clinical concern for an acute fracture - an MRI may be\nhelpful for further evaluation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6 pm, 10 minutes after discovery\nof the findings." }, { "input": "There is no traumatic malalignmentno acute fractures are seen.Degenerative\nchanges are seen with disc height loss at C5-6 and C6-7, progressed at the\nformer level since ___. Facet joint hypertrophy is noted on the left at C2-3\nand on the right at C3-4. Uncovertebral joint hypertrophy results in moderate\nleft foraminal narrowing at C5-C6 and C6-C7. There is no prevertebral soft\ntissue swelling.\n\nImaged portion of the lung apices demonstrate centrilobular emphysema and\nbiapical scarring. In the right upper lobe, there is a 5 mm lung nodule\n(2:64). The thyroid gland is normal.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate degenerative changes of the cervical spine as noted above." }, { "input": "There is mild retrolisthesis of C3 over C4 and anterolisthesis of C4 over C5,\npotentially degenerative changes.Motion obscures detailed evaluation of C2. \nNo fractures are identified.There is anterior posterior bridging osteophyte\nformation throughout the cervical spine, most severe at C3-4 and C5-6. There\nis moderate to severe loss of disc heights at C3-4 and C5-6 with subchondral\nsclerosis and subchondral cysts. Intervertebral and facet osteophytes cause\nmild to moderate canal stenosis at C3-4 and C5-6. Uncovertebral and facet\nosteophytes cause moderate right neural foraminal narrowing at C3-4 and\nmoderate left neural foraminal narrowing at C4-5.There is no prevertebral soft\ntissue swelling.\n\nThe visualized thyroid is unremarkable. Visualized lung apices demonstrate\nmild emphysematous changes. There are bilateral carotid bulb atherosclerotic\ncalcifications.", "output": "1. Motion obscures detailed evaluation of C2. Given the limitation, no\nfracture.\n2. Mild retrolisthesis of C3 over C4 and anterolisthesis of C4 over C5,\npotentially due to degenerative changes. No prior studies to assess\nchronicity. Please correlate clinically.\n3. Multilevel degenerative changes of the cervical spine most severe at C3-4\nand C5-6." }, { "input": "Patient is status post C3 through C6 laminectomies and C3 through C7 posterior\nfusion. Lucency about the C7 screws is noted bilaterally, though the\nremainder of the hardware appears intact. Alignment is normal. No fractures\nare identified.Moderate to severe multilevel degenerative changes are present\nwith anterior and posterior osteophyte formation, intervertebral disc space\nnarrowing, and endplate irregularity. Assessment of the thecal sac is limited\nby streak artifact from the hardware, though no gross evidence of high-grade\ncentral canal stenosis. Bilateral multilevel mild to moderate neural\nforaminal narrowing is demonstrated, most pronounced at C5-6. There is no\nprevertebral soft tissue swelling.Visualized thyroid gland is unremarkable. \nScarring is seen within the lung apices.", "output": "1. No acute fracture or malalignment.\n2. Status post C3 through C7 posterior fusion and C3 through C6 laminectomies.\nLucency about the C7 screws is noted bilaterally, and comparison with previous\nimaging is recommended. Remainder of the hardware appears unremarkable." }, { "input": "There is no evidence of fracture or subluxation.Multilevel degenerative\nchanges are seen.\nThere is partially calcified pannus posterior to the odontoid.\nAt C2-3, a partially calcified bulging disc mildly encroaches on the spinal\ncanal and contacts the anterior surface of the spinal cord. Uncovertebral and\nfacet osteophytes narrow the left neural foramen.\nAt C3-4, a partially calcified bulging disc narrows the spinal canal and\nflattens the anterior surface of the spinal cord. Uncovertebral and facet\nosteophytes produce severe left neural foraminal narrowing.\nAt C4-5, small intervertebral osteophytes mildly narrow the spinal canal. \nThere is moderate right and severe left neural foraminal narrowing due to\nuncovertebral and facet osteophytes.\nAt C5-6, large intervertebral osteophytes narrow the spinal canal and flatten\nthe spinal cord. There is severe bilateral neural foraminal narrowing.\nAt C6-7, intervertebral osteophytes narrow the spinal canal and flatten the\nspinal cord. Uncovertebral osteophytes produce severe bilateral neural\nforaminal narrowing.\nAt C7-T1 and the included portions of the upper thoracic spine, there is no\nevidence of spinal canal or neural foraminal compromise.\nThere is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No evidence of fracture or subluxation.\nThe level degenerative changes with spinal canal and neural foraminal\nnarrowing." }, { "input": "Trace anterolisthesis of C4 on C5 and retrolisthesis C5 on C6 appear unchanged\nfrom prior, likely degenerative.No fractures are identified. Moderate to\nsevere multilevel degenerative changes are noted along the cervical spine,\nmost notable at C3-C4 through C6-C7 with moderate spinal canal stenosis at\nC5-C6, moderate left C4-C5 neural foraminal narrowing, and bilateral mild to\nmoderate C5-C6 neural foraminal narrowing. Fusion of the right C3-4 facet is\nnoted. There is no prevertebral soft tissue swelling\n\nVisualized lung apices appears unremarkable. There appears to be a 7 mm\nhypodense nodule in the right thyroid gland which does not necessitate further\nimaging workup per ACR criteria.", "output": "1. No cervical spine fracture or prevertebral edema.\n2. Moderate to severe cervical spondylosis with unchanged alignment." }, { "input": "Alignment is normal. No acute fracture is seen. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm.\n\nGround-glass opacities at the right lung apex are nonspecific and pulmonary\nhemorrhage cannot be excluded.\n\nThe patient is intubated. Complex fluid is noted in the oropharynx and\nnasopharynx. Intracranial and facial bone abnormalities are better evaluated\non dedicated CT head and CT sinus performed concurrently.", "output": "1. No acute spinal fracture or malalignment.\n\n2. Intracranial and facial bone abnormalities are better evaluated on CT head\nand CT sinus from the same date.\n\n3. Ground-glass opacities at the right lung apex are nonspecific and pulmonary\nhemorrhage cannot be excluded in the setting of trauma." }, { "input": "There is exaggerated cervical lordosis. There is no significant vertebral\nbody subluxation. No fractures are identified.Extensive degenerative changes\nof the cervical spine are noted, and are most severe at C4-5 where posterior\nand uncovertebral osteophytes cause moderate canal narrowing. Neural\nforaminal narrowing appears most severe at C5-6 where there is at least\nmoderate right and left narrowing.There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nA 1.8 cm hypodense right thyroid nodule is noted. Numerous cervical and\nsupraclavicular lymph nodes are noted, some of which are top-normal (03:41),\nare nonspecific.", "output": "1. No evidence of acute fracture or traumatic subluxation.\n2. Multilevel, multifactorial degenerative changes most severe at C4-5 with\nmoderate canal narrowing.\n3. 1.8 cm hypodense right thyroid nodule. According to current ___\nCollege of Radiology guidelines, a nonemergent dedicated thyroid ultrasound\ncan be obtained for further evaluation.\n4. Extensive cervical and supraclavicular lymphadenopathy of uncertain\nclinical significance. Recommend correlation with clinical history and\nlaboratory evaluation.\n\nNOTIFICATION: An update to the wet read regarding cervical lymphadenopathy\nwas paged to Dr. ___ by Dr. ___ at 10:22 on ___." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges are noted, including loss of intervertebral disc height, small\nendplate osteophytes, and uncovertebral arthropathy. Uncovertebral\narthropathy and endplate osteophytes result in moderate to severe stenosis of\nthe left C3-4 and right C4-5 levels. There is no evidence of critical spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.\n\nThere is diffuse nodal enlargement measuring up to 7 mm in short axis, similar\nto prior, nonspecific though raises potential concern for an underlying\nmalignant process.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Numerous prominent bilateral subcentimeter cervical lymph nodes, as seen on\nprior, please correlate clinically. Underlying malignancy is a concern." }, { "input": "The known extra medullary soft tissue mass extending into the left T11-12\nneural foramen contains heterogeneous calcification (3:66, 09:28), and is\nassociated with adjacent sclerosis of the posterolateral left T12 vertebral\nbody, pedicle, and facet (3:68, 9:31). There is also sclerosis along the left\nT11 pedicle, facet, lamina (3:61, 9:32). There is no evidence of direct bony\ninvasion or osseous destruction. No fractures are identified. Spinal canal\nand neural foraminal narrowing at this level is better assessed on recently\nobtained MRI of the thoracic spine. No other suspicious osseous foci for\nneoplasm or infection are identified.\n\nOtherwise, alignment of the thoracic spine is normal. Vertebral body heights\nand disc spaces are maintained. No significant degenerative changes are\npresent. Partially visualized asymmetric size of the kidneys is again noted. \nOtherwise, the paraspinal soft tissues and visualized thoracoabdominal\nstructures are unremarkable.", "output": "1. Calcified intradural, extramedullary soft tissue mass at the level of the\nleft T11-12 neural foramen with adjacent vertebral sclerosis but no bony\nremodeling or osseous destruction is most compatible with meningioma with\nsurrounding hyperostosis.\n2. Right renal atrophy." }, { "input": "There is straightening of the normal cervical lordosis. Otherwise, alignment\nis normal. No fractures are identified. There is no evidence of spinal canal\nor neural foraminal stenosis. There is no prevertebral soft tissue swelling.\n\nPartially visualized lung apices are within normal limits. No thyroid\nnodules. No cervical lymphadenopathy.", "output": "Straightening of the normal cervical lordosis, but no evidence of fracture or\ntraumatic malalignment." }, { "input": "There is no fracture. Vertebral bodies are maintained in height and\nalignment. Multiple areas of sclerosis involve the visualized lumbosacral\nvertebral bodies, most notable at L3 with near-complete sclerosis of the\nvertebral body, which, in the setting of patient's known prostate cancer,\nsuggests osteoblastic involvement. Additional less well-defined regions of\nsclerosis seen throughout the remaining vertebral bodies most extensively at\nthe partially visualized T12 level. See report from pelvic CT for additional\ndetails in the pelvis.\n\nDegenerative changes notable for a disc bulge, facet joint hypertrophy and\nligamentum flavum thickening result in mild to moderate canal narrowing and\nmild bilateral foraminal narrowing at L2-3.\n\nAt L3-4, there is a disc bulge, facet joint hypertrophy and ligamentum flavum\nthickening resulting in likely moderate canal narrowing and moderate bilateral\nforaminal narrowing.\n\nAt L4-5 there is a disc bulge and facet joint hypertrophy with thickening of\nthe ligamentum flavum resulting in at least mild canal narrowing and moderate\nbilateral foraminal narrowing. Schmorl's node seen at the superior endplate\nof L5.\n\n\nIncluded retroperitoneal soft tissue structures are notable for\natherosclerotic calcification in a normal caliber abdominal aorta.", "output": "1. Numerous sclerotic foci throughout the vertebral bodies compatible with\nmetastases with near complete replacement of the L3 vertebral body.\n2. No fracture or malalignment. Degenerative changes as above." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema. There is a\nfocal, air-containing structure posterolateral to the trachea at the thoracic\ninlet at approximately the level of C7 measuring 1.7 x 1.5 cm (3:64) most\nsuggestive of a tracheal diverticulum.\n\nThere is a partially calcified thyroid nodule measuring approximately 8 x 7\nmm. The included lung apices are better assessed on dedicated torso CT.", "output": "1. No acute fracture or traumatic subluxation identified.\n2. Intrathoracic findings to be described in further detail on CT torso." }, { "input": "Grade 1 retrolisthesis of C5 on C6 is likely degenerative in etiology. No\nacute fractures are identified.Multilevel degenerative changes are seen\nthroughout the cervical spine, with moderate to severe bilateral neural\nforaminal narrowing, worse at C5-C6. Severe degenerative changes are seen\nbetween the dens and the anterior arch of C1. There is no prevertebral edema.\n\nThe thyroid is unremarkable. Biapical scarring is noted.", "output": "1. No acute fracture.\n2. Grade 1 retrolisthesis of C5 on C6 is likely degenerative in etiology.\n3. Extensive degenerative changes at the craniocervical junction." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Moderate\nmucosal thickening of the left maxillary sinus is noted. Subtle asymmetry of\nthe left fossa of ___ is likely due to secretions, as this finding is\nnot present on the CTA of the same date.", "output": "1. No evidence of fracture or malalignment.\n2. Subtle asymmetry of left fossa of ___ is likely due to secretions.\n\nRECOMMENDATION(S): Consider direct oropharyngeal visualization for further\nevaluation." }, { "input": "Alignment is normal. No fractures are identified.Mild disc space narrowing at\nC6-C7 and C7-T1 is identified. There is no prevertebral soft tissue swelling.\n\nVisualized thyroid and lung apices are unremarkable.", "output": "No evidence of cervical spinal fracture or traumatic malalignment." }, { "input": "Overall postsurgical cervical spinal alignment is unchanged compared to the\nprior study with mild anterolisthesis of C3 on C4 and C7 on T1 as well as mild\nretrolisthesis of C5 on C6 and C6 on C7. Posterior fixation hardware spans\nC5-T1, and appears in appropriate position and alignment without evidence of\nperihardware fracture or lucency. The tip of the left T1 screw extends to the\nsuperior endplate (602:27), unchanged. Laminectomies of the C5 through C7\nvertebral body levels are re-demonstrated. No evidence of traumatic\nsubluxation. No acute fractures.\nThere is a well corticated minimally displaced fracture of the right C7\ntransverse process and the right T1 articular pillar (series 2, image 56)\nwhich appear chronic.\nMild multilevel central canal stenosis is present due to posterior disc\nosteophytes, most pronounced C4-5. Bilateral neural foraminal narrowing is\nmoderate to severe, most pronounced C5-6 bilaterally.There is no prevertebral\nedema.\n\nThe thyroid and included lung apices are unremarkable, apart from mild\nbiapical scarring.", "output": "1. No acute fracture or alignment change. No prevertebral soft tissue\nswelling.\n2. Status post C5-T1 posterior fusion without change in alignment or new\nhardware complications." }, { "input": "Motion and dental amalgam streak artifact limits study. Please note study is\nlimited secondary to patient body habitus, especially evaluation of the\nthyroid gland.\n\nThere is straightening of cervical lordosis. Vertebral body heights are\npreserved. No fractures are identified.Intubation status limits evaluation\nfor prevertebral soft tissue swelling.\n\nMultilevel degenerative changes cervical spine are noted, including loss of\nintervertebral disc height, endplate sclerosis, Schmorl's nodes, facet joint\nhypertrophy, and disc osteophytes. There is no definite evidence of moderate\nor severe bony vertebral canal narrowing.\n\nOrotracheal tube is partially visualized.\n\nLimited imaging lungs demonstrate nonspecific medial upper lobe opacities. No\npneumothorax. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", "output": "1. Patient body habitus, motion and dental amalgam streak artifact limits\nstudy.\n2. Within limits of study, no definite evidence of cervical spine fracture or\ntraumatic malalignment in the cervical spine.\n3. Partially visualized medial upper lobe opacities are nonspecific, with\ndifferential considerations including atelectasis, aspiration, and contusion. \nIf clinically indicated, consider correlation with dedicated chest imaging.\n4. Multilevel cervical spondylosis as described.\n5. Please see concurrently obtained noncontrast head CT for description of\ncranial structures." }, { "input": "The patient is status post posterior cervical spinal fixation from the occiput\nto the C4 level. There is evidence of lucency suggesting loosening of the\nlower-most right screw, which closely abuts the C4-5 facet joint. The\nleft-sided screw also closely abuts the interspace at C4-C5 but without\nsurrounding lucency. There is slight anterior widening of the C4-C5\ninterspace but no spondylolisthesis. No acute fractures are identified. Loss\nof height of the C4 and C5 vertebral bodies with anterior wedging and\nassociated sclerosis appears likely chronic with associated sclerosis. \nDegenerative changes are most pronounced at the C3-4, C4-5, C5-6 and T2-3\nlevels with uncovertebral hypertrophy, loss of intervertebral disc space,\nspurring, and endplate sclerosis and subchondral cyst formation. There is no\nevidence of infection or neoplasm. A tracheostomy tube is in place. The\nthyroid gland is prominent in size without dominant nodule. The imaged lung\napices are clear.", "output": "1. No evidence of acute fracture of the cervical spine.\n2. Loss of height of the C4 and C5 vertebral bodies with associated sclerosis\nappears chronic.\n3. Status post posterior spinal fixation from the occiput to C4 with evidence\nof loosening of the lowermost right screw, which abuts the C4-C5 facet joint. \nFollowup spine consultation and comparison with prior studies is recommended.\n\nRECOMMENDATION(S): Followup spine consultation and comparison with prior\nstudies.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\ntelephone on ___ at 11:50 ___, 15 minutes after discovery of the\nfindings." }, { "input": "Mild 3 mm of anterolisthesis of C4 on C5 is new from ___. A new linear\nlucency through the right fourth/fifth facet raises the possibility of an\nage-indeterminate fracture (601:24, 602:17). A left seventh facet fracture is\nminimally displaced and probably chronic (602:28, 601:33). Posterior fusion\nhardware extending from the occiput to C5 with bilateral transpedicle screws\nis re-demonstrated with surrounding streak artifact which limits assessment.\nExtensive degenerative changes from C3 through C5 again seen.There is no\nevidence of severe spinal canal stenosis. There is no prevertebral soft tissue\nswelling.", "output": "1. New 3 mm of anterolisthesis of C4 on C5 since ___, but of otherwise\nindeterminate age and could be acute. Ligamentous injury could be present.\n2. Lucency through the right for/fifth facet may suggest an age-indeterminate\nfracture, new from ___.\n3. Left seventh facet fracture, probably chronic." }, { "input": "A comminuted fracture of the left mandible and subluxation of the right\ntemporomandibular joint are better assessed on the concurrent head/ facial CT,\nwhich is reported separately.\n\nThere is no fracture or subluxation within the cervical spine. There is a mild\ncervical dextroconvex curvature. The prevertebral soft tissues are\nunremarkable. At C5-6, a central disc protrusion indents the ventral thecal\nsac and appears to slightly indent the ventral spinal cord. The visualized\nlung apices are grossly clear. The thyroid gland is grossly unremarkable.", "output": "1. No fracture or subluxation of the cervical spine.\n2. A disc protrusion at C5-6 appears to slightly indent the ventral spinal\ncord. If the patient has neurologic symptoms, this could be better assessed by\nMRI.\n3. Comminuted fracture of the left mandible and subluxation of the right\ntemporomandibular joint are better assessed on the concurrently reported head/\nfacial bone CT." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes include\nintervertebral disc height loss, posterior osteophytes and uncovertebral joint\nhypertrophy, most notable at C5-6 and C6-7. Facet joint hypertrophic changes\nare most extensive on the right at C4-5. There is no prevertebral edema.\n\nAtherosclerotic calcifications noted at the carotid bulbs. Thyroid is grossly\nunremarkable. Centrilobular emphysema noted at the lung apices.", "output": "Degenerative changes without fracture or malalignment." }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture. No\nacute alignment abnormality is identified. There is no prevertebral soft\ntissue abnormality.\n\nModerate multifactorial degenerative changes are seen within the cervical\nspine with intervertebral disc height loss, uncovertebral joint hypertrophy\nand disc bulges superimposed on a congenitally narrow canal resulting in\nmultilevel moderate canal narrowing worst at the C3-4 through the C5-6 levels.\nThere is no critical spinal canal stenosis identified by CT examination.\n\nThe thyroid is grossly unremarkable in appearance. No lymphadenopathy is\npresent by CT size criteria. The visualized lung apices are clear.", "output": "1. No evidence of acute fracture or malalignment.\n2. Multilevel degenerative changes of the cervical spine superimposed on a\ncongenitally narrow canal." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Multilevel degenerative changes are mild.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "The study is slightly limited by motion artifact. However, within these\nconfines:\nEvidence of multilevel mild degenerative changes with intervertebral disc\nnarrowing at C5-C6 and C7-T1 vertebral levels. Minimal retrolisthesis seen at\nthe C5-C6 vertebrae along with disc osteophyte complexes causing mild\nindentation of thecal sac. Alignment is maintained.\n\n No fractures are identified. There is no evidence of gross spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm.\n\nThis exam is not technically optimized for the study of intracranial contents,\nhowever, the known left temporal intraparenchymal hemorrhages are\nredemonstrated.", "output": "1. Evidence of multilevel mild degenerative changes.\n2. No acute fractures are identified." }, { "input": "The examination is slightly motion degraded. Alignment is normal.No definite\nfracture is identified. Multilevel degenerative changes cervical spine. Disc\nosteophyte complex at C5-C6 level contributes to mild-to-moderate central\ncanal narrowing. Multilevel mild-to-moderate foraminal narrowing. There is\nno prevertebral soft tissue swelling.\n\nAppearance of the left oropharynx with asymmetric mild fullness, may be\nsecondary to patient position, and opposition of the base of tongue and\npalatine tonsil, direct visualization recommended to exclude underlying\nneoplasm pre", "output": "-No definite acute fracture identified.\n-Fullness left oropharynx may be secondary to patient position, direct\nvisualization recommended to exclude underlying neoplasm.\n\nNOTIFICATION: The findings were communicated with the ED QA nurses via mail\nby ___, M.D. At 10:13 am, 5 minutes after discovery of the\nfindings." }, { "input": "The patient is status post posterior spinal fusion of L4-L5 and L5-S1. The\nmild levoscoliosis of the lumbar spine is unchanged. The 3 mm left lateral\nlisthesis and 3 mm retrolisthesis of L4 on L5 are unchanged. No fractures are\nidentified. The height of the vertebral bodies are maintained. The extensive\nsclerosis and subchondral cystic formation at the endplates of L4-L5 are\nunchanged. Vacuum disc phenomena is noted at L3-L4 and L4-L5. The L4-L5\nintervertebral disc is moderately narrowed. A sclerotic focus in the left\nsacrum measures 6 mm and likely represents a bone island. The paraspinal soft\ntissues are normal.\n\nAt T12-L1, there is no disc herniation, spinal canal, or neural foraminal\nstenosis, unchanged from prior.\n\nAt L1-L2, there are large, bilateral, bulky facet osteophytes without disc\nherniation, spinal canal, or neural foraminal stenosis, unchanged from prior.\n\nAt L2-L3, there are large, bilateral, bulky facet osteophytes without disc\nherniation, spinal canal, or neural foraminal stenosis, unchanged from prior.\n\nAt L3-L4, there is minimal disc bulge, ligamentum flavum thickening, and\nlarge, bulky bilateral facet osteophytes without spinal canal or neural\nforaminal stenosis, unchanged from prior.\n\nAt L4-L5, disc bulge with superimposed right neural foraminal disc protrusion,\nligamentum flavum thickening, and large, bilateral bulky facet osteophytes\ncause mild spinal canal, mild left neural foraminal, and moderate right neural\nforaminal stenosis, unchanged from prior. The synovial cyst is seen within\nthe left spinal canal on the prior MRI is not well visualized on this\nexamination.\n\nAt L5-S1, there is central disc protrusion and bilateral bulky facet\nosteophytes without spinal canal or neural foraminal stenosis, unchanged from\nprior.\n\nThe left kidney contains multiple exophytic cysts. A nonobstructing calculus\nin the right upper pole of the kidney measures 2 mm. The patient is status\npostcholecystectomy.", "output": "Unchanged postsurgical and multilevel degenerative changes of the lumbar\nspine, most advanced at L4-5, where there is mild spinal canal, mild left\nneural foraminal, and moderate right neural foraminal stenosis." }, { "input": "Overlying surgical hardware streak artifact limits examination. Limited\nintraoperative CT imaging demonstrates multiple thoracic transpedicular screws\nwith associated postsurgical changes. Additionally, multiple transpedicular\nscrews are noted in the lower lumbar vertebral bodies, with associated\npostsurgical changes. Bilateral iliosacral screws with associated\npostsurgical changes are also present.\n\nLimited imaging of the abdomen suggests multiple renal lesions that are\nnonspecific and cholecystectomy postsurgical changes.", "output": "1. Surgical hardware streak artifact substantially limits examination.\n2. Limited intraoperative imaging for the purposes of thoracic, lumbosacral\nand iliosacral fusion as described.\n3. Limited imaging of the abdomen suggests nonspecific right renal lesions,\nwhich may represent cysts, however other etiologies cannot be excluded on the\nbasis examination. If clinically indicated, consider dedicated renal\nultrasound for further evaluation.\n4. Postsurgical changes related to prior cholecystectomy." }, { "input": "Alignment is normal. No acute fractures are identified.Multilevel moderate\ndegenerative changes are seen, most extensive at C5-6 and C6-7 and notable for\nposterior osteophytes and uncovertebral hypertrophy contributing to mild to\nmoderate spinal canal and mild neural foraminal stenosis..There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. There is mild\ncalcification of the right common carotid bifurcation.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Multilevel moderate degenerative changes, most prominent at C5-C6 and\nC6-C7." }, { "input": "The patient is status post L4 laminectomy with postoperative appearance with\nair within the epidural space and within the subcutaneous tissues and edema\nand fluid within the subcutaneous tissues. No radiopaque catheter is\nidentified within the epidural space. Pneumocephalus along the epidural space\nis identified, extending to the visualized lower thoracic levels. Small\nosseous fragments are seen in the surgical bed. Alignment is normal.There\nremains a residual disc bulge at L4-L5, with unchanged moderate left and mild\nright neural foraminal narrowing.\n\nA 2 cm left renal cysts is unchanged.", "output": "1. Postoperative appearance status post L4 laminectomy. No radiopaque\ncatheter identified within the epidural space.\n2. Additional findings as described above." }, { "input": "Alignment is normal. No fractures are identified. Mild anterior prominence\nof the intervertebral disc space at the level of C6-7 is presumed to be\ndegenerative in nature. Multilevel degenerative changes are most severe at\nC4-5, and C5-6, were there is notable disc height loss.There is no\nprevertebral edema.\n\nThe thyroid is unremarkable. Mild pleural parenchymal scarring is seen at the\nbilateral lung apices. Left cerebellar hemorrhage is better assessed on head\nCT performed concurrently. Gas in the left internal jugular vein is likely\nthe result of recent intravenous access. Carotid artery calcifications are\nseen bilaterally.", "output": "1. No evidence of fracture or malalignment.\n2. Left cerebellar hemorrhage is better evaluated on head CT performed\nconcurrently." }, { "input": "There is no acute fracture or traumatic malalignment of the cervical spine. \nThere is no prevertebral soft tissue swelling. Degenerative changes are most\nnotable at C6-7 and C7-T1 where there is intervertebral disc height loss,\nposterior osteophytes and disc bulges as well as uncovertebral joint\nhypertrophy resulting in moderate canal and moderate bilateral foraminal\nnarrowing at these levels.\n\nPatient is status post thyroidectomy. Lung apices are clear.", "output": "Degenerative changes without acute fracture or traumatic malalignment of the\ncervical spine." }, { "input": "Mild anterolisthesis of C3 on C4 is new since ___, but likely\ndegenerative in etiology. The C4 on 5 vertebrae are partially fused. No\nacute fracture is seen. The bones are diffusely demineralized. Apparent\npatchy lucencies throughout the cervical spine are likely related to\ndemineralization. There are multilevel degenerative changes, worst and severe\nat the C4-5 level which is partially fused with loss of the intervertebral\ndisc space and marginal osteophytosis. Spinal canal narrowing is worst and\nmild at the C4-5 level due to hypertrophic endplate changes. Neural foraminal\nnarrowing is worst and moderate at the left C4-5 level due to uncovertebral\nand facet hypertrophy. There is no prevertebral edema.\n\nThere is normal variant retropharyngeal course of the bilateral cervical ICAs.\nA hypoattenuating nodule with coarse calcifications in the inferior left\nthyroid lobe measures 1.5 cm (3:54). There are few prominent borderline\nenlarged lymph nodes throughout the cervical spine, worst at the left level\nIIb station. The included lung apices are clear.", "output": "1. No acute fracture. Age-indeterminate, mild anterolisthesis of C3 on C4 is\nnew since ___, but may be degenerative in etiology. If there is\nclinical concern for ligamentous injury, MRI is more sensitive.\n2. 1.5 cm nodule in the inferior left thyroid lobe. Nonurgent thyroid\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S): Thyroid ultrasound." }, { "input": "There is mild anterolisthesis of C4 on C5 most likely degenerative, given\nbackground findings described below. Elsewhere, vertebral bodies are well\naligned. No fractures are identified.There are multilevel degenerative change\nof the cervical spine with loss of intervertebral disc height, uncovertebral\nhypertrophy, and facet arthropathy, most notable at C3-4 through C5-C6. There\nis mild to moderate canal narrowing at C5-6 and moderate to severe left\nforaminal narrowing at C4-5.there is no prevertebral soft tissue\nswelling.Visualized lung apices are unremarkable. There is mild heterogeneity\nof the thyroid gland without nodule large enough to require follow-up.", "output": "No acute fracture cervical spine. Anterolisthesis of C4 on C5 is likely\ndegenerative given background degenerative changes in this region and lack of\nprevertebral soft tissue swelling." }, { "input": "Fracture lucencies of the anterior right C1 arch and left C1 transverse\nprocess are re-identified, slightly less apparent when compared to prior\nexamination, compatible with intraosseous bridging and with very mild bony\ncallus formation along the anterior aspect of the right arch fracture. The\nposition of the fracture fragments are unchanged. Re-identified is a fracture\nof the T1 spinous process, slightly more distracted when compared to the prior\nexamination. No additional fractures are identified. Known right manubrial\nfracture is not within the field of view.\n\nThe cervical alignment is anatomic. The craniocervical junction and anterior\natlantodental interval are within expected limits. Vertebral body heights are\npreserved. Prominent anterior marginal bridging osteophytes are unchanged. \nThere are multilevel degenerative changes, most prominent at C5-C6 where a\ndisc protrusion results in mild spinal canal narrowing.\n\nThe lung apices are not within the field of view of the current study. The\nthyroid gland is heterogeneous demonstrating multiple hypo attenuating nodules\nmeasuring up to 6 mm with mild prominence of the isthmus. There is no\ncervical lymphadenopathy by size criteria. Mild atherosclerotic\ncalcifications of the bilateral carotid bifurcations are unchanged.", "output": "1. Re-identified are fractures through the anterior C1 arch in left C1\ntransverse process with evidence for intra for osseous bridging as well as\nadditional mild bony callus formation overlying the anterior C1 arch fracture.\n2. Minimal increased distraction of a T1 spinous process fracture.\n3. No additional fractures are identified. Known right manubrial fracture is\nnot within the field of view." }, { "input": "There has been progressive healing of the fractures through the right anterior\narch and left lateral mass of C1. The fracture lines are barely visible. The\ndistance between the odontoid process and the left lateral mass of C1 remain\nslightly wider compared to the right. The lateral masses of C1 are well\naligned with the lateral masses of C2 and with the occipital condyles.\n\nThe previously noted comminuted fracture through the base of T1 transverse\nprocess demonstrates a slightly decreased gap between the fracture fragments\nsecondary to new bone formation. However, the fracture fragments remain\nnonunited, now demonstrating sclerotic margins of the main fracture fragment.\n\nNo additional fracture is seen. Alignment from C2-C3 through T1-T2 is normal.\n\nSmall disc protrusions indent the ventral thecal sac at multiple levels, as\nseen previously. Left greater than right facet arthropathy is again noted,\nwith some degree of left neural foraminal narrowing at several levels.\n\nVisualized lung apices are unremarkable. Partially visualized thyroid gland\nis diffusely heterogeneous and nodular, as seen previously. There are\nasymmetric right level 2B, 3 B, and 5 B lymph nodes, similar to the prior\nstudy, not pathologically enlarged but unusual for the patient's age. Right\npalatine tonsilliths are again noted. Mild calcified plaque is again seen at\nbilateral carotid bifurcations and in the intracranial vertebral arteries.", "output": "1. Progressive healing of the fractures through the right anterior arch and\nleft lateral mass of C1. Fracture lines a barely visible. C1-C2 alignment is\nunchanged.\n2. Comminuted fracture through the base of T1 transverse process remains\nnonunited, with decreased gap between the fracture fragments secondary to new\nbone formation and sclerosis along the margins of the main fracture fragments.\n3. Heterogeneous and nodular thyroid gland is again partially visualized.\n4. Asymmetric nonenlarged right cervical lymph nodes are again noted, of\nuncertain clinical significance." }, { "input": "The spinal alignment is maintained. Multilevel degenerative changes are\ndemonstrated in the thoracolumbar spine. There is no severe central canal or\nneural foraminal narrowing. The bones appear diffusely demineralized. There\nis no acute fracture.\nSclerotic focus in the L3 vertebral body is compatible with a bone island. \nOtherwise, no erosions or concerning lesions are identified. There are no\nlarge enhancing collections in the spinal canal.\n\nModerate left, small right pleural effusions are partially imaged.\nThere is a peripancreatic collection superior to the head of the pancreas not\nseen in the previous abdominopelvic CT. This collection measuring 2.7 x 6.8\ncm and displaces and partially compresses the adjacent inferior vena cava. \nAdditional collections in distal body and tail of the pancreas are partially\nimaged.\nAlso image is a slight heterogeneous hyperdense collection in the left renal\nbed measuring 4.0 x 3.2 cm, overall similar in size to the most recent study.\n\nThere is a amount free pelvic fluid.", "output": "1. No evidence of fracture, dislocation, erosion, or enhancing collections in\nthe spine.\n2. New fluid collection superior to the pancreatic head and extending to the\nporta hepatis measuring 6.8 x 2.7 cm.\n3. Additional partially imaged collections in the body and tail of the\npancreas appear similar to prior study." }, { "input": "An acute/subacute 2 column burst fracture of T12 is noted. There is 6 mm bony\nretropulsion into the central spinal canal causing narrowing of the central\nspinal canal at this level. No significant surrounding perivertebral hematoma\nis seen. There is also a sacral fracture at the level of S2 best seen on\nseries 601b image 28 with cortical disruption noted anteriorly. No\nsignificant associated hematoma. Degenerative changes are mild at l4-5 with\nmild loss of disc space and small reciprocal osteophytes. There is mild facet\narthropathy in the lower lumbar spine.\n\nWithin the imaged portion of the abdomen pelvis, note is made of moderate\naortic calcification, gallstones, normal appendix, moderate fecal loading of\nthe colon.", "output": "Acute/subacute fractures involving T12 and S2 detailed above. Given 2 column\ninvolvement, T12 fracture is on stable. Bony retropulsion may impinge upon\nthe spinal cord and if needed, MRI may be performed to further assess.\n\nRECOMMENDATION(S): Pelvis radiograph to assess for additional pelvic\nfractures (in the setting of a sacral fracture)\n\nNOTIFICATION: Findings were discussed with Dr. ___ at 18:20 on date of\nexam." }, { "input": "No evidence of traumatic malalignment. No acute fracture. There is mild\nthickening of the posterior longitudinal ligament which causes mild diffuse\nnarrowing of the vertebral canal. Multilevel mild bilateral neural foraminal\nnarrowing is most pronounced at C3-4. No prevertebral edema.\n\nVisualized lung apices are clear. Thyroid is unremarkable. Degenerative or\npossibly remote posttraumatic changes are noted at the right clavicular head. \nScattered cervical nodes are not enlarged by CT size criteria. Calcified\ntonsilliths are seen in the palatine tonsils.", "output": "No acute fracture or traumatic malalignment. No prevertebral edema." }, { "input": "There is no evidence of traumatic malalignment or acute fracture.. Moderate\nto severe degenerative changes of the cervical spine with large bridging\nosteophyte formation, endplate sclerosis and intervertebral disc height loss. \nThere is no evidence of high-grade spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling.On the sagittal reformats\nslightly indistinct margin of the anterior aspect of C3-4 disc appears to be\nsecondary to incomplete ossification is no prevertebral soft tissue swelling\nis identified in the region.", "output": "1. No evidence of traumatic malalignment or acute fracture.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "No traumatic malalignment is identified.No fractures are identified.Mild\nmultilevel degenerative changes are notable for small anterior osteophyte at\nC6-7. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "No fracture is identified." }, { "input": "There is no acute fracture or malalignment in the cervical spine. At C1 along\nthe left lateral arch there is a sclerotic focus, likely a bone island.\nDiffuse demineralization is noted. Prevertebral soft tissues are normal. Given\npatient's age, there is only minimal degenerative disc disease. Imaged lung\napices are clear. The thyroid gland is unremarkable. Tortuous vessels are\nnoted in the superior mediastinum.\n\nAerosolized fluid is partially visualized in the right sphenoid sinus. The\ninferior left maxillary sinus appears completely opacified. Minimal right\ninferior mastoid air cell opacification is noted. The cervical spine is\ndiffusely demineralized though appears intact. No fracture or malalignment is\nseen. No prevertebral soft tissue swelling. The visualized outline of the\nthecal sac is unremarkable.", "output": "No fracture or malalignment. Partially visualized sinus disease." }, { "input": "Patient is status post C3-C7 laminectomy, right C3-C7 posterior fusion, and\nleft C3-C6 posterior fusion. There is no evidence of hardware failure.\n\nInferior to the C2 spinous process and possibly extending to the C6-C7 level,\nthere is a hypodense fluid collection measuring up to 2.9 x 2.2 cm in the\naxial plane (301:21), which is somewhat nonspecific in appearance and may\nrepresent a postoperative seroma, although CSF leak is also possibility. \nPlease note however that the extent of this fluid collection is not well\nevaluated on CT due to streak artifact and can be better appreciated on\nsame-day MR ___. Soft tissue stranding is also seen within the soft tissue\nstructures of the posterior neck overlying the surgical site and fluid\ncollection, likely post surgical in nature.\n\nAlignment is normal. No fractures are identified. There is no evidence of\ncritical spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.", "output": "1. No evidence of traumatic malalignment or fracture.\n2. Status post C3-7 laminectomy, right C3-7 posterior fusion, and left C3-6\nposterior fusion without evidence of hardware failure.\n3. Hypodense fluid collection in the surgical bed extending from the C2\nspinous process to likely the posterior C6-7 level, which may represent a\npostoperative seroma, although CSF leak is also possibility." }, { "input": "Patient's known AAA vascular graft streak artifact limits examination.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level. Please note that following is convention, the T12\nvertebral body again only demonstrates rudimentary ribs.\n\nThere is levoscoliosis of the lumbar spine. Grossly stable T12 approximately\n30% anterior compression deformity is again seen (see 08:49 current study and\n07:26 on ___ prior thoracic spine CT. Otherwise, vertebral body\nheights are preserved. Multiple Schmorl's nodes are seen throughout the\nvisualized thoracolumbar spine. The visualized osseous structures are\nosteopenic.\n\nThere is loss of intervertebral disc height again noted at multiple levels of\nthe lumbar spine.\n\nL2-3, L3-4, L4-5, and L5-S1 disc bulges with at least mild vertebral canal\nnarrowing are again noted. There is no definite evidence of bony vertebral\ncanal narrowing. Question at least mild bilateral neural foraminal narrowing\nat L2-3 through L5-S1 levels.\n\nFacet joint hypertrophy is noted at multiple levels throughout lumbar spine.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. The right kidney is noted to be atrophic, question\nto be progressed compared to ___ prior exam (see 05:14 on current\nstudy and 2: 18 on prior lumbar spine CT).\n\nApproximately 1.7 cm right renal probable cystic structures noted with average\nHounsfield units of approximately 9 is noted (see 07:28).\n\nNonspecific approximately 9 mm right retroperitoneal nonspecific probable\nlymph node is seen (see 05:32). Atherosclerotic vascular calcifications are\nnoted.", "output": "1. Patient's known AAA vascular graft streak artifact and diffuse osteopenia\nlimits examination.\n2. Please note that patient's known AAA cannot be evaluated on this\nnoncontrast examination. If concern for endoleak, consider dedicated abdomen\nand pelvis CTA.\n3. Chronic approximately 30% T12 anterior compression deformity.\n4. Within limits of study, no definite evidence of acute lumbar spine\nfracture.\n5. Multilevel lumbar spondylosis as described with at least mild vertebral\ncanal and neural foraminal narrowing at L2-3 through L5-S1 secondary to disc\nbulges.\n6. Atrophic right kidney, question do have progressed compared to ___ prior\nexam. Question proximal point cm right renal cyst as described. If\nclinically indicated, consider renal ultrasound for further evaluation.\n7. Approximately 9 mm nonspecific right retroperitoneal probable lymph node." }, { "input": "Alignment is normal.No acute fractures. Moderate to severe multilevel\ndegenerative changes are worse at C5-6.There is mild spinal canal narrowing at\nC5-6 and C6-7 secondary to posterior osteophytes. There is no severe neural\nforaminal stenosis.There is no prevertebral soft tissue swelling.\nPartially imaged maxillary sinuses demonstrate partial opacification of the\nleft maxillary sinus and complete opacification of the right maxillary sinus\nwith hyperdense fluid.\nAn endotracheal tube is partially imaged.", "output": "1. No acute fracture or traumatic malalignment.\n2. Hyperdense opacification of the maxillary sinuses may represent fungal\nsinusitis." }, { "input": "Alignment is normal. No fractures are identified. There is intervertebral\ndisc space narrowing, endplate irregularity, and osteophyte formation at\nmultiple levels of the cervical spine, most severe at C5-C6. Mild multilevel\ncentral canal narrowing is demonstrated, most pronounced at C5-6 and C6-7. \nThere is facet arthropathy at multiple levels of the cervical spine resulting\nin mild to moderate bilateral neural foraminal narrowing, most pronounced at\nC3-C4. There is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. The partially imaged thyroid is unremarkable.", "output": "1. No fracture or malalignment.\n2. Multilevel moderate multilevel degenerative changes of cervical spine." }, { "input": "Bones are diffusely demineralized. Alignment is normal. No fractures are\nidentified. There are extensive multilevel degenerative changes worst about\nthe T10-T11 and T11-12 level where there is moderate loss of intervertebral\ndisc space with vacuum disc phenomenon, marginal osteophytosis, and\nsubchondral sclerosis and cystic change. There is no evidence of large spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.Linear 1.1 cm sclerotic focus in the right posterior fourth rib\n(02:21) likely represents a bone island. Heterotopic calcification is seen\nwithin the C3-4 interspinous space.\n\nThere is suggestion of diffuse, circumferential esophageal wall thickening\nwhich could suggest esophagitis.\n\nThere is a 4 mm subpleural left upper lobe nodule (02:23).\n\nAdditionally, there is mild bronchiectasis in the bilateral bases with\nbronchial wall thickening. Patchy bibasilar opacities likely reflect\natelectasis.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes, severe about the T10-11 and T11-12 levels.\n3. Circumferential esophageal wall thickening could suggest esophagitis.\n4. Mild bibasilar bronchiectasis and bronchial wall thickening could reflect\nfindings of chronic aspiration. Patchy bibasilar opacities likely reflect\natelectasis, although aspiration cannot be excluded in the proper clinical\nsetting.\n5. 4 mm left upper lobe nodule can be followed up with optional CT in 12\nmonths if the patient is high risk.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "Bones are diffusely demineralized with somewhat mottled appearance likely\nattributable to this.\n\nAge indeterminate mild anterolisthesis of C2 on C3 and C3 on C4 is likely\ndegenerative in etiology. No fractures are identified. There are extensive\nmultilevel degenerative changes worst about the C4-5, C5-6, and C6-7 levels\nwith near bone-on-bone joint space narrowing and hypertrophic endplate\nchanges. There is fusion of the bilateral C2-3 facet joints. Spinal canal\nnarrowing is worst and moderate at the C5-6 level due to hypertrophic endplate\nchanges. Neural foraminal narrowing is worst and moderate at the same level\nbilaterally due to uncovertebral hypertrophy. There is no prevertebral soft\ntissue swelling.\n\nVisualized lung apices are clear. The thyroid is unremarkable.", "output": "1. No acute fracture.\n2. Age indeterminate mild anterolisthesis of C2 on C3 and C3 on C4 is likely\ndegenerative in etiology.\n3. Multilevel degenerative changes, as above." }, { "input": "Mild anterolisthesis of C2 on C3, C3 on C4, T1 on T2 is unchanged, and likely\ndegenerative in nature. No acute fracture is seen..There is no prevertebral\nsoft tissue swelling.\n\nModerate degenerative disc disease throughout the cervical spine, most severe\nat C5-6 and C6-7. Small posterior intervertebral osteophytes, but no\nhigh-grade spinal canal stenosis. There is also multilevel moderate neural\nforaminal stenosis due to a combination of uncovertebral and facet\nosteophytes, most severe at C3-4 on left.\n\nMultiple hypodense nodules within the thyroid measuring up to 8 mm. No\ncervical lymphadenopathy. Pleuroparenchymal scarring at the bilateral lung\napices. Azygos fissure is seen in the partially imaged right lung apex.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Mild anterolisthesis of C2 on C3, C3 on C4, and T1 on T2 is unchanged\ncompared to ___, likely degenerative in nature.\n3. Multiple hypodense nodules in the thyroid measuring up to 8 mm, for which\nno specific follow up is recommended per ACR guidelines.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified.\n\nImages at C2-3 and C3-4 appear normal.\nAt C4-5, a midline and right-sided disc protrusion slightly flattens the\nanterior aspect of the spinal cord. The neural foramina appear normal.\nAt C5-6, a tiny midline protrusion slightly indents the thecal sac without\ncontacting the spinal cord. The neural foramina appear normal.\nImages at C6-7, C7-T1 and the included portions of the upper thoracic spine\nreveal no evidence of spinal canal or neural foraminal compromise. There is\nno evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "Mild degenerative disc disease with disc protrusions at C4-5 and C5-6. \nOtherwise normal study." }, { "input": "When compared to the most recent prior ___ cervical spine CT, there\nis no acute fracture or change in alignment. There is no prevertebral soft\ntissue swelling. Multilevel degenerative changes are again noted including\nprominent anterior osteophytosis at C5-C6 and C6-C7 and prominent posterior\nosteophytosis at C5-C6; unchanged from prior.\n\nThere is no severe vertebral canal or neural foraminal narrowing.There is no\nevidence of infection or neoplasm.\n\nThe imaged portion of the thyroid gland and lung apices are unremarkable. \nNormal appearing parotid and submandibular glands.", "output": "1. No acute fracture or change in alignment of the cervical spine.\n2. Multilevel degenerative disc disease; similar to ___ CT cervical\nspine." }, { "input": "There is no acute fracture identified. No abnormal prevertebral soft tissue\nswelling is identified. There is exaggeration of the normal cervical\nlordosis. Severe, multilevel, multifactorial degenerative changes of the\ncervical spine are noted, most significant at the level of C6-C7 with complete\nloss of intervertebral disc height, endplate sclerosis, and osteophytosis. \nThere is no critical spinal canal stenosis identified. A benign-appearing,\nsclerotic focus in the right facet of C4 is noted (60___:24), and likely\nrepresents a bone island.\n\n The visualized lung apices are grossly clear bilaterally. Multiple bilateral\nhypodense lesions are noted throughout the thyroid, measuring up to 1.5 cm in\ndiameter. There is no evidence of pathologic cervical lymphadenopathy.", "output": "1. Severe multilevel degenerative changes of the cervical spine without acute\nfracture.\n2. Multinodular thyroid, with the largest nodule measuring up to 1.5 cm in\nthe right thyroid lobe. Nonurgent thyroid ultrasound could be performed if\nclinically indicated for further evaluation." }, { "input": "No acute fractures are identified.Mild anterolisthesis of C4 on C5 and C5 on\nC6 is noted. There is mild widening of the anterior disc space at C4-C5. \nModerate multilevel degenerative changes are noted throughout the cervical\nspine most prominent at C5 through C7 with subcortical sclerosis, large\nflowing anterior osteophytes and disc space narrowing. Small posterior\nosteophyte and disc protrusion at C3-C4. At C4-C5 large posterior disc bulge\nis seen causing indentation of the thecal sac and moderate canal narrowing. \nAt C5-C6, and C6-C7 disc protrusions and intervertebral osteophytes results in\nmild and moderate spinal canal narrowing respectively. Prominent left greater\nthan right C6-C7 uncovertebral osteophyte results in severe bilateral neural\nforaminal narrowing. Severe bilateral neural foraminal narrowing at C7-T1 is\nalso noted. There is no prevertebral soft tissue swelling.There is biapical\npleural-parenchymal scarring of the visualized lung apices. The thyroid gland\nis unremarkable. There is no cervical lymphadenopathy by size criteria. \nProminent atherosclerotic calcification of the bilateral carotid siphons are\nnoted.", "output": "1. No acute traumatic fracture.\n2. Mild anterolisthesis of C4 on C5 and C5 on C6 is likely degenerative in\nnature, however clinical correlation recommended to assess for focal\ntenderness. MRI, if there no contraindications, would be more sensitive for\nthe detection of ligamentous injury.\n3. Multilevel cervical spondylosis, including a large posterior disc bulge at\nC4-C5 causing indentation of thecal sac and moderate canal narrowing. \nIntervertebral osteophytes at C5-C6 and C6-7 results in mild and moderate\nspinal canal narrowing respectively. Of note MR is more sensitive in the\ndetection of cord injury." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. There is no evidence of spinal canal or neural foraminal\nnarrowing. There is no evidence of infection or neoplasm. A 3 mm nodule is\npresent at the right lung apex. The thyroid gland is unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. 3 mm nodule at the right lung apex. CT is recommend in ___ year according to\n___ society guidelines in a high risk patient." }, { "input": "Cervical spine alignment is normal. No acute cervical spine fractures are\nidentified.There are mild degenerative changes of the cervical spine, with\nloss of intervertebral disc height, minimal uncovertebral hypertrophy as well\nas facet arthropathy. These findings are most severe at C5-6.there is no\nprevertebral soft tissue swelling.Visualized thyroid gland and lung apices are\nunremarkable.", "output": "No acute fracture or traumatic subluxation of the cervical spine." }, { "input": "Limited study due to motion, particularly at the C3-C4 level. Within this\nlimitation:\n\nNo acute fracture or malalignment is identified. The visualized outline of\nthe thecal sac is unremarkable. No prevertebral edema. Minimal loss of disc\nheight and uncovertebral osteophytosis, worst at C3-C4, is consistent with\nmild degenerative change.\n\nThe aerodigestive tract appears patent. Lung apices are clear. Thyroid appears\nnormal.", "output": "1. Limited study due to motion at the C3-C4 level. Please note that fracture\ncannot be definitively excluded at this level.\n2. No definite acute fracture or malalignment of the cervical spine.\n3. Mild multilevel degenerative changes cervical spine, as described above." }, { "input": "There is no significant interval change. There is no traumatic malalignment.\nNo acute fractures are identified. Mild degenerative changes of the cervical\nspine, worst at C3-6 with vertebral body height loss and disc space loss is\nseen. There is moderate narrowing of the spinal canal at multiple levels due\nto disc bulge and uncovertebral hypertrophy, worst at C6-7. Moderate neural\nforaminal narrowing on the right is seen at C4-5 and C5-6. There is no\nprevertebral soft tissue swelling. There is mucosal thickening of the ethmoid\nsinuses and the bilateral maxillary sinuses. The visualized portion of the\nlung apices and the thyroid are unremarkable. Bilateral carotid bulb\ncalcifications are seen.", "output": "1. No acute traumatic malalignment or fracture." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. There is mild\nbiapical pleural and parenchymal scarring, unchanged. Mucosal thickening of\nthe maxillary sinuses is moderate on the right and mild on the left.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "Status post fusion procedure of the posterior elements of C5 and C6 as well as\nthe C6 and C7 vertebral bodies. Associated splaying of the spinous processes\nat C6-7 with subluxation of the C6-C7 facets is unchanged, with progressing\nosseous fusion of the right facets. There has been progression of fusion of\nthe C6 and C7 vertebral bodies. Alignment is unchanged from prior exam.No\nacute fractures are identified.Mild spinal canal narrowing at C3-4 secondary\nto posterior disc bulge. No significant neural foraminal narrowing.There is\nno prevertebral soft tissue swelling.No cervical lymphadenopathy by size\ncriteria. The thyroid is grossly unremarkable. Aerosolized secretions are\nnoted in the upper thoracic trachea. The visualized lungs are clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Aerosolized secretions noted in the upper thoracic trachea.\n3. Additional findings described above." }, { "input": "There has been complete osseous fusion fusion of C5 and C6 posterior elements,\nmediated with bone graft and cerclage wires There also has been ACDF of C6-C7\nwith an intervertebral graft and plate/screws construct. The construct is\npositioned eccentrically in the right aspect of the disc space. There is a\nmild dextroconvex curvature centered at C6-C7 and kyphotic angulation at C6-C7\nwith widening of the posterior disc space and splaying of the spinous\nprocesses of C6 and C7, of unknown chronicity in the absence of comparison\nexams. Furthermore, there is prevertebral edema, most prominent from C3-C4\nthrough C6-C7. There is also minimal retrolisthesis of C3 on C4. There is no\nevidence for a fracture.\n\nThe spinal canal does not appear narrowed from the craniocervical junction\nthrough C6, but evaluation at and below the level of C6-C7 is technically\nlimited by hardware related artifact and artifact from the shoulder girdles.\n\nThere is mild to moderate left neural foraminal narrowing from C2-C3 through\nC4-C5, as well as left greater than right C6-C7 and moderate bilateral C7-T1\nneural foraminal narrowing, by uncovertebral osteophytes.\n\nThere are asymmetric ground-glass opacities in the included apical left upper\nlung. Concurrent portable AP chest radiograph suggests mild pulmonary edema. \nThere are secretions in the trachea just below the thoracic inlet. The\nthyroid gland is grossly unremarkable on noncontrast CT. There is no evidence\nfor cervical lymphadenopathy.", "output": "1. Status post posterior fusion of C5 and C6 and ACDF at C6-C7, without\nevidence for hardware related complications. The C6-C7 metallic construct is\npositioned eccentrically in the right aspect of the disc space.\n2. Prevertebral edema, kyphotic angulation at C6-C7, widening of the posterior\nC6-C7 disc space and widening of the C6-7 interspinous space are concerning\nfor acute ligamentous injury. There are no comparison exams to assess\nchronicity of the kyphotic angulation and disc space/interspinous widening.\n3. No evidence for a fracture.\n4. Asymmetric ground-glass opacities in the included apical left upper lung\nare compatible with pulmonary edema or infection. Concurrent portable AP\nchest radiographs suggest mild pulmonary edema. Please correlate clinically.\n\nRECOMMENDATION(S): MRI to assess for ligamentous injury.\n\nNOTIFICATION: The impression item 2 and the recommendation above were\ndiscussed with ___, M.D. by ___, M.D. on the telephone on\n___ at 4:35 ___, 5 minutes after discovery of the findings. Preliminary\nreport overnight by the radiology resident Dr. ___ stated \"Status post\nfixation of C5, C6 and C7 as described above without evidence of acute\nfracture or traumatic subluxation.\"" }, { "input": "There is no evidence of fracture, malalignment, or prevertebral soft tissue\nswelling. The vertebral body heights and disc spaces are maintained. There\nare mild degenerative changes with a small disc bulge at C4-C5 which indents\nthe thecal sac.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or malalignment." }, { "input": "There is no evidence of fracture or traumatic malalignment. Chronic appearing\nossification within the left aspect of the spinal canal at the level of C3-4. \nMultilevel degenerative changes of the cervical spine most prominent the level\nof C4-5 with posterior osteophyte formation, endplate sclerosis and\nintervertebral disc height loss. Diffuse osseous demineralization. There is\nno evidence of high-grade spinal canal or neural foraminal stenosis. There is\nno prevertebral soft tissue swelling.4.5 x 4.3 cm right thyroid nodule..", "output": "1. No evidence of traumatic fracture or malalignment.\n2. Moderate to severe multilevel degenerative changes of the cervical spine\nmost pronounced at C4-5 level where moderate-to-severe spinal stenosis is seen\ndue to posterior osteophytes..\n3. 4.5 x 4.3 cm right thyroid nodule. Thyroid ultrasound is recommended for\nfurther evaluation.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "There is a congenital non fusion defect in the posterior arch of C1. There is\nno evidence for an acute fracture. There is a chronic, partially healed\nfracture of the distal T1 spinous process with callus formation. There is\nmild reversal of cervical lordosis. There is minimal anterolisthesis of C7 on\nT1. There is no evidence for prevertebral edema. Disc protrusions and\nendplate osteophytes indent the ventral thecal sac at multiple levels with up\nto moderate spinal canal stenosis at C5-C6. There is multilevel neural\nforaminal narrowing by uncovertebral and facet osteophytes.\n\nThe thyroid and included lung apices are unremarkable. Concurrent head CT is\nreported separately.", "output": "1. No evidence for an acute cervical spine fracture.\n2. Chronic, partially healed fracture of the distal T1 spinous process.\n3. Minimal anterolisthesis of C7 on T1, almost certainly degenerative, though\nthere are no comparison exams to confirm chronicity.\n4. Multilevel degenerative disease with up to moderate spinal canal stenosis." }, { "input": "Multilevel degenerative changes throughout the cervical spine predominating\ninvolving C5 through T1 with multilevel disc space narrowing, subchondral\nsclerosis, and osteophyte formation. Mild anterolisthesis of C6 on T1 and mild\nlateral and anteriorolisthesis of C7 on T1 is noted. There is mild rightward\ncurvature of the cervical spine. No acute fracture is seen.\n\nA 1.5 x 1.4 cm (02:57) nodule is seen posterior to the esophagus and appears\nto be extending off of the left lobe of the thyroid. An additional 0.8 x 0.7\ncm (02:58) left thyroid lobe nodule is noted. Mild mucosal thickening of the\nethmoidal air cells and sphenoid sinus is noted. Additional visualized\nparanasal sinuses, mastoid air cells and middle ear cavities are clear. \nCalcification of cavernous portions of bilateral carotid arteries are noted.", "output": "1. No acute fracture.\n2. Mild anterolisthesis of C6 on T1 and mild lateral and anteriorolisthesis\nof C7 on T1 is a likely chronic in nature, although there are no priors to\nconfirm chronicity. If clinical concern for ligamentous injury, MRI is more\nsensitive. .\n3. Multilevel degenerative changes throughout the cervical spine\npredominately involving C5 through T1.\n4. Multiple thyroid nodules largest measuring 1.5 cm posterior to the\nesophagus, extending off the left lobe of thyroid. If clinically indicated\nconsider dedicated non urgent thyroid ultrasound for further evaluation." }, { "input": "Alignment is normal. No fractures are identified. T12 vertebral body\nhemangioma again noted.\n\nThere is redemonstration of a severe disc bulge and facet arthropathy at L3-L4\ncausing severe spinal canal stenosis, better detailed on recent MRI.\n\nRight lung base atelectasis noted. Calcification in the right lung base may\nrepresent a calcified granuloma. Moderate atherosclerotic disease noted. \nSubmucosal fat deposition in the colon is seen compatible with history of\nchronic inflammatory bowel disease.", "output": "1. No acute lumbar spine fracture.\n2. Redemonstration of a severe disc bulge and facet arthropathy at L3-L4\ncausing severe spinal canal stenosis. Degree of spinal canal stenosis is\nbetter characterized on MR from ___.\n3. Incidentally noted submucosal fat deposition in the colon, likely sequela\nof patient's known inflammatory bowel disease." }, { "input": "There is loss of cervical lordosis. However, there is no evidence traumatic\nmalalignment. There are degenerative changes in the cervical spine. There is\nC5-C6 disc space narrowing, endplate sclerosis, subchondral cystic changes,\nmost likely degenerative. Infection is unlikely, there is no paravertebral\nedema at this level. C5-6 disc osteophyte complex, uncovertebral and facet\narthropathy cause probably mild-to-moderate central canal narrowing and\nprobably mild bilateral foraminal narrowing. Probably mild central canal and\nbilateral foraminal narrowing at C6-C7 level. There is no prevertebral soft\ntissue swelling. Posterior paraspinal fat pad is preserved.There is a 6 mm\nhypodensity in the right thyroid gland. The lung apices are clear. There is\n0.5 cm focus of sclerosis within central C3 vertebral body, may be benign in\nthe absence of history of malignancy.", "output": "1. No evidence of traumatic malalignment.\n2. Appearance at C5-6 is most consistent with degenerative changes. This area\ncould be evaluated with MRI if clinically indicated." }, { "input": "There is no evidence of acute cervical spine fracture. There is no\nprevertebral soft tissue swelling. There are severe multilevel, multifactorial\ndegenerative changes of the cervical spine most pronounced at the C4-C5 and\nC5-C6 levels with disc space narrowing and endplate sclerosis. Mild\nanterolisthesis of C4 on C5 is unchanged. The thyroid is unremarkable. The\nlung apices are clear.", "output": "1. No evidence of acute cervical spine fracture.\n2. Severe multilevel degenerative changes, not significantly changed from ___." }, { "input": "Alignment is normal. No acute fractures are identified. There is no evidence\nof spinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nImaged thyroid is unremarkable. Lung apices are difficult to assess due to\nrespiratory motion. Incidentally, the parotid gland abscess described in\n___ has resolved.", "output": "No acute cervical spinal fracture or traumatic malalignment." }, { "input": "Alignment is normal. No C-spine fractures are identified. There is a\nnondisplaced left clavicle fracture. There is no evidence of spinal canal\nstenosis.There is no prevertebral soft tissue swelling.", "output": "1. No acute C-spine fracture or traumatic malalignment.\n2. Nondisplaced left clavicle fracture." }, { "input": "Minimal anterolisthesis of C4 on C5, unchanged since ___. No fractures are\nidentified.There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nMultilevel degenerative disc disease spanning C5-6 through C7-T1, similar to\n___. Multilevel small posterior intervertebral osteophytes cause mild\nnarrowing of the spinal canal. No high-grade bony spinal canal stenosis. \nMultilevel mild-to-moderate neural foraminal stenosis due to a combination of\nuncovertebral and facet osteophytes.\n\nThe partially visualized lung apices are within normal limits. There is a\nheterogeneous right thyroid lesion measuring at least 3.4 x 2.8 cm (series 2,\nimage 57), and causing leftward deviation of the trachea, grossly stable in\nsize since ___. No cervical lymphadenopathy.", "output": "1. Minimal anterolisthesis of C4 on C5, stable and likely degenerative in\nnature.\n2. No evidence of traumatic malalignment or fracture.\n3. Multilevel degenerative changes.\n4. Large heterogeneous right thyroid lesion measuring up 3.4 cm, stable since\n___. The ___ College of Radiology guidelines suggest thyroid ultrasound\nfor further evaluation, if not already obtained.\n\nRECOMMENDATION(S): Large heterogeneous right thyroid lesion measuring up 3.4\ncm, stable since ___. The ___ College of Radiology guidelines suggest\nthyroid ultrasound for further evaluation, if not already obtained.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 17:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Mild anterolisthesis of C2 on C3 is likely degenerative in etiology.No\nfractures are identified.There are mild-to-moderate multilevel degenerative\nchanges of the cervical spine, worst at the C3-4 and C5-6 levels, where there\nis mild intervertebral disc height loss and endplate sclerosis. Posterior\nosteophyte and disc bulge at the C3-4 level results in mild spinal canal\nnarrowing. Intervertebral osteophytes at the C5-6 level cause moderate spinal\ncanal narrowing. Uncovertebral and facet hypertrophy at the C5-6 level cause\nmild to moderate bilateral neural foraminal narrowing, worse on the\nright.There is no prevertebral soft tissue swelling.\n\nThere is a peripherally calcified nodule in the left thyroid lobe that\nmeasures up to 0.8 cm and a 4 mm hypodense nodule in the right thyroid gland. \nSeveral prominent cervical lymph nodes are not pathologically enlarged.\nVisualized lung apices are clear.", "output": "1. No acute fracture.\n2. Mild to moderate multilevel degenerative changes of the cervical spine,\nmost pronounced at C5-6. Mild C2 on C3 anterolisthesis is likely degenerative\nin etiology." }, { "input": "Alignment of the cervical spine is normal. No cervical spine fractures are\nidentified. There is no evidence for prevertebral soft tissue swelling. \nSmall central disc protrusions mildly indent the ventral thecal sac from C3-C4\nthrough C5-C6. Evaluation of the spinal canal at C6-C7 and C7-T1 is limited\nby streak artifact from the shoulder girdles. Left C2-C3 neural foramen is\nmildly narrowed by facet osteophytes, and left C6-C7 neural foramen is mildly\nnarrowed by uncovertebral osteophytes.\n\nThere is a nondisplaced fracture of the left posterior first rib at the\ncostovertebral junction, images 601b:12 and 2:50. There is no associated\nosseous remodeling to suggest that this fracture may be chronic.\n\nVisualized lung apices are clear without pneumothorax.\n\nThe thyroid gland is grossly unremarkable. No enlarged cervical lymph nodes\nare seen.", "output": "1. No evidence for cervical spine fracture. Normal cervical alignment.\n2. Nondisplaced fracture of the left posterior first rib at the costovertebral\njunction. No pneumothorax at the visualized left lung apex.\n\nNOTIFICATION: Presence of the left posterior first rib fracture, which was\nnot included in the preliminary report, was emailed to the ED QA nurses list\nby Dr. ___ on ___ at 12:11, 5 min after discovery." }, { "input": "Alignment is normal. No acute fractures are identified. There is no\nsignificant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\nThe imaged lung apices and thyroid appear unremarkable.", "output": "No acute cervical spine fracture or traumatic malalignment." }, { "input": "Slightly displaced fracture of the right occipital condyle. In addition,\nthere are slightly displaced fractures of the left C6 and C7 transverse\nprocesses best appreciated on the coronal images, at C6 on image 35 of series\n601 and at C7 on images 37 and 38 of series 601. Otherwise, alignment is\nnormal. No other fractures are identified.There is no significant canal or\nforaminal narrowing. Extensive subcutaneous air tracking superiorly between\ntissue planes of the left neck. Extensive soft tissue stranding in the\nparaspinal musculature as well as tracking in fat planes along with the\nsubcutaneous/soft tissue emphysema. Multiple surgical clips in the\nsubmandibular region bilaterally. Partially imaged ORIF of mandibular\nfractures.\nThe endotracheal and nasogastric tubes are partially imaged.\n\nNondisplaced fracture of the left posterior 2nd rib.\n\nExtensive opacities in lung apices better seen on dedicated CT of the torso.", "output": "1. Slightly displaced right occipital condyle fracture.\n2. There are also fractures of the left C6 and C7 transverse processes better\nappreciated on coronal reconstructions.\n3. Partially imaged fracture of the left posterior 2nd rib.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 11:50 pm, 2 minutes after\ndiscovery of the findings.\nUpdated findings were discussed with ___ from ICU team, answering pager for\nDr. ___, at 9:48 AM on ___ approximately 10 minutes after discuvery\nof additional findings.\nUpdated Findings also discussed with neurosurgery NP ___ at\n9:56 AM ___." }, { "input": "Alignment is normal. No acute fractures are identified. There is chronic\ndeformity of the C2 spinous process, may be congenital or from chronic\nfracture. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. Few small nodules in the right lung apex may be from\ninfection or aspiration.", "output": "No acute fracture, malalignment, or prevertebral soft tissue edema.\nFew small nodules in the right lung apex may be infectious or from aspiration." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nThere is a 1 cm hypodense left thyroid nodule. This meets ___ College of\nRadiology size criteria indicating further evaluation with ultrasound for an\nincidental thyroid nodule.", "output": "1. Normal cervical spine CT.\n2. 1 cm hypodense left incidental thyroid nodule. Further evaluation with\nultrasound is recommended.\n\nRECOMMENDATION(S): Ultrasound for evaluation of incidental thyroid nodule\n\nNOTIFICATION: The finding of an incidental left thyroid nodule and\nrecommendation for ultrasound were entered in the Radiology department\ncritical imaging findings reporting system" }, { "input": "There is no acute fracture or traumatic malalignment. There are mild\nmultilevel degenerative changes most pronounced at C5-6. There is no\nprevertebral soft tissue swelling. The lung apices are clear. The thyroid is\nunremarkable. There is no cervical lymphadenopathy by CT size criteria.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Mild anterior and posterior\nosteophytes are centered at C5-6 with mild loss of disc heights. The\nvertebral body heights are preserved.\n\nThere is a small midline disk protrusion at C3-4. This appears too small to\ncontact the spinal cord. The neural foramina appear normal.\n\nThere is a small midline disk protrusion at C4-5 that appears likely to touch\nthe anterior surface of the spinal cord. The neural foramina appear normal.\n\nAt C5-6 intervertebral osteophytes narrow the spinal canal and likely flatten\nthe spinal cord. Uncovertebral osteophytes produce severe bilateral neural\nforaminal narrowing.\n\nAt C6-7, images of the spinal canal are obscured by artifacts from the\nshoulders. There appears to be a broad bulge of the disc that is not likely\nlarge enough to compress the spinal cord. The neural foramina appear normal.\n\nAt C7-T1 and the included portions of the upper thoracic spine there is no\nspinal canal or neural foraminal narrowing.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. The thyroid appears somewhat heterogeneous with a 0.4\ncm nodule in the right lobe. The bilateral lung apices are unremarkable. The\npatient is intubated. An enteric tube is noted.", "output": "1. No fracture or traumatic malalignment.\n2. Mild degenerative changes centered at C5-6." }, { "input": "The study is limited by patient motion and dental amalgam streak artifact.\n\nSequela of left temporal bone, occipital bone fracture, better seen on ___ CT scan. Previously seen mastoid opacification has nearly\nresolved.\nNo cervical spine fracture. No prevertebral edema. Multilevel degenerative\nchanges, disc space narrowing, disc osteophyte complexes, similar compared to\nprior. There is multilevel moderate to severe central canal narrowing, most\nprominent at C5-C6, C6-C7 levels.. C6-C7 level there is broad-based central\ndisc protrusion, similar to prior. Multilevel moderate to severe foraminal\nnarrowing. Benign hemangioma C5, C6 vertebral bodies.\n\n There is no evidence of infection or neoplasm. Partial opacification left\nmastoids.\n\nSignificant narrowing of the subglottic trachea, may be related to prior\ntracheostomy, or secretions, images are partially degraded. Clinically\ncorrelate, it measures 0.6 cm in AP diameter, new since CT ___.\n\nIncidental note is made of a subcentimeter hypodense nodule within the right\nthyroid lobe without concerning features.", "output": "1. No evidence of cervical spine fracture.\n2. Sequela of prior left temporal, occipital bone fracture, better seen on\nprior.\n3. Subcentimeter thyroid nodule within the right thyroid gland.\n4. Significantly narrowed proximal trachea, may be from prior tracheostomy,\nsecretions. Images through this area are degraded, clinically correlate.\n5. Degenerative changes cervical spine, disc protrusion at C6-C7 level,\nmoderate to severe central canal narrowing C5-C6, C6-C7 level, similar." }, { "input": "The cervical spine alignment is grossly normal. Vertebral body heights are\ngrossly maintained. No acute cervical spine fractures are identified.\n\nMild multilevel degenerative changes are worst and more moderate at the C5-6\nlevel where there is pronounced intervertebral disc space loss and posterior\nendplate osteophytosis. Mild spinal canal narrowing without significant\nspinal cord mass effect is worst at the C5-6 level due to this osteophytosis. \nModerate bilateral neural foraminal narrowing is seen at the same level due to\nuncovertebral hypertrophy. Focal areas of low attenuation at C5 level towards\nthe right are consistent with hemangioma, focal sclerotic density with brushed\nborders within the C6 vertebral likely represents a benign bone island. There\nis no evidence of infection or neoplasm.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Multilevel degenerative changes worst at the C5-6 level causing mild spinal\ncanal and moderate bilateral neural foraminal narrowing." }, { "input": "There is no acute fracture or traumatic malalignment in the cervical spine.\nThe visualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. Mild dependent atelectasis is\nseen in the left lung. Thyroid gland appears normal.", "output": "No acute fracture or traumatic malalignment." }, { "input": "No definite evidence of acute cervical spine fracture. Multilevel\ndegenerative changes of the cervical spine are extensive. The left curvature\nof the cervical spine is moderate. Anterolisthesis of C3 on C4 is moderate,\nlikely degenerative. Anterolisthesis of C4 on C5 is mild. Anterolisthesis of\nC7 on T1 is mild. Degenerative changes are most pronounced C3-C4 and C5-C6\nwith significant loss of intervertebral disc height, endplate sclerosis,\nsubchondral cysts, and anterior posterior osteophytes. There is also moderate\nfacet joint hypertrophy.\n\nA disc bulge and posterior osteophytes at C5-C6 indents the anterior spinal\ncanal and probably cause narrowing, incompletely evaluated on this exam. \nRight neural foraminal narrowing at C3-C4 is severe. Other levels of neural\nforaminal narrowing throughout the cervical spine are less pronounced.\n\nExpansion of the C5 and C6 right transverse foramina (series 602b, image 29;\nseries 2, image 47, 44) and C6-C7 right neural foramina is thought to be\nsecondary to a chronic process given appearance of the bone. The differential\nincludes nerve sheath tumor, although the location is atypical, and less\nlikely, vascular abnormality such as aneurysm which cannot be excluded.\n\nNo prevertebral soft tissue swelling. The bones are diffusely demineralized. \nAtherosclerotic calcifications noted at the carotid bulbs bilaterally.", "output": "1. No definite evidence for acute cervical spine fracture.\n2. Severe multi-level degenerative changes as above, most pronounced at C3-C4\nand C5-C6 with multiple levels of spondylolisthesis that are thought to be\ndegenerative.\n3. Spinal canal narrowing at C5-C6 from disc bulge and posterior osteophytes.\n4. Severe C3-C4 right neural foraminal narrowing.\n5. Expansion of the right C5-C6 transverse foramen now C6-C7 right neural\nforamina appears chronic for which the etiology includes nerve sheath tumor,\nwith atypical location, and less likely a vascular abnormality such as\naneurysm. As clinically indicated, further evaluation with MRI could be\nperformed.\n\nRECOMMENDATION(S): 1. If there is clinical concern for ligamentous injury or\nneurologic symptoms suggesting spinal cord, MRI could be performed to further\nevaluate.\n2. As clinically indicated, further evaluation with MRI could be performed to\nevaluate for nerve sheath tumor and/or vertebral artery abnormality/aneurysm\nas above." }, { "input": "There is mild anterolisthesis of C3 on C4 and C4 on C5. Multilevel\ndegenerative changes are seen, with significant intervertebral disc space\nheight loss at C5-C6 and C6-C7. Disc osteophyte complexes at these levels\nmildly narrow the spinal canal. No definite acute fracture is identified. \nThere is no prevertebral tissue abnormality, though evaluation of the upper\ncervical spine is somewhat limited from streak artifact from dental amalgam. \nThere is no evidence of infection or neoplasm.", "output": "Multilevel degenerative changes without acute fracture." }, { "input": "There is exaggerated cervical lordosis, unchanged from prior examinations. \nThe previously seen fracture extending through the right aspect of the\nanterior C1 arch demonstrates interval healing since the prior outside CT from\n___ (02:27, 601b:23). There is no change in overall alignment\nof fractured elements compared to the prior study. No large epidural hematoma\nor significant prevertebral soft tissue swelling is identified. No new\ncervical spinal fractures are present. There is mild height loss of the T2\nvertebral body, compression deformity of the inferior endplate with associated\nsclerosis which is new since prior.\n\nMild multilevel bilateral facet arthropathy is present. The bones are\ndiffusely demineralized, as before. The partially visualized lung apices are\ngrossly clear. There is no lymphadenopathy. Dense atherosclerotic\ncalcifications are noted in the aortic arch in at the origins of the great\nvessels. The thyroid gland is small, but unremarkable in this age group. \nMild mucosal thickening is present in the sphenoid sinuses.", "output": "1. Interval healing of known nondisplaced fracture through the right anterior\narch of C1.\n2. Mild interval height loss of the T2 vertebral body with sclerosis at the\ninferior endplate suggesting interval compression deformity." }, { "input": "For the purposes of spinal numbering, the lowest rib-bearing vertebral body is\ndesignated as T12. Using this numbering schema, the T1 vertebral body and\nsuperior endplate of T2 are not imaged.\n\nSevere thoracic kyphotic curvature is unchanged compared to prior\nexaminations. Multiple wedge compression deformities in the thoracic spine\nare again noted, most severe at the T9 level, where there is heterogeneous\nsclerosis throughout the vertebral body, unchanged. There is no retropulsion\nof fracture fragments or interval height loss since the prior CT torso from ___. No associated soft tissue mass or prevertebral soft tissue\nswelling is identified. Other vertebral compression deformities at the T3,\nT5- 8, and T10 vertebral bodies are also unchanged. The bones are diffusely\ndemineralized.\n\nA large hiatal hernia is present, with the majority of the stomach within the\nintrathoracic cavity. Small bilateral pleural effusions with adjacent\natelectasis are unchanged. A 4.0 x 3.4 cm hypodense hepatic segment V mass is\nagain noted (3:90), previously described as a hemangioma on the prior\ncontrast-enhanced examination. Dense atherosclerotic calcifications are noted\nthroughout the aorta and major branch vessels.", "output": "1. Numerous thoracic vertebral compression deformities are unchanged since ___, most severe at T9.\n2. No evidence of retropulsion or change in spinal alignment since the prior\nexamination.\n3. Large hiatal hernia.\n4. Small bilateral pleural effusions with adjacent atelectasis, unchanged.\n5. Previously characterized hemangioma in hepatic segment V." }, { "input": "Alignment is normal. No fractures are identified.Mild to moderate, multilevel\ndegenerative changes of the lumbar spine are noted, most prominent at L3-L4\nwith a posterior disc bulge which moderately narrows the spinal canal and\ncontacts the thecal sac. There is no critical canal narrowing.There is no\nprevertebral soft tissue swelling.\n\nLimited evaluation of the intra-abdominal contents demonstrates extensive\natherosclerotic and chronic pancreatic calcifications.", "output": "Moderate multilevel degenerative changes of the lumbar spine without evidence\nfor acute fracture or traumatic subluxation." }, { "input": "Alignment is normal. No fractures are identified. Grossly stable\nmild-to-moderate multilevel degenerative changes, including loss of\nintervertebral disc height, endplate sclerosis and Schmorl's nodes, are noted.\nThere is posterior disc bulge at C4-5 and C5-6 resulting in at least mild\nspinal canal narrowing, grossly unchanged.There is no prevertebral soft tissue\nswelling.\n\nSevere centrilobular and paraseptal emphysematous changes with bullae are seen\nin the lung apices. Atherosclerotic vascular calcifications are seen in\nbilateral carotid bifurcations. 9 x 7 mm C3-4 level dorsal soft tissue\nprobable sebaceous cyst is noted (see 3:31), with additional smaller left\ndorsal mid C4 soft tissue probable cysts also present (see 3:34). Scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Grossly stable multilevel cervical degenerative changes as described, most\npronounced at C4-5 and C5-6, where there is at least mild spinal canal\nnarrowing. If clinically indicated, consider cervical spine MRI for further\nevaluation.\n3. Limited imaging of lungs demonstrate severe centrilobular and paraseptal\nemphysematous changes with bulla.\n4. Multiple dorsal cervical soft tissue probable sebaceous cysts." }, { "input": "Minimal retrolisthesis of C3 on C4 and C5 on C6 appears similar to prior and\nlikely degenerative in etiology. Otherwise, alignment is unchanged.No\nfractures are identified. Multilevel moderate degenerative changes of the\ncervical spine, including intervertebral disc height narrowing and anterior\nand posterior osteophyte formation, is most prominent at C4-C6. Spinal canal\nstenosis due to disc bulging is most prominent at C3-C4 where it is mild, and\nat C4-C5 where it is moderate in degree. Mild left C4-C5 neural foraminal\nnarrowing due to the disc bulge is also noted. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. \nAtherosclerotic calcifications of the bilateral carotid arteries is\nre-demonstrated.\n\nSevere bilateral, apical bullous emphysema, most prominent in the right apex,\nis similar to prior. Thyroid gland appears slightly heterogeneous without\nconcerning nodule.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Moderate cervical spondylosis. Moderate spinal canal narrowing at C4-C5\ndue to large disc bulge with associated left C4-5 neural foraminal narrowing." }, { "input": "Alignment is unchanged with similar minimal C3 on C4 and C5 on C6\nretrolisthesis.No fractures are identified. There is no evidence of critical\nspinal canal or neural foraminal stenosis. Moderate multilevel degenerative\nchanges with intervertebral disc height narrowing, endplate irregularity, and\nanterior and posterior osteophyte formation are re-demonstrated. Posterior\ndisc bulges at C4-C5, C5-C6, and C6-C7 cause mild to moderate spinal canal\nstenosis, unchanged. Mild neural foraminal narrowing bilaterally at C5-6 is\ndemonstrated due to uncovertebral spurring. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Severe bolus\nemphysema within the right upper lobe is demonstrated with postsurgical\nchanges.", "output": "1. No acute fracture or change in alignment of the cervical spine.\n2. Moderate multilevel degenerative changes.\n3. Severe biapical emphysema." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis.Moderate multilevel degenerative\nchanges are most pronounced from C4-5 through C6-7 with intervertebral disc\nspace narrowing, endplate irregularity, and anterior and posterior osteophyte\nformation. Multilevel moderate central canal stenosis is most pronounced from\nC3-C4, C4-C5, and C5-C6 due to the presence of posterior disc bulges. Mild\nbilateral neural foraminal narrowing is most pronounced at C5-6 due to\nuncovertebral spurring.There is no evidence of infection or neoplasm. No\nprevertebral soft tissue swelling. Dense atherosclerotic calcifications of\nthe carotid bifurcations are noted.\n\nBullous changes are seen within the right lung apex with severe centrilobular\nemphysema. Visualized thyroid gland is unremarkable. Visualized left\ninferior mastoid air cells are partly opacified.", "output": "1. No acute fracture or malalignment.\n2. Moderate multilevel spondylosis with moderate central canal narrowing at\nC3-C4, C4-C5, and C5-C6, unchanged.\n3. Severe emphysema within the imaged lung apices." }, { "input": "Alignment is normal. No fractures are identified. There are moderate\nmultilevel degenerative changes of the cervical spine, most severe at C5-C6. \nFacet and uncovertebral osteophytes result in multilevel bilateral neural\nforaminal narrowing, most severe at C5-C6. Dense atherosclerotic\ncalcifications of the carotid bifurcations are again noted. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Severe emphysema is noted in the bilateral lung apices.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C5-6 and notable for uncovertebral\nhypertrophy and facet hypertrophy contributing to mild bilateral neural\nforaminal narrowing at this level.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Severe emphysema is again noted at the lung\napices.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Alignment is normal. No acute fracture or traumatic dislocation. \nDegenerative changes notable for intervertebral disc height loss, posterior\nosteophytes and uncovertebral joint hypertrophy. In combination with disc\nbulges and thickening of the ligamentum flavum there is moderate canal\nnarrowing at C3-4 and C4-5.There is no critical canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nThe visualized portion of the lung apices contain large bulla and emphysema. \nDense atherosclerotic calcifications noted at the carotid bulbs bilaterally.", "output": "No acute fracture or subluxation." }, { "input": "There is no evidence of fracture or subluxation..At C3-4, bulging of the disc\nand thickening of the ligamentum flavum produces moderate narrowing of the\nspinal canal and slight deformity of the spinal cord. Facet osteophytes\nmildly narrow the left neural foramen.\nAt C4-5, a disc bulge narrows the spinal canal and likely flattens the\nanterior surface of the spinal cord. There is mild bilateral neural foraminal\nnarrowing.\nAt C5-6, bulging of the disc encroaches on the spinal canal and likely\nflattens the anterior surface of the spinal cord. There is moderate left and\nmild right neural foraminal narrowing.\nAt C6-7, C7-T1 and the included portions of the upper thoracic spine there is\nno spinal canal or neural foraminal compromise. There is no prevertebral soft\ntissue swelling.\nThere is minimal bilateral opacification of the mastoid air cells. There are\nprominent emphysematous changes at the pulmonary apex bilaterally. Visualized\nlung apices are unremarkable.", "output": "1. No evidence of fracture or subluxation.\n2. Degenerative disease with spinal canal and neural foraminal narrowing.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):___-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "Alignment is normal. No fractures are identified.Moderate multilevel\ndegenerative changes are again demonstrated with disc space narrowing,\nendplate osteophyte formation, and endplate sclerosis most notable from C4-C5\nthrough C6-C7. Again, posterior disc bulges from C3-C4 through C5-C6 result\nin moderate spinal canal narrowing. There is no high-grade neural foraminal\nnarrowing.There is no prevertebral soft tissue swelling.\n\nVisualized thyroid appears unremarkable. Visualized bilateral lung apices\nagain demonstrate severe upper lobe paraseptal and centrilobular emphysema. \nSevere atherosclerotic calcifications of bilateral internal carotid arteries\nat the level of the bifurcations again noted.", "output": "1. No evidence of acute fracture or prevertebral edema." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges of the cervical spine are essentially unchanged compared to ___, including multilevel loss of intervertebral disc space, and multiple\nposterior disc bulges causing up to mild spinal canal narrowing most prominent\nat C4-5 and C5-6. No high-grade neural foraminal narrowing.There is no\nprevertebral soft tissue swelling.\n\nSevere emphysematous changes are noted at the lung apices, including bullae at\nthe right lung apex. There are dense calcifications at both carotid\nbifurcations. Neck soft tissues are otherwise unremarkable.", "output": "No acute fracture or malalignment. Degenerative changes as stated above. \nDense carotid bowl calcifications. Severe emphysema at the imaged apices." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\ncritical spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.\n\nSevere emphysematous changes are again noted at the lung apices, including a\nlarge bulla at the right lung apex. Additionally, dense atherosclerotic\ncalcifications are noted at the bilateral common carotid bifurcations.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Dense atherosclerotic calcifications noted at the bilateral carotid\nbifurcations.\n3. Severe emphysematous changes noted at the bilateral lung apices." }, { "input": "Grossly stable minimal approximately 1 mm C3 and C4 retrolisthesis is present,\nlikely degenerative. Vertebral body heights are preserved. The visualized\nosseous structures are osteopenic. There is no prevertebral edema. Within\nlimits of study, no definite acute cervical spine fractures are identified.\n\nThere is grossly stable multilevel degenerative changes most notable at C5-C6\nthrough C6-C7 with loss of disc space, endplate osteophyte formation, endplate\nsclerosis, and uncovertebral hypertrophy. Posterior disc osteophyte complex\nand ligamentum flavum thickening results in moderate spinal canal narrowing at\nC3-C4 through C5-C6.\n\nThe included lung apices demonstrate centrilobular emphysema. Atherosclerotic\nvascular calcifications are noted.", "output": "1. Limited study as described.\n2. Within limits of study, no definite evidence of acute cervical spine\nfracture.\n3. Grossly stable multilevel cervical spondylosis compared to ___\nprior exam as described.\n4. Emphysematous changes as described.\n5. Additional findings as described above." }, { "input": "No acute fracture. Minimal retrolisthesis of C3 on C4 is unchanged. There is\nalso mild retrolisthesis of C5 on C6 also unchanged. No prevertebral edema. \nDegenerative changes are not significantly changed from recent prior performed\n2 days earlier. The imaged portion of the thyroid is unremarkable. The lung\napices notable for severe emphysema. The upper esophagus partially visualized\nappears circumferentially thickened as on prior. Dense carotid calcifications\nare again seen.", "output": "1. No acute cervical fracture or traumatic malalignment.\n2. Circumferential thickening of the upper esophagus, please correlate\nclinically.\n3. Severe emphysema at the imaged lung apices." }, { "input": "Grade 1 retrolisthesis of C3 on C4 and of C5 on C6, unchanged compared to\nprior and likely degenerative. Alignment is otherwise normal. No fractures\nare identified. Similar to prior, there are mild multilevel degenerative\nchanges with intervertebral disc space narrowing, osteophyte formation, and\nendplate sclerosis, most prominent at C5-C6, C6-C7. There is unchanged\nmoderate spinal canal narrowing from C3-C5. There is no neural foraminal\nnarrowing.There is no prevertebral edema.\n\nThe included lung apices are notable for centrilobular predominant\nemphysematous changes.", "output": "No evidence of fracture or subluxation." }, { "input": "Mild retrolisthesis of C3 on C4 is unchanged compared to prior and likely\ndegenerative. Alignment is otherwise anatomic.No fractures are\nidentified.Moderate multilevel degenerative disease is unchanged compared to\nCT C-spine ___, most prominent at C3-C4 which is notable for disc bulge\nand ligamentum flavum thickening resulting in moderate canal narrowing. \nIntervertebral disc height loss with posterior osteophytes and uncovertebral\njoint hypertrophy is most extensive at C4-5 through C6-7. No significant\nneural foraminal narrowing is identified.There is no prevertebral soft tissue\nswelling.\n\nPartially imaged lung apices are notable for emphysematous changes with large\nbullae particularly on the right, unchanged from prior. Extensive\natherosclerotic calcifications noted at the carotid bulbs, right more so than\nleft.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Mild retrolisthesis of C3 on C4 is unchanged compared to prior, likely\ndegenerative. Alignment is otherwise anatomic.No acute fractures are\nidentified.Multilevel degenerative disease of the cervical spine is unchanged\ncompared to prior.There is no prevertebral soft tissue swelling.\n\nExtensive atherosclerotic calcifications of the carotid bulbs right greater\nthan left.", "output": "No acute fracture or traumatic malalignment of the cervical spine.\n\nOf note, this is the patient's ___ cervical spine CT this month, ___." }, { "input": "Minimal retrolisthesis of C3 on C4 is seen and is unchanged. No acute\nfractures are identified. Multilevel degenerative changes are seen along the\ncervical spine including osteophyte formation, intervertebral disc space\nnarrowing, vacuum phenomenon, and facet/uncovertebral arthropathy. There is\nmild to moderate bilateral neural foraminal narrowing at multiple levels. \nThere is no prevertebral edema.\n\nThe thyroid is unremarkable. Biapical emphysematous changes are partially\nimaged.", "output": "1. No evidence of acute cervical fracture or traumatic malalignment.\n2. Multilevel degenerative changes along the cervical spine, as described\nabove." }, { "input": "No fracture or change in alignment with subtle retrolisthesis again seen of C3\nrelative to C4. ___ degenerative changes are unchanged without\ncritical central canal or neural foraminal stenosis. No prevertebral edema.\nHeavy atherosclerotic calcification of the carotid bulbs are noted\nbilaterally. Thyroid appears normal. Partially visualized bullous emphysema\nat the lung apices.", "output": "No evidence of acute cervical fracture or traumatic malalignment. Degenerative\nchanges are unchanged from recent prior without critical neural foraminal or\ncentral canal stenosis." }, { "input": "Alignment is normal. No acute fractures are identified.Moderate degenerative\nchanges of the cervical spine with mild spinal canal narrowing at the C4-5\nlevel. There is no substantial neural foraminal narrowing.There is no\nprevertebral soft tissue swelling. Severe emphysematous changes within the\nbilateral lung apices, right greater than left. The thyroid is unremarkable. \nHeavy carotid bulb calcifications are incidentally noted. On the coronal\nimaging, chronic fracture of the right clavicle is noted.", "output": "No evidence of acute fractures or traumatic malalignment of the cervical\nspine.\n\nChronic fracture of the right clavicle." }, { "input": "Minimal retrolisthesis C3-C4, likely degenerative. No fractures are\nidentified.Degenerative changes cervical spine with multilevel disc space\nnarrowing, disc osteophyte complexes findings are most prominent at C3-C4\nlevel, were there is probably moderate central canal narrowing. Multilevel\nprobably mild-to-moderate foraminal narrowing, most prominent at the left\nC5-C6 foramen. . There is no prevertebral soft tissue swelling.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes" }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling.Multilevel degenerative changes are present with\nprominent osteophytosis, Schmorl's nodes, and disc bulges.\n\nAt L1-2, there is mild bulging of the disc with no encroachment on the spinal\ncanal or neural foramina.\n\nAt L2-3, there is anterior and lateral bulging of the disc with no canal\nencroachment. The neural foramina appear normal.\n\nAt L3-L4, asymmetric disc bulge combines with thickening of the ligamentum\nflavum and bilateral facet osteophytes to produce moderate canal narrowing. \nThere may be compression of the traversing L4 nerve roots bilaterally at this\nlevel. There is a vacuum phenomenon in the intervertebral disc. Effacing the\nthecal sac and mild bilateral neural foraminal narrowing.\n\nAt L4-L5, a broad bulge of the disc combines with thickening of the ligamentum\nflavum to produce mild -moderate spinal canal narrowing. The disc bulge\nextends into the neural foramina bilaterally and displaces the dorsal root\nganglia, greater on the right than left. There is likely compromise of the\ntraversing L5 nerve roots, trapped between the thick ligamentum flavum and the\nbulging disc.\n\nAt L5-S1, there is a bulge of the intervertebral disc without evidence of\nsignificant narrowing of the spinal canal or compression of the nerve roots. \nThere are bilateral facet osteophytes but no evidence of nerve root\ncompression.\n\nAtherosclerotic calcifications in the aorta are moderate. Calcifications with\nin the pancreas are consistent chronic pancreatitis.", "output": "1. No evidence of fracture. Multilevel degenerative changes cause moderate\nvertebral canal narrowing multiple levels." }, { "input": "No evidence of acute fracture is seen. There is no dislocation. Multilevel\ndegenerative changes are seen, similar to prior, worst at C5/C6 where there is\ndisc space narrowing, anterior and posterior osteophytes and disc bulge which\nmild to moderately narrows the central canal at this level. There is also\nmoderate disc bulge at C4/C5, which also moderately narrows the central canal.\nNo prevertebral soft tissue swelling is seen. Coarse calcification of the\ncarotid arteries noted.\nThe thyroid gland is homogeneous. The lung apices demonstrate severe\ncentrilobular and paraseptal emphysematous changes with the paraseptal\nemphysematous/bullous changes more severe on the right as compared to the\nleft.", "output": "No acute fracture of the cervical spine. Multilevel degenerative changes\nagain seen, which cause mild to moderate narrowing at C5/C6 and moderate disc\nbulge causes moderate narrowing at C4/C5.\n\nPartially imaged lung apices demonstrate severe pulmonary emphysematous\nchanges, right greater than left." }, { "input": "Cervical vertebral bodies are maintained in height and alignment. There is\npreservation of the normal cervical lordosis. Prevertebral soft tissues are\nunremarkable. There is no fracture or traumatic subluxation. The facet joint\nalignment is normal. The prevertebral soft tissue thickness is maintained. \nWithin the limitation of CT contrast, no evidence of disc herniation or\nhigh-grade spinal stenosis is seen. The craniocervical junction and alignment\nis normal. Portion of the shunt catheter is seen within the right side of the\nneck.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or malalignment. No spinal stenosis or focal disc herniation\nwithin the contrast resolution of CT." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.The visualized lungs are clear. There is no cervical\nlymphadenopathy by size criteria.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Vertebral body heights are maintained and there is no evidence of cervical\nspine fracture. Multilevel cervical spine degenerative changes are most severe\nat C5-7 with loss of intervertebral disc space height, endplate sclerosis, and\nsmall posterior disc osteophytes. There is no prevertebral soft tissue\nswelling. No lymphadenopathy is present by CT size criteria. Please note\nstreak artifact limits evaluation of thyroid gland. Within limits of study, no\ndefinite focal thyroid lesions identified. Severe right and moderate left\ncentrilobular and paraseptal emphysema. Dense atherosclerotic calcifications\nof the carotid bulb and vertebral arteries. Nonspecific fluid is seen within\nthe visualized portion of bilateral mastoid air cells. Soft tissue densities\nnoted in left external auditory canal, similar in appearance to outside ___ head CT (see series 3 image ___ on outside exam). There is small\nnonspecific aerated fluid along the right lateral wall of the trachea (see\nseries 3 images 67- 70). Question ossification of right stylohyoid ligament\n(see series 602b image (___).", "output": "1. No cervical spine fracture, acute alignment abnormality, or prevertebral\nsoft tissue abnormality.\n2. Extensive atherosclerotic vascular changes as described.\n3. Extensive bilateral emphysematous changes of visualized portion lungs as\ndescribed. Recommend clinical correlation, and correlation with dedicated\nchest imaging.\n4. Nonspecific left external auditory canal soft tissue density, which may\ncerumen or foreign body such as hearing protected device. Recommend clinical\ncorrelation and correlation with direct examination.\n5. Multilevel degenerative changes as described.\n6. Suggested ossification of right stylohyoid ligament. Recommend clinical\ncorrelation." }, { "input": "There is no evidence of acute cervical spine fracture. There is loss of the\nnormal cervical lordosis. There are multilevel degenerative changes in the\ncervical spine including diffuse osteopenia, several prominent osteophytes,\nmore significant at C4-C5 and C5-C6 levels.\n\nUncovertebral hypertrophy at C4-C5 causes moderate left-sided neural foraminal\nnarrowing, there is no evidence of central spinal canal stenosis at this\nlevel.\n\nAt C5-C6, bilateral uncovertebral hypertrophy is more pronounced on the left\ncausing moderate to severe left-sided neural foraminal narrowing.\n\nNo prevertebral soft tissue edema.\nThe left thyroid lobe is asymmetrically enlarged and contains a discrete\nhypodense nodule measuring approximately 9 mm.. There is a probable 5 mm\nnodule in the right apex.", "output": "1. There is no evidence of acute cervical spine fracture.\n2. There is loss of the normal cervical lordosis.\n3. Multilevel, multifactorial degenerative changes throughout cervical spine,\nmore significant at C4-C5 and C5-C6 levels.\n4. Asymmetrically enlarged left thyroid lobe with a discrete 9 mm nodule." }, { "input": "No evidence for acute fracture or malalignment of the cervical spine. \nRedemonstrated loss of the normal cervical lordosis. There is diffuse\nosteopenia. There are moderate degenerative changes, most significant at\nC4-C5 and C5-C6 including disc height loss and osteophyte formation. No\nevidence for prevertebral edema. Mild biapical pleural thickening is seen,\nwithout focal consolidation in the imaged lung apices. Heterogeneous and\nenlarged left lobe of the thyroid is re-demonstrated. Coarse calcification is\nagain seen in the right lobe of the thyroid.", "output": "No acute fracture or malalignment of the cervical spine.\n\nAgain seen heterogeneous and enlarged left lobe of the thyroid and coarse\ncalcification in the right lobe of the thyroid." }, { "input": "Patient is status post laminectomy from C3 through C7 and spinal fusion from\nC2 through T2, with the postsurgical changes partially visualized on this\nexam. Grade 1 anterolisthesis is seen involving C7 on T1. Within the C5\nvertebral body, re-demonstrated known 1.4 cm sclerotic lesion, as described on\nthe prior MRI and concerning for a focal metastatic lesion. Subtle focal area\nof sclerosis is also seen within the T1 vertebral body also similar to the\nprior exam.\n\nIn the region of the prominent known T7 metastases, the bone marrow\ndemonstrates slightly heterogeneous trabeculation, with subtle increased\nsclerosis, also extending into of the bilateral pedicles and spinous process,\nwhich is new compared with CT chest ___. Within the posterior\nepidural space, re-demonstrated is a 3 cm mildly enhancing soft tissue lesion\nresulting in severe spinal canal narrowing, and mass effect on the cord. \nThere is right paraspinal mass at the level low lower T7 vertebral body\nmeasuring 3 cm x 1.5 cm, extending into the adjacent foramen.\n\nPartially visualized is asymmetrically increased sclerosis involving the left\nninth rib, concerning for metastatic infiltration. Sclerotic metastasis\ninvolving T12, L2, L3, L4 vertebral bodies, without evidence of epidural\ncomponent. Postoperative changes L2 laminectomy. L2-L3 vertebral bodies are\nfused, there is mild retrolisthesis of L2 on L3 and there is fusion across\nanterior half of disc space.\n\nThere is no significant spinal canal or neural foraminal narrowing within the\nthoracic spine. For evaluation of the torso, please refer to the dedicated CT\nof the torso performed the same day. Basilar atelectasis. Coronary artery\ncalcifications. Diffuse fatty liver. Extensive atherosclerotic disease and\nvascular calcifications are seen along the thoracic and visualized segments of\nthe abdominal aorta.", "output": "1. Re-demonstrated is a 3 cm partially enhancing epidural, paraspinal\nabnormality, consistent with tumor, at the level of T7, resulting in severe\nspinal canal narrowing and cord compression.\n2. Skeletal metastases." }, { "input": "There is 2 mm of anterolisthesis of C3 over C4 and 3 mm anterolisthesis of C6\nover C7. No fractures are identified. There is endplate sclerotic and\nsubchondral cystic change, intervertebral disc space narrowing, osteophyte\nformation, and facet arthropathy at multiple levels in the cervical spine,\nworse at C4-C5 and C5-C6. There is mild spinal canal narrowing at C3-C4. \nThere is mild right-sided neural foraminal narrowing at C4-C5. There is no\nprevertebral soft tissue thickening. The lung apices are normal.", "output": "1. No evidence of fracture.\n2. Mild anterolisthesis of C3 and C6, likely chronic though clinical\ncorrelation is advised given absence of prior imaging studies to ensure\nstability of this alignment abnormality.\n3. Moderate degenerative changes of the cervical spine as detailed above.\n\nRECOMMENDATION(S): Please correlate for focal pain at C3 and C6 levels given\nminimal anterolisthesis, thought to be chronic." }, { "input": "There is no fracture or evidence for prevertebral edema. Alignment is normal. \nNo fractures are identified. There are small central disc protrusions at C3-4\nand C4-C5 which mildly indent the ventral thecal sac, and a central disc\nprotrusion at C5-C6 which indents the ventral thecal sac and approaches the\nventral spinal cord. There is left greater than right neural foraminal\nnarrowing at C5-6 by uncovertebral osteophytes.\n\nA 4 mm hypodense nodule is noted in the lower pole of the right thyroid lobe.\nThere is minimal pleural/ parenchymal scarring in the visualized upper lungs.", "output": "1. No fracture or subluxation.\n2. Central disc protrusions from C3-4 through C5-6. At C5-6, the disc\nprotrusion approaches the ventral spinal cord, but it is not clear whether it\ncontacts the cord.\n3. 4 mm right thyroid nodule, which may be better assessed by sonography, if\nnot previously performed elsewhere." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Normal study." }, { "input": "Alignment is preserved. No fractures are identified.There is moderate\nmultilevel anterior, posterior, uncovertebral, and facet osteophytosis. A\ncombination of posterior osteophytes and disc bulges or protrusions and\nligamentum flavum thickening result in as much as mild to moderate spinal\ncanal narrowing, worst at C3-C4 and C5-C6. Osteophytes results in mild right\nneural foraminal narrowing at C3-C4, mild left neural foraminal narrowing at\nC5-C6, and mild left neural foraminal narrowing at C6-C7.There is no\nprevertebral soft tissue swelling. There is mild left and moderate right\ncarotid bifurcation calcification. There is mild left V4 segment\ncalcification.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Re-demonstrated are moderate\nmultilevel degenerative changes including loss of intervertebral disc space\nheight, endplate sclerosis, anterior posterior osteophytosis and vacuum\nphenomena. There is mild multilevel canal narrowing due to ligamentum flavum\nhypertrophy and posterior osteophytes, most pronounced at C3-4 and C5-6. \nThere is also mild multilevel neural foraminal narrowing secondary to\nuncovertebral osteophytes and facet hypertrophy, most pronounced at C5-6. \nThere is no evidence of severe spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling.", "output": "1. No acute fracture or traumatic malalignment.\n2. Re-demonstration of moderate multilevel degenerative disease with mild\nmultilevel neural foraminal narrowing and mild canal narrowing, most\npronounced at C5-6." }, { "input": "There is straightening of cervical lordosis. No fractures are identified. \nMultiple sclerotic lesions in the cervical spine and sternum are consistent\nwith patient's history of metastatic prostate cancer. There is no evidence\nof bone spinal canal stenosis. There is no prevertebral soft tissue swelling. \nMultilevel degenerative changes, including loss of intervertebral disc height\nand Schmorl's nodes are noted. Endotracheal tube is partially visualized. \nLimited imaging of the lungs demonstrate small emphysematous changes.", "output": "1. No evidence of fracture.\n2. Multilevel degenerative changes as described.\n3. Numerous sclerotic osseous lesions as described, compatible with patient's\nhistory of known metastatic prostate cancer.\n\n1. Multiple sclerotic bone lesions are consistent with history of metastatic\nprostate cancer." }, { "input": "Alignment is normal. Multilevel degenerative changes are seen in the cervical\nspine worst at C5-C6, with intervertebral disc space narrowing. Posterior\nosteophytosis is noted at this level, which mildly narrows the central canal. \nThere is mild to moderate multilevel bilateral neuroforaminal stenosis. No\ndefinite acute fracture is identified. There is no prevertebral soft tissue\nswelling. Posterior ligamentous calcifications are noted.", "output": "1. No acute fracture identified." }, { "input": "There is no fracture or traumatic subluxation. No abnormal prevertebral soft\ntissue swelling is identified. There is no significant canal or foraminal\nnarrowing.\n\nThe visualized lung apices are grossly clear bilaterally. The thyroid is\nhomogeneous in attenuation. There is no evidence of pathologic cervical\nlymphadenopathy.", "output": "No acute fracture or subluxation of the cervical spine." }, { "input": "Mild anterior widening of the C3/C4 and C4/C5 intervertebral disc spaces is\ngrossly similar compared to prior C-spine CT from ___. Minimal\nanterolisthesis of C4 over C5 is similar to possibly slightly less conspicuous\nas compared to the prior study. No acute fracture is seen. Multilevel\ndegenerative changes include disc space narrowing at C5/C6 and C6/C7, where\nthere are also small anterior and posterior osteophytes. Small amount of\nvacuum phenomenon is seen at C5/C6. Multilevel bilateral facet arthropathy is\nseen. There is no prevertebral soft tissue swelling.The imaged thyroid gland\nis grossly homogeneous. The partially imaged lung apices demonstrate some\napical pleural thickening/scarring.", "output": "No acute fracture or dislocation of the cervical spine. Degenerative changes." }, { "input": "The patient is status post C3 through T1 laminectomies and C5 through C7\ndiscectomies with osseous vertebral body fusion of C5-C7. There is mild\nanterolisthesis of C7 relative to T1, not substantially changed from prior\nstudy dated ___ likely degenerative. There is no traumatic\nmalalignment.No fractures are identified.There are extensive degenerative\nchanges of the cervical spine with vertebral body osteophytosis,\nintervertebral disc space narrowing, and facet hypertrophy, most prominent at\nC4-C5. There is no significant spinal canal narrowing. There is multilevel\nneural foraminal narrowing, most prominent bilaterally at C3-C4 and C4-C5\nwhere it is moderate to severe, and C6-C7 on the left where it is mild. There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThere is a small right apical bleb (3:56). Otherwise, the bilateral lung\napices are clear. There are no suspicious thyroid nodules. There is no\ncervical lymphadenopathy. Moderate atherosclerotic calcifications of the\ncarotid bifurcations.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Multilevel cervical spondylosis with extensive postsurgical changes\nincluding C3 through T1 laminectomies and C5 through C7 osseous vertebral body\nfusion, grossly unchanged from prior MRI dated ___.\n3. Unchanged mild anterolisthesis of C7 relative to T1, unchanged and likely\ndegenerative." }, { "input": "There are five lumbar-type vertebral bodies which are maintained in height. \nThere is grade 1 anterolisthesis of L4 on L5 which is new since ___. There is\nno fracture. No focal osseous abnormality.\n\nAt L3-4, there is mild intervertebral disc height loss with posterior disc\nbulge and ligamentum flavum thickening secondary mild canal narrowing and mild\nbilateral foraminal narrowing.\n\nAt L4-5, there is intervertebral disc height loss, uncovering of the disc with\na superimposed disc bulge and facet joint hypertrophy with ligamentum flavum\nthickening. There is secondary least moderate canal narrowing and moderate\nright and moderate to severe left foraminal narrowing.\n\nIncluded retroperitoneal paraspinal soft tissues are unremarkable.", "output": "1. No fracture. No acute malalignment.\n2. Degenerative changes most notably at L4-5 with grade 1 anterolisthesis, a\ndisc bulge and ligamentum flavum thickening resulting in at least moderate\ncanal narrowing, moderate right and moderate to severe left foraminal\nnarrowing.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):___\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "No acute fracture or malalignment is present. Vertebral body heights and\nintervertebral disc spaces are maintained. No prevertebral soft tissue\nswelling is demonstrated. There are no significant degenerative changes. \nThere is no evidence of spinal canal or neural foraminal stenosis.\n\nVisualized lung apices are clear. Moderate mucosal thickening is seen within\nthe imaged aspects of the maxillary sinuses.", "output": "No acute fracture or malalignment." }, { "input": "There is grade 1 anterolisthesis of C3 on C4. No fractures are\nidentified.Extensive multilevel degenerative changes, worst at C5-6 and C6-7\nwith endplate sclerosis, disc space narrowing, osteophytosis, facet\nhypertrophy and mild vertebral canal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or dislocation. Extensive multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.\n\nThere is intervertebral disc space narrowing, endplate irregularity, and\nanterior and posterior osteophyte formation at C5-C6 and C6-C7. There is\nuncovertebral hypertrophy resulting in mild bilateral neural foraminal\nnarrowing at C6-C7. There is mild spinal canal narrowing at C5-C6 and C6-C7.\n\nThere is no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.", "output": "1. No fracture or malalignment.\n2. Moderate degenerative changes at C5-C6 and C6-C7 resulting in mild spinal\ncanal narrowing at these levels." }, { "input": "Alignment is anatomic.No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.2 punctate nonobstructing nephrolith for vascular\ncalcification are seen in the left renal midpole. Otherwise, visualized\nprevertebral paraspinal soft tissues are unremarkable. The visualized lungs\nare clear.", "output": "No acute fracture or malalignment of the thoracic spine." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nThe partially visualized thyroid gland and lung apices are unremarkable.", "output": "1. No evidence of acute cervical spine fracture or acute malalignment." }, { "input": "There is no acute fracture or malalignment in the cervical spine. \nDegenerative changes are noted most pronounced at the atlanto-dens interval\nwith thickening and calcification of the transverse ligament. Endplate\nspurring is noted in the mid cervical spine with relative preservation of the\ndisc spaces. Lucent lesions in C2 and C6 appear unchanged from prior exams\nlikely representing simple cysts. No prevertebral soft tissue swelling. Imaged\nthyroid gland appears similar to prior with small nodules noted.", "output": "No fracture or malalignment. Degenerative changes as stated." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Nuchal ligament and\nligamentum flavum calcification is noted. Multilevel degenerative disc\ndisease appears most pronounced at C3-4 and C5-6 levels. No evidence of\ncritical central canal stenosis. No significant neural foraminal stenosis. \nNo significant degenerative disease. No prevertebral edema. The\naerodigestive tract appears patent. Lung apices are clear. Thyroid gland\nappears normal.", "output": "No acute fracture or malalignment. Degenerative changes as stated." }, { "input": "Alignment is normal.No acute fracture is identified. There is a chronic left\nL5 pars defect.Mild disc bulge and ligamentum flavum hypertrophy at the L3-4\nlevel results in mild to moderate spinal canal stenosis. Ligamentum flavum\nhypertrophy and disc bulging result in moderate spinal canal stenosis and\nlikely bilateral neural foraminal narrowing, left greater than right, at the\nL4-5 level.There is no prevertebral soft tissue swelling.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "No fracture or dislocation. Alignment is anatomic and no compression\ndeformity is identified. No prevertebral soft tissue abnormality.\n\nNo lymphadenopathy is present by CT size criteria. The thyroid is\nunremarkable. The visualized lung apices are clear.", "output": "No fracture or dislocation." }, { "input": "Alignment is anatomic. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Multilevel mild degenerative changes are noted throughout\nthe cervical spine including anterior posterior osteophytosis, disc space\nnarrowing, and sclerotic endplate changes, most prominent at the C5-6 and C6-7\nlevels. At these levels, there is mild spinal canal narrowing and mild\nbilateral neural foraminal narrowing. Mild pleural-parenchymal scarring is\nnoted at the bilateral lung apices. A bone island is present in the posterior\nT2 to vertebral body (602b:37). There is no cervical lymphadenopathy by size\ncriteria. The visualized thyroid glands are atrophic but otherwise\nunremarkable.", "output": "No acute cervical spine fracture or malalignment." }, { "input": "Cervical alignment is normal. No fractures are identified. No evidence for\nprevertebral soft tissue swelling. Beam hardening artifact limits evaluation\nof the spinal canal below the C4-C5 level. Disc protrusions and endplate\nosteophytes appear to cause moderate spinal canal narrowing at C4-C5 through\nC6-C7. Neural foraminal narrowing by uncovertebral and facet osteophytes is\nalso present at C4-C5 through C6-C7.\n\nThe visualized thyroid is unremarkable. Lung apices appear clear. Concurrent\nhead CT is reported separately.", "output": "1. No evidence for a fracture. Normal alignment.\n2. Lower cervical degenerative disease. Spinal canal narrowing appears\nmoderate from C4-C5 through C6-C7." }, { "input": "Patient is status post total laminectomy of L4 and L5 with fusion of L4\nthrough S1. Grade 1 anterolisthesis of L4 on L5 is stable. There is mild\nscoliosis. Multilevel moderate degenerative changes have progressed since\nprior CT examination with intervertebral disc space loss and posterior\nosteophytosis noted most prominently at the T12-L1 and L1-L2 levels. There is\nalso moderate multilevel facet arthropathy, most severe at the L3-L4 levels. \nNo fractures are identified.There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm.\n\nPostcholecystectomy clips are noted in the right upper quadrant. A tiny\nnonobstructive stone is seen in the left kidney. Multiple small bilateral\nhypodensities in the kidneys are too small to further characterize but\nstatistically reflect cysts. There is moderate to severe atherosclerotic\ndisease throughout visualized portions of the abdominal aorta and its major\nbranches. Electrodes are present in the posterior and inferior lumbar region,\napparently terminating posterior to the S1 level, connected with an electrical\nstimulator device.", "output": "1. Expected postsurgical changes from prior laminectomy of L4 and L5 as well\nas fusion of L4 through S1.\n2. Stable grade 1 anterolisthesis of L4 on L5.\n3. Moderate multilevel degenerative changes progressed since prior CT\nexamination from ___." }, { "input": "There is minimal anterolisthesis of C4 on C5, unchanged from prior exam.No\nacute fractures are identified. Severe multilevel degenerative changes are\nnoted with osteophytosis, intervertebral disc space loss, subcortical cystic\nchanges, facet joint arthropathy, and vacuum phenomena. There is mild\nmultilevel spinal canal narrowing and moderate spinal canal narrowing at C7-T1\nsecondary to disc osteophyte complexes. There is moderate left C3-C4, severe\nright C5-C6, severe left C6-C7 and severe right C7-T1 neural foraminal\nnarrowing. There is no prevertebral soft tissue swelling. The visualized\nlung apices are clear. The thyroid gland is unremarkable. There is no\ncervical lymphadenopathy by size criteria. Atherosclerotic calcification of\nthe bilateral carotid bifurcations are identified.", "output": "1. No acute traumatic fracture or malalignment.\n2. Prominent multilevel degenerative changes as detailed above." }, { "input": "There is no acute fracture or malalignment. There are multiple lucent lesions\nthroughout the cervical vertebrae compatible with metastases. Exact\ncomparison of the lesions is difficult given differences in technique. There\nis evidence of lucent, expansile lesion centered at the right transverse\nprocess of C3 with extension into the adjacent soft tissues. The lesion\nmeasures at least 2.9 x 1.8 cm (03:29) , approximately 2.1 by 1.6 cm on prior.\nSoft tissue density extends to the region of the traversing right vertebral\nartery which cannot be delineated from the mass.\nEnlarged heterogeneous right-sided lymph nodes are seen, specifically a 1.5 cm\nright level 2B lymph node (03:21).", "output": "Multiple lucent lesions throughout the vertebrae compatible with metastases. \nExpansile lytic lesion centered at the right C3 transverse process with\napparent enlargement since prior recent exam. If additional detail is\ndesired, contrast-enhanced exam, preferably by MRI, could be obtained for more\naccurate comparison.\nRight cervical adenopathy compatible with metastatic disease.\nNo fracture or malalignment." }, { "input": "There is an acute compression deformity of C7 vertebral body with disruption\nof the anterior and middle column without bony retropulsion. Loss of\napproximately 40% of the C7 vertebral body height noted. Multilevel\ndegenerative changes are noted most prominent at the C5-C6 level with disc\nspace narrowing and osteophyte formation. No prevertebral soft tissue swelling\nis noted. No definite additional fracture is seen. The thyroid gland is\nwithin normal limits. Biapical lungs are clear.", "output": "C7 compression deformity with 40% loss of vertebral body height, involving\nanterior and middle column, unstable, appears acute.\n\nNOTIFICATION: Findings communicated to the ordering physician, ___, by\nDr. ___ telephone at 9:10 at the time findings were discovered." }, { "input": "There is no evidence of cervical spine fracture. There are moderate to severe\nmultilevel degenerative changes which have minimally progressed from ___ and\nare most pronounced at the C4/5 and C5/6 levels. Mild anterolisthesis of C4/5\nand C7/T1 is stable. There is no prevertebral soft tissue swelling. There\nis no evidence of infection or neoplasm. A 6 mm hypodense left thyroid nodule\nrequires no specific followup. The lung apices are clear.", "output": "1. No evidence of cervical spine fracture.\n2. Moderate to severe degenerative changes which have mildly progressed from\n___." }, { "input": "The patient is status post posterior fusion without laminectomy from C5 to T1.\nThe left C6-7 perched facet at is partly reduced, and there is been removal of\nthe large bony fragment fractured off the right C7 superior articular facet.\nRetropulsion of C7 is improved, with less canal encroachment. Overall,\nalignment is near anatomic. Hardware is intact without sign of hardware\nfailure. There is no evidence of infection. A compression fracture of C7 is\nagain visualized. A significant amount bony grafting material is in place\nposteriorly. No new fractures are visualized. The lung apices are free of\nsuspicious lesions.", "output": "Status post posterior fusion from C5-T1 with resultant near anatomic\nalignment. No signs of hardware failure." }, { "input": "The endotracheal tube terminates in the upper thoracic trachea at T2 and the\nenteric tube courses into the midthoracic esophagus and out of view. There is\npartial opacification of the paranasal sinuses likely due to intubation. \nPatient is not in a collar.\n\nLoss of cervical lordosis, patient is flexed towards the right, alignment\notherwise maintained.\n\nNo fractures are identified.There is minimal early multilevel uncovertebral\nand facet arthrosis, with posterior disc osseous complex, most pronounced at\nC5/C6. No significant narrowing the central canal or neural foramina.\n\nThere is no prevertebral soft tissue swelling. Foci of gas overlying the left\nneck, and both clavicular regions, may relate to recent line attempt\nplacement.\n\nThere are confluent consolidations and ground-glass opacities, some\ncentrilobular, in the partially visualized bilateral upper lungs, with smooth\ninterlobular septal thickening. Evaluation of the thyroid is limited due to\nstreak artifact.", "output": "1. No fracture or malalignment of the cervical spine.\n2. There are infective/inflammatory appearing consolidations. There may be an\nelement of edema given smooth interlobular septal thickening. Differential\nalso includes hemorrhage." }, { "input": "A type 3 odontoid fracture is re-demonstrated, callus formation is noted in\nthe odontoid fracture. Additionally, there are multilevel degeneratives\nchanges. Anteriorolithesis at C4/5, C6/7 is again noted. There is minimal\nretrolisthesis at C5/6, all unchanged.\n\nThe previously seen comminuted fracture involving the right pedicle,\ntransverse process, lamina, superior and inferior articular facet of C6 with\nextension into C5/6 and C6/7 appears with some callus formation.\n\nThere is no evidence of infection or neoplasm.\n\nThe lung apices are clear, the thyroid gland is unremarkable. The patient is\nstatus post CABG. Bilateral atherosclerotic calcification are seen in cervical\narteries.", "output": "1. Type 3 odontoid fracture appears improved with callus formation.\n2. Comminuted fracture involving the right pedicular transverse process,\nlamina, superior and inferior articular facet of C6 with extension C5/6 and\nC6/7 appears improved with some callus formation." }, { "input": "Mandibular fixation hardware is visualized on the scout images. In addition,\nthere is a chronic nonunited fracture at the junction of the right mandibular\ncondyle and ramus (series 602, image 8).\n\nAlignment is normal. No cervical fractures are identified.There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nModerate degenerative disc disease at C5-6 and C6-7. Posterior intervertebral\nosteophytes cause moderate narrowing of the spinal canal at C5-6 and C6-7. \nThere is also moderate neural foraminal stenosis at C5-6 bilaterally, and C6-7\non the left.\n\nNo cervical lymphadenopathy. No thyroid nodules.", "output": "1. No evidence of acute cervical fracture or traumatic malalignment.\n2. Multilevel multifactorial degenerative changes causing moderate spinal\ncanal and neural foraminal stenosis at C5-6 and C6-7.\n3. Chronic nonunited fracture at the junction of the right mandibular condyle\nand ramus." }, { "input": "Alignment is normal.No acute fractures detected.There are anterior and\nposterior osteophytes, most severe at C5-6, C6-7, and C7-T1 with moderate loss\nof disc heights at these same levels. The vertebral body heights are\npreserved. There is mild to moderate spinal canal stenosis at C5-6 and C6-7. \nThere is moderate neural foraminal stenosis bilaterally at C5-6 and on the\nleft at C6-7 due to uncovertebral spurring and facet arthropathy.There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. The thyroid and bilateral lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel moderate degenerative changes of the cervical spine, most severe\nat C5-6 and C6-7." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are noted including intervertebral disc height loss and posterior\nosteophytes most notably at C5-6 and C6-7. There is mild canal narrowing at\nthese levels. Uncovertebral joint hypertrophy contributes to mild foraminal\nnarrowing bilaterally at these levels. There is facet joint hypertrophy with\ndegenerative changes on the left particularly at C2-3 and C3-4 which has\nsignificantly progressed since prior.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Degenerative changes without cervical spine fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges of the cervical spine, with loss of intervertebral disc space and\nosteophytosis that are most prominent at the C5-C6 and C6-C7 levels. Spinal\ncanal narrowing is mild-to-moderate at C5-C6. Very prominent facet joint\nhypertrophy at the left C2-C3 level as before. This causes moderate narrowing\nof the left neural foramen. Neural foraminal narrowing at the remaining\nlevels is mild. There is no prevertebral soft tissue swelling.", "output": "No acute fractures or traumatic subluxation." }, { "input": "There is mild anterolisthesis of C3 on C4 which may be degenerative in\netiology. There is multilevel left-sided uncovertebral spurring resulting in\nmoderate to severe neural foraminal narrowing, most pronounced at C2-C3,\nC3-C4, C5-C6, and C6-C7. Bridging vertebral body osteophytes involving C5\nthrough C7 result in mild canal narrowing at this level. No acute fractures\nare identified.There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nThe partially visualized bilateral lung apices are clear. Thyroid gland is\nunremarkable.", "output": "1. No acute fractures or prevertebral soft tissue swelling.\n2. Moderate degenerative changes of the cervical spine, with mild canal\nnarrowing from C5 through C7 and multilevel moderate to severe left-sided\nneural foraminal stenosis.\n3. Mild anterolisthesis of C3 on C4, likely degenerative in etiology." }, { "input": "Alignment is normal. No fractures are identified.Moderate multilevel\ndegenerative changes with intervertebral disc space narrowing, anterior and\nposterior osteophyte formation and small disc bulging are seen throughout the\ncervical spine. Mild central canal narrowing is seen at multiple levels due\nto disc bulging, most pronounced at C5-6. No significant neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nMinimal scarring is seen in the imaged lung apices. Thyroid gland slightly\nheterogeneous without discrete nodule.", "output": "1. No acute fracture or malalignment." }, { "input": "There is minimal anterolisthesis of C7 on T1, which is likely degenerative in\nnature. Otherwise, alignment is normal.No acute fracture is seen. There is\nno prevertebral soft tissue swelling.\n\nMultislice level degenerative disc disease is noted. There is no significant\nspinal canal stenosis. There is minimal multilevel neural foraminal stenosis\nbilaterally due to a combination of facet and uncovertebral hypertrophy.\n\nThere is a 7 mm hypodense right thyroid nodule. The partially visualized\nskull base and lung apices are within normal limits. Atherosclerotic\ncalcifications of the aortic arch and left the carotid bifurcations\nbilaterally is noted. No cervical lymphadenopathy demonstrated.", "output": "1. Minimal anterolisthesis of C7 on T1, which is likely degenerative in\nnature. Multilevel degenerative changes.\n2. No evidence of acute fracture.\n3. 7 mm hypodense right thyroid nodule, which does not meet the ACR criteria\nfor ultrasound follow-up of incidental thyroid nodules." }, { "input": "Re demonstrated is smooth expansion of the sacrum secondary to patient's known\nlarge sacral arachnoid cyst, measuring approximately 3.3 cm x 6.2 cm x 6.5 cm\nas seen on the prior MRI from ___. No acute fracture is\nidentified. There is no evidence of traumatic malalignment.\n\nMultilevel multifactorial degenerative changes are seen throughout the lumbar\nspine including anterior posterior osteophytosis worst at L3-L4, L4-L5, L5-S1\nand severe left neural foraminal narrowing secondary to facet joint\nosteophytes at L4-L5.\n\nNo definite paraspinal or paravertebral soft tissue abnormalities are\nidentified.", "output": "1. Stable large 6.5 cm sacral lesion, previously characterized as an arachnoid\ncyst.\n2. No acute fracture or traumatic malalignment.\n3. Moderate to severe degenerative changes throughout the lumbar spine, better\nevaluated on the MRI from ___." }, { "input": "There is straightening of the cervical lordosis. No subluxation. No\nfractures are identified. Vertebral body heights and intervertebral disc\nspaces are maintained. There is no significant canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "There is no acute fracture, traumatic malalignment or prevertebral soft tissue\nswelling. Vertebral body heights in the cervical spine are maintained. There\nis mild compression of the T4 vertebral body, age indeterminate. There is\nmild anterolisthesis of C6 on C7 likely degenerative. There is no significant\ncanal narrowing. There mild multilevel degenerate changes with fusion of the\nC2-C3 facets bilaterally. There are calcifications at the carotid bifurcations\nbilaterally. A small calcification is noted within the upper pole of the left\nlobe of the thyroid. The visualized lung apices are clear.", "output": "1. No acute fracture or traumatic malalignment. Mild multilevel degenerate\nchanges.\n2. Mild compression of the T4 vertebral body, age-indeterminate." }, { "input": "Cervical spine: Alignment is normal. No fractures are identified.Vertebral\nbody and intervertebral disc heights are maintained. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Visualized thyroid gland and lung apices are clear. Patient\nis status post occipital craniotomy with encephalomalacia noted in the right\ncerebellum.\n\nLumbar spine: Alignment is normal. No fractures are identified.Vertebral body\nheights and intervertebral disc spaces are maintained. There is no evidence\nof spinal canal or neural foraminal stenosis. No paravertebral abnormality. \nImaged soft tissue structures are within normal limits.", "output": "1. No acute fracture or traumatic malalignment of the cervical or lumbar\nspine.\n2. Evidence of prior occipital craniotomy with encephalomalacia in the right\ncerebellum." }, { "input": "Postsurgical changes are noted from L2-L3 laminectomy. The thecal sac is\nsomewhat narrowed in this area with a broad-based indentation of the posterior\nthecal sac from a combination of probable packing material and trace fluid. In\nthe laminectomy bed at the level of the posterior elements, there is an\nintermediate density collection measuring 2.9 x 2.4 x 5.7 cm compatible with a\nhematoma. Small locules of superficial soft tissue gas is noted. Small\nlocules of intradural air are seen throughout the imaged lumbar spine. There\nis no abnormal focus of post contrast enhancement. The lumbar vertebral body\nheights and alignment are well maintained. The neural foramina appear grossly\npatent. There is minimal disc space narrowing at the level of L4-5. There\nare mild degenerative changes of the facet joints.", "output": "Postsurgical changes from L2-L3 laminectomy with mild narrowing of the thecal\nsac from a combination of fluid and packing material. Several locules of\nsubdural gas are expected given recent procedure. 2.9 x 2.4 x 5.7 cm fluid\ncollection in the operative bed with density suggestive of hematoma. No\ndefinite focus of abnormal postcontrast enhancement. Given limited evaluation\nof the thecal sac and nerve roots on CT, repeat MR with gadolinium is\nrecommended when tolerable, or possibly under anesthesia.\n\nNOTIFICATION: These findings were communicated via phone call by Dr. ___ to\nDr. ___, at 13:00 hrs on ___." }, { "input": "There is no spondylolisthesis. There is minimal anterior osteophyte formation\nat the C3-C4 level and the C6-C7 interspace is mildly narrowed posteriorly.\nHowever, degenerative changes are minimal. There is no evidence for fracture,\ndislocation or bone destruction. Surrounding soft tissue structures are\nunremarkable. Minimal subpleural scarring is noted at each lung apex.", "output": "No evidence for fracture or dislocation. No evidence for substantial\ndegenerative change." }, { "input": "No evidence of traumatic malalignment. No evidence of acute fracture. No\nsignificant spinal canal or neural foraminal stenosis. No prevertebral soft\ntissue swelling. No evidence of infection or neoplasm. There are multilevel\ndegenerative changes loading anterior osteophytes as well as ossification of\nthe posterior longitudinal ligament example at the level of C6-C7. \nThyroidectomy clips are noted. Visualized lung apices are clear, incidental\nnote is made of a partially imaged azygos fissure.", "output": "No evidence of traumatic malalignment or acute fracture of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm.", "output": "1. No acute fracture, malalignment, or prevertebral soft tissue abnormality of\nthe cervical spine." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. Disc\nspaces are preserved. There are no suspicious blastic or lytic osseous\nlesions. No evidence of acute fracture. Unchanged right sacral ala 7 mm bone\nisland adjacent is sacroiliac joint since ___.\n\nT12-L1 through L2-L3: There is no significant spinal canal or neural\nforaminal narrowing.\n\nL3-L4: There is a central protrusion which has increased in size when\ncompared to prior exam of ___ resulting in moderate spinal canal narrowing\n(series 4, image 43). There is mild bilateral neural foraminal narrowing.\n\nL4-L5: A disc bulge results in mild spinal canal narrowing, improved in size\nwhen compared to examination of ___. There is mild bilateral neural\nforaminal narrowing.\n\nL5-S1: There is a small disc bulge without significant spinal canal or neural\nforaminal narrowing.\n\nPrevertebral paraspinal soft tissues are unremarkable.", "output": "1. A central protrusion at L3-L4 has increased in size when compared to prior\nexam of ___, resulting in moderate spinal canal narrowing. There is mild\nbilateral neural foraminal narrowing at this level.\n2. L4-L5 disc bulge seen in examination of ___ has decreased in size. There\nis mild spinal canal narrowing.\n3. No acute fracture." }, { "input": "Alignment is normal. No cervical spine fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.There is a small occipital scalp hematoma\nand subcutaneous air.", "output": "1. No acute fracture traumatic malalignment.\n2. Small occipital scalp hematoma and subcutaneous air." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. Mild-to-moderate multilevel degenerative disc disease\nis noted in the cervical spine. For example there is moderate left neural\nforamina narrowing at C4-C5 secondary to uncovertebral hypertrophy (CT: 36,\n602:44). There is no vertebral canal narrowing.There is no evidence of\ninfection or neoplasm.\n\nThere are multiple prominent but non pathologically enlarged bilateral\ncervical and supraclavicular lymph nodes, for example measuring up to 7 mm in\nthe right submandibular space (02:25). The thyroid gland is normal in\nappearance. Limited views of the lung apices is unremarkable.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Mild-to-moderate degenerative changes in the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nScattered minimally prominent cervical lymph nodes are not pathologically\nenlarged, possibly reactive. Unremarkable thyroid. Incidentally noted\ntracheal diverticulum (3:65).\n\nPlease see report from dedicated CT torso for description of the intrathoracic\nfindings.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is fusion of the C2\nand C3 articular facets (401b:55). Moderate to severe multilevel degenerative\nchanges, including disc space narrowing, anterior and posterior osteophyte\nformation, and vacuum disc phenomena, particularly in the lower cervical spine\nwhich result in mild spinal narrowing in this region. There is no significant\ncentral canal narrowing. There is no prevertebral soft tissue swelling. \nVisualized lung apices are clear.", "output": "1. No acute cervical spinal fracture or malalignment.\n\n2. Moderate to severe cervical spinal degenerative changes, as described\nabove." }, { "input": "Alignment of the cervical spine is maintained. There is a nondisplaced\nfracture of the C6 spinous process (series 602b:32). A nondisplaced fracture\nthrough the left C7 transverse process/superior articular facet is also seen\n(series 601b:image 25).\n\nDegenerative changes are noted within endplate sclerosis and disc height loss,\nmost notable at C5-C6 and C6-C7. Posterior osteophytes and disc bulges cause\nat least mild canal narrowing, most pronounced at C5-C6. The visualized\nthyroid gland is unremarkable. An endotracheal tube and enteric tube are\npartially visualized. The visualized lung apices are grossly clear.", "output": "Nondisplaced C6 spinous process fracture and left C7 transverse\nprocess/superior facet fracture.\n\nRECOMMENDATION(S): The findings were discussed by Dr. ___ with Dr. ___\non the telephone on ___ at 11:15 ___, 2 minutes after updated findings." }, { "input": "There is unchanged mild anterolisthesis of C5 on C6 and unchanged minimal\nretrolisthesis of C6 on C7. There is no acute subluxation. There is no\nevidence for prevertebral edema. No displaced fractures are identified. \nVertebral body heights are within normal limits. There is disc space\nnarrowing throughout the cervical spine except for the C5-C6 level, unchanged.\nDisc protrusions and endplate osteophytes indent the ventral thecal sac at\nmultiple levels, with greatest, mild to moderate spinal canal narrowing at\nC6-C7. There is advanced multilevel facet arthropathy, right greater than\nleft, with fusion of bilateral C2-C3 and C3-C4 facet joints due to end-stage\narthropathy. There is multilevel neural foraminal narrowing by uncovertebral\nand facet osteophytes.\n\nConcurrent head CT is reported separately. There is mild degenerative\nremodeling of the left mandibular condyles at the left temporomandibular\njoint. There is calcified pleural/parenchymal thickening at the included lung\napices, as seen previously. Partially visualized thyroid gland is grossly\nunremarkable on noncontrast CT.", "output": "1. No evidence for a fracture. No acute subluxation.\n2. Multilevel degenerative disease is again demonstrated." }, { "input": "The alignment is overall similar to prior exam on ___ with\napproximately 2 mm anterolisthesis of C5 on C6. No acute fracture is\nidentified. Degenerative changes of the cervical spine is moderate, most\nnotable at C4-5, C6-7, and C7-T1. At C4-5, uncovertebral hypertrophy and\nright facet arthropathy result in mild spinal canal narrowing and severe right\nand moderate left neural foraminal narrowing. At C5-6, uncovertebral\nhypertrophy and right facet arthropathy results in moderate to severe right\nand moderate left neural foraminal narrowing. No significant spinal canal\nnarrowing is noted at that level. At C6-7, posterior osteophytes with loss of\nintervertebral disc spaces results in moderate to severe bilateral neural\nforaminal narrowing and mild to moderate spinal canal narrowing. At C7-T1,\nthere is mild-to-moderate neural foraminal and spinal canal narrowing.There is\nno prevertebral soft tissue swelling. Pacer lead is partially visualized. \nImaged upper lungs demonstrate part calcified pleural plaque in the upper\nupper lobes, left greater than right, unchanged from prior exam.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate degenerative changes as noted above resulting in moderate to\nsevere spinal canal and bilateral neural foraminal narrowing, most severe at\nC5-6 through C7-T1." }, { "input": "In comparison with the prior MRI examinations the lumbar spine, there is\nunchanged grade 1 anterolisthesis at L4 upon L5 level, otherwise, the\nconfiguration of the lumbar vertebral bodies appears maintained.\n\nFrom T12-L1 through L2-L3 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt L3-L4 level, there is mild diffuse disc bulge causing mild bilateral neural\nforaminal narrowing there is also moderate articular joint facet hypertrophy\nand mild ligamentum flavum thickening causing mild spinal canal narrowing\n(image 54, series 3).\n\nAt L4-5 level, there is grade 1 anterolisthesis with no evidence of\nspondylolysis, there is uncovering this and diffuse disc bulging causing\nanterior thecal sac deformity and bilateral neural foraminal narrowing,\nadditionally there is articular joint facet hypertrophy with vacuum phenomenon\nbilaterally and ligamentum flavum thickening resulting in moderate to severe\nspinal canal stenosis (image 64, series 3).\n\nAt L5-S1 level, there is vacuum disc phenomenon and diffuse disc bulging\ncausing bilateral neural foraminal narrowing and anterior thecal sac\ndeformity, articular joint facet hypertrophy with vacuum phenomenon is also\nseen.\n\nThe visualized paravertebral structures are grossly unremarkable..", "output": "1. Unchanged grade 1 anterolisthesis at L4 upon L5 level with no evidence of\nspondylolysis.\n2. Multilevel, multifactorial degenerative changes throughout the lumbar\nspine, more significant at L3-L4, L4-5 and L5-S1 levels." }, { "input": "Alignment is normal. No fractures are identified. There are multilevel\ndegenerative changes, resulting in mild narrowing of the spinal canal and\nneural foramina, more significant from C3/C4 through C6/C7 levels. There is\nno evidence of infection or neoplasm.", "output": "No evidence of acute cervical spine fracture, malalignment or prevertebral\nsoft tissue abnormality." }, { "input": "There is no acute fracture or traumatic malalignment. Trace anterolisthesis\nof C4 on C5 is most likely secondary to degenerative change, specifically\nfacet joint hypertrophy on the left.\n\nMultilevel degenerative changes of the cervical spine are noted, with loss of\nvertebral body height, anterior and posterior osteophytes and predominately\nleft-sided facet joint hypertrophy. No critical canal or foraminal narrowing.\nCongenital non-fusion of the C1 posterior arch is noted.\n\nThere is enlargement of the left submandibular gland with surrounding edema\nthat involves the left retropharyngeal space (3:47). Mild prevertebral edema\nis also noted anterior to the C3 through C5 vertebral bodies.\n\nDense atherosclerotic calcifications are noted. The thyroid and included lung\napices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Predominantly left retropharyngeal edema, without an obvious cause on this\nunenhanced exam. Given enlargement of the left submandibular gland, please\ncorrelate with clinical exam for sialadenitis.\n3. Mild edema anterior to the C3 through C5 vertebral bodies, potentially\nretropharyngeal from adjacent stranding on the left as detailed above. \nAlthough less likely, ligamentous injury is not entirely excluded. If there\nis further clinical concern, may consider MRI for further evaluation.\n4. Trace anterolisthesis of C4 on C5 is most likely secondary to degenerative\nchange. Additional degenerative changes of the cervical spine, as detailed\nabove." }, { "input": "Mild anterolisthesis of C3 over C4 and minimal anterolisthesis of C4 over C5\nare age indeterminate, but likely degenerative. Multilevel degenerative\nchanges are seen, including disc space narrowing at C5-C6 and C6-C7. \nMultilevel anterior and posterior osteophytes are seen. Neural foraminal\nnarrowing is seen on the left at C3-C4 and C4-C5.There is no prevertebral\nedema.\n\nThere is a partially imaged left pleural effusion again seen.", "output": "1. Mild anterolisthesis of C3 over C4 minimal anterolisthesis of C4 over C5\nare age indeterminate but likely degenerative. No acute fracture of the\ncervical spine.\n2. Partially imaged left pleural effusion, also present on prior chest CT\nfrom ___." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nA 6 mm left upper lobe nodule is unchanged. Small pyramidal lobe of thyroid\nconsistent with normal variant. Thyroid is mildly enlarged.", "output": "1. No malalignment or fracture a sequela of trauma.\n2. Persistent mild enlargement of the thyroid. ___ be appropriate correlate\nwith any relevant history as well as consideration of correlation with thyroid\nfunction testing." }, { "input": "Retrolisthesis of C3 on 4 is similar to prior. Cervical alignment is\notherwise normal. No acute fractures are identified. Severe canal stenosis at\nC3-4 is similar to prior. Multilevel degenerative changes are again seen,\nworst at C3-4. There is no prevertebral edema.\n\nDiffusely enlarged nodules within and adjacent right parotid gland measures up\nto 1.9 x 1.5 cm (AP, TRV), likely representing lymph nodes (series 2, image\n15). In the context of the known right orbital mass, this may represent\nlymphoma and lymphadenopathy.\n\nCalcified left apical pleural plaque (series 601b, image 36) is unchanged from\nexaminations dating back to ___.", "output": "1. No acute fracture or traumatic malalignment.\n2. Diffusely enlarged nodules measure up to 1.9 cm within and adjacent to the\nright parotid gland, suspicious for lymphoma given MRI findings of known right\norbital mass. Clinical correlation is recommended." }, { "input": "Study is mildly degraded by motion. There is mild loss of cervical lordosis. \nOtherwise the alignment is unremarkable.No fractures are identified.The\nvertebral body and disc heights are preserved. No spinal canal stenosis or\nneural foraminal narrowing.There is no prevertebral soft tissue swelling.The\nthyroid and visualized bilateral lung apices are preserved.", "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no acute fracture traumatic malalignment." }, { "input": "Alignment is normal. No definite fractures are identified.There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture identified." }, { "input": "There is scoliosis of lumbar spine convex to the left side in the mid-lumbar\nregion.\n\nAt T12-L1 no abnormalities are seen. At L1-2 and L2-3 levels mild disc\nbulging and osteophyte formation seen without high-grade spinal stenosis.\n\nAt L3-4 level, diffuse disc bulge and posterior osteophyte result in moderate\nspinal stenosis. Predominantly left-sided osteophyte formation is seen. \nThere is moderate-to-severe left foraminal narrowing.\n\nAt L4-5 level, a vacuum is seen within the disc with disc bulging. \nMild-to-moderate spinal stenosis is seen with moderate right foraminal\nnarrowing.\n\nAt L5-S1 level, disc osteophyte is seen on the right side. There is moderate\nto severe right subarticular recess and severe right foraminal narrowing seen.\nThere is mild-to-moderate left foraminal narrowing. There is vacuum within\nthe disc.\n\nSmall subarticular cysts are seen at L3-4 and L4-5 levels within the vertebral\nendplates with sclerosis at the endplates predominantly at L4-5 level due to\ndegenerative change.\n\nThere is calcification within the abdominal aorta.", "output": "1. Scoliosis of lumbar spine convex to the left side.\n2. No lytic abnormalities are seen.\n3. Degenerative changes with spinal canal and foraminal narrowing as described\nabove." }, { "input": "The patient is status post T10-ilium posterior fusion. Pedicle screws are\nseen at T10, T11, T12, and L1. The surgical hardware appears intact and in\nappropriate position. There is no evidence of extrapedicular extension of the\npedicle screws. There is no focal fluid collection. A calcified density is\nseen within the T10-T11 intervertebral disc space, unchanged from prior study\n(07:42). Alignment is normal.No fractures are identified.Within the\nlimitations of the study, there is no evidence of high-grade spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling.", "output": "1. Status post lower thoracic spine posterior fusion. Surgical hardware\nappears intact and in appropriate position.\n2. No evidence of acute fracture or hematoma." }, { "input": "The patient is status post T10-ilium posterior fusion and removal of the L2\npedicle screws. Pedicular screws are seen at L1, L3, L4, L5 and the bilateral\nilium. Interbody devices are seen at L3-L4, L4-L5, and L5-S1. Overall, the\nsurgical hardware appears intact and in appropriate position. There is no\nevidence of extrapedicular extension of the pedicle screws. There is no focal\nfluid collection. Alignment is near anatomic.No fractures are\nidentified.Within the limitations of the study, there is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.", "output": "1. Status post posterior fusion of the lumbar spine and removal of L2 pedicle\nscrews, as described above. Surgical hardware appears intact and in\nappropriate position.\n2. No acute fracture or hematoma." }, { "input": "Alignment is normal. No acute fractures are identified.There are mild\ndegenerative changes with small anterior and posterior osteophytes. There is\nno evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. The coarse calcification is incidentally\nnoted in the left lobe of the thyroid. Mild biapical pleural thickening is\nchronic.", "output": "1. No acute fracture or malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is intervertebral\ndisc space narrowing, and osteophyte formation at multiple levels of the\ncervical spine. Superimposed disc bulge at C4-5 effaces the ventral CSF and\ncontributes to at least mild to moderate canal narrowing at this level. At\nthe there is multilevel facet arthropathy. There is no evidence of\nsignificant neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.There is mild scarring the bilateral lung apices.", "output": "1. No fracture or malalignment.\n2. Moderate multilevel degenerative changes of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. Mild multilevel degenerative\nchanges of the cervical spine.There is no prevertebral soft tissue swelling.\n\nVisualized apices are unremarkable. The thyroid is normal. A 10 mm nodule in\nthe superficial portion of the left parotid gland (03:39) has enlarged,\npreviously 7 mm in ___. Given interval enlargement of additional left-sided\ncervical nodes (a left level 2b lymph node measuring 8 mm (03:43) was\npreviously 5 mm), this is also likely a lymph node with interval enlargement", "output": "No fracture or subluxation.\nInterval enlargement of a 10 mm nodule in the superficial portion of left\nparotid gland which is felt most likely to represent a lymph node." }, { "input": "Alignment is normal. No fractures are identified. Again seen are mild\nmultilevel degenerative changes of the cervical spine. At C3-C4 there is mild\nbilateral neural foraminal narrowing due to uncovertebral osteophytes. At\nC4-C5 there is moderate right-sided neural foraminal narrowing due to\nuncovertebral osteophyte formation. At C5-C6 neural foraminal narrowing is\nmild-to-moderate in association with uncovertebral osteophytes, more striking\non the left than right.There is no prevertebral soft tissue swelling. There is\nno evidence of infection or neoplasm within the limits of this noncontrast\nenhanced study. Visualized lung apices are unremarkable. A right anterior\ncervical node of 5 mm in short dimension is stable. Possibly this is within\nthe parotid versus level II. Intraparotid lymph node on the left measuring 9\nx 5 mm is enlarged but decreased in size, previously 10 x 8 mm.", "output": "No evidence of traumatic fractures or subluxation. Decreased left parotid\nlymph node." }, { "input": "Alignment is normal. No fractures are identified. There is no significant\ndegenerative disease. No prevertebral edema. No critical central canal or\nneural foraminal stenosis. Imaged portion of the thyroid is unremarkable.", "output": "No acute fracture or malalignment." }, { "input": "There minimal anterolisthesis of C2 over C3, mild to moderate anterolisthesis\nof C3 over C4 and moderate anterolisthesis of C4 over C5, with no prior for\ncomparison. No jumped or perched facet is seen. Multilevel bilateral facet\narthropathy is seen. Linear lucency through the inferior right C4 facet may\nrepresent fracture of indeterminate age. Old appearing fragmentation of the\ninferior left C4 facet. There is disc space narrowing, worst at C5/C6 where\nthere also anterior posterior osteophytes, which mildly narrow the central\ncanal. No prevertebral soft tissue swelling is seen. The very partially\nimaged superior lung apices show no focal consolidation.", "output": "1. Three consecutive levels of anterolisthesis; moderate anterolisthesis of C4\nover C5, mild-to-moderate anterolisthesis of C3 over C4, and minimal\nanterolisthesis of C2 over C3. No prior study available for comparison; if a\nprior is available, would be helpful to assess for chronicity. No jumped or\nperched facet seen, however, ligamentous injury cannot be excluded on this\nstudy and if there is clinical concern for such without prior for comparison,\nMRI is more sensitive and should be considered.\n2. Linear lucency through the inferior right C4 sub facet may represent\nfracture of indeterminate age, but felt most likely chronic." }, { "input": "Alignment is normal. There is no evidence of fracture. There is no\nprevertebral swelling. There are multilevel degenerative changes most\npronounced in the lower cervical spine which have progressed from ___. These\ninclude disc space narrowing at C5-6 and C6-7. Mild anterolisthesis of C3-4\nhas increased from ___ and is likely degenerative.\nAt C2-3 a midline protrusion of the disc slightly indents the anterior surface\nof the spinal cord. The neural foramina appear normal.\nAt C3-4, a disc bulge and tiny midline protrusion slightly flatten the\nanterior surface of the spinal cord. Uncovertebral and facet osteophytes\nproduce moderate right and mild left neural foraminal narrowing.\nAt C4-5, intervertebral osteophytes narrow the spinal canal and slightly\nflatten the spinal cord. There is bilateral moderate neural foraminal\nnarrowing due to uncovertebral and facet osteophytes.\nAt C5-6, intervertebral osteophytes narrow the spinal canal and flatten the\nspinal cord. There is a minor contribution from a disc bulge. There is\nbilateral severe neural foraminal narrowing due to uncovertebral and facet\nosteophytes.\nAt C6-7, intervertebral osteophytes narrow the spinal canal and flatten the\nspinal cord. There is mild right neural foraminal narrowing due to\nuncovertebral and facet osteophytes.\nThe C7-T1 and included portions of the T1-2 levels demonstrate no spinal canal\nor neural foraminal encroachment.\nThe thyroid is unremarkable. No lymphadenopathy by CT size criteria.", "output": "Degenerative disc disease, progressive since the study of ___" }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "Normal study" }, { "input": "Alignment is normal.No acute fracture seen. Mild degenerative changes seen\nincluding mild narrowing. There is no prevertebral soft tissue\nswelling.Partially imaged lung apices demonstrates a partially imaged right\npleural effusion. Small amount of dependent secretions are seen in the\ntrachea at the thoracic inlet, question aspirated.", "output": "1. No acute fracture or dislocation of the cervical spine.\n2. Partially imaged right pleural effusion.\n3. Small amount of dependent secretion in the trachea at the thoracic inlet,\nquestion aspirated." }, { "input": "Alignment is normal. No cervical spine fractures are identified.There is no\nevidence of spinal canal or neural foraminal stenosis.There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm. 11 mm\nright thyroid nodule does not require follow-up by ACR guidelines unless there\nis additional clinical concern.", "output": "No evidence of cervical spine fracture or cervical malalignment.\n\nRECOMMENDATION(S): 11 mm right thyroid nodule does not require follow-up by\nACR guidelines unless there is additional clinical concern." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Degenerative changes\nmoderate at C5-6 with loss of disc space and small posterior disc bulge. No\nprevertebral edema. The aerodigestive tract appears patent. Lung apices are\nclear. Thyroid gland appears normal.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes at C5-6, moderate." }, { "input": "There is no acute fracture or malalignment. There is no prevertebral soft\ntissue swelling. Multilevel degenerative changes are present within the\ncervical spine with loss of intervertebral disc space at the C4-C5 and C5-C6\nlevels. Multilevel uncovertebral joint hypertrophy is present with neural\nforaminal narrowing, worst at the C4-5 and C5-6 levels. Posterior osteophytes\nand ossification of the posterior longitudinal ligament at the C5 and C6 level\neffaces the thecal sac and mildly narrows the spinal canal. Alignment of the\ncervical spine appears within normal limits.\n\nThere is no cervical adenopathy. Biapical pleuroparenchymal scarring is mild\nand symmetric. The thyroid gland is homogeneous in attenuation without focal\nnodularity.", "output": "No acute cervical fractures or malalignment. Degenerative changes as\ndescribed." }, { "input": "Alignment is normal. The previously described C6-7 fracture is better\nappreciated on the prior cervical spine CT. No additional fractures are\nidentified. Anterior fusion hardware spanning C4 through C7 is visualized. \nThere are minimal multilevel degenerative changes, most pronounced at T11-12\nwhere there is loss of intervertebral disc space height, vacuum phenomena and\nbridging anterior osteophytes. There is mild multilevel canal narrowing due\nto posterior osteophytes. However, there is no evidence of spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling.\n\nA subcentimeter hypodensity in the left upper pole kidney is too small to\ncharacterize, but statistically likely represents a simple cyst. There is a 5\nmm pulmonary nodule in the right upper lobe (3:71). There is also mild\ndependent bibasilar atelectasis.", "output": "1. No evidence of fracture or malalignment within the thoracic spine.\n2. Minimal degenerative disc disease.\n3. 5 mm right upper lobe pulmonary nodule. See recommendations below.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "There is minimal anterolisthesis of L3 on L4 and mild anterolisthesis at L4 on\nL5, likely chronic and reflecting degenerative disease which is extensive\nalong the posterior facet joints of the mid and lower lumbar spine. No acute\nfractures are identified. There are multilevel degenerative changes\nconsisting of loss of intervertebral disc height, anterior and posterior\nosteophyte formation, and facet arthropathy as described above. No\nperivertebral hematoma. Multiple surgical clips are noted in the abdomen and\npelvis.", "output": "1. No acute fracture.\n2. Multilevel degenerative changes with subtle misalignment thought to reflect\nchronic degenerative disease.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "There is redemonstration of anterior plate and screw fixation hardware\nextending from C4-C7, with anterior osseous fusion of the C5, C6 and C7\nvertebral bodies with partial fusion of the C4 and C5 vertebral bodies. There\nis similar appearance of the fractured right C6-C7 screw (series 602, image\n21), unchanged since ___. There is unchanged 2 mm retrolisthesis\nof C3 on C4 and 4 mm anterolisthesis of C7 on T1. Alignment is otherwise\nmaintained.There is redemonstration of nondisplaced fractures extending\nthrough the pedicles of the C7 vertebral body with regional sclerosis, not\nsignificantly changed since the prior exam. The prevertebral and paraspinal\nsoft tissues are within normal limits.\n\nC2-C3: Posterior disc bulge and endplate osteophytes with uncovertebral and\nfacet joint osteophytes results in mild right neural foraminal narrowing.\n\nC3-C4: Mild retrolisthesis in conjunction with a posterior disc bulge and\nendplate osteophytes results in mild spinal canal narrowing with moderate to\nsevere right and mild-to-moderate left neural foraminal narrowing.\n\n\nC4-C5: No significant spinal canal stenosis. Uncovertebral and facet joint\nosteophytes result in mild to moderate left neural foraminal narrowing.\nC5-C6: No significant spinal canal stenosis. Uncovertebral and facet joint\nosteophytes result in mild left neural foraminal narrowing.\n\nC6-C7: Posterior endplate osteophytes and facet joint hypertrophy results in\nmild spinal canal narrowing without in significant neural foraminal stenosis.\n\nC7-T1: Mild anterolisthesis of C7 on T1 in conjunction with a posterior disc\nprotrusion and endplate osteophytes without significant spinal canal stenosis\nor neural foraminal narrowing.", "output": "1. Similar appearance of the previously seen bilateral C7 pedicle fractures.\n2. Stable postsurgical changes related to anterior fusion of C4-C7 with\nunchanged appearance of the fractured right lateral screw at C6-C7 compared\nto the prior study from ___.\n3. Multilevel cervical spondylosis, most pronounced at C3-C4 where there is\nmild spinal canal stenosis and multilevel neural foraminal narrowing as\ndetailed above.\n4. Similar 2 mm retrolisthesis of C3 on C4 and 4 mm anterolisthesis of C7 on\nT1.\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation.\n\nNOTIFICATION: The findings including the appearance of the right lateral\nscrew at C6-C7 were discussed with ___, M.D. by ___, M.D. on\nthe telephone on ___ at 2:00 pm, 10 minutes after discovery of the\nfindings." }, { "input": "Exaggerated cervical lordosis and exaggerated thoracic kyphosis result in\nobliquity on axial images, limiting evaluation. There is also a levoconvex\ncervical scoliosis and incompletely assessed dextroconvex thoracic scoliosis.\n\nThe bones are demineralized. Vertebral body heights are preserved. No\ndisplaced fracture is seen. There is mild retrolisthesis of C3 on C4 with\nassociated disc space narrowing and facet arthropathy. There is no disc space\nwidening, prevertebral soft tissue swelling, or splaying of the posterior\nelements. The spinal canal is moderately narrowed at C3-C4. Disc osteophyte\ncomplexes mildly indent the ventral thecal sac at other cervical levels. \nThere is multilevel neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nThere is pleural/parenchymal scarring at the included left lung apex. \nConcurrent torso CT is reported separately.", "output": "1. No evidence for an acute fracture.\n2. Mild retrolisthesis of C3 on C4 is almost certainly degenerative, but there\nare no comparison exams to confirm chronicity.\n3. Cervical and thoracic scoliosis. Exaggerated thoracic kyphosis.\n4. Multilevel cervical degenerative disease with moderate spinal canal\nnarrowing at C3-C4." }, { "input": "Alignment is normal.There is osseous fusion of C5-C6 vertebral bodies. No\nacute fracture is identified. There is no prevertebral tissue swelling. Mild\ndegenerative changes at C6-C7 mildly narrow the spinal canal and the bilateral\nneural foramina, greater on the right than on the left. Additionally, mild\nbilateral neural foraminal narrowing is noted C4-5.\n\nA mucous retention cyst is seen in the partially visualized right sphenoid\nsinus. Visualized thyroid gland and lung apices are unremarkable.", "output": "Status post C5-C6 fusion without acute fracture or malalignment." }, { "input": "There is minimal anterolisthesis C4-C5, likely degenerative in etiology.No\ndefinite acute fractures are identified.There is no prevertebral edema. \nModerate degenerative changes are seen along the cervical spine with disc\nspace narrowing, subchondral sclerosis and irregularity, and osteophytes.\nThere are multilevel posterior osteophytes and disc bulges with resultant mild\nnarrowing of the vertebral canal. Multilevel uncovertebral and facet joint\narthropathy results in moderate neural foraminal stenoses. There is no\nevidence of infection or neoplasm. Incidental 6 mm left upper lobe nodule is\nseen. The thyroid gland is unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate cervical spondylosis with multilevel mild vertebral canal\nnarrowing and moderate neural foraminal stenoses.\n3. Incidental 6 mm left upper lobe nodule seen. Recommend follow-up in 6\nmonths.\nNote: CT chest in 6 months is recommended." }, { "input": "2 mm retrolisthesis C3 on C4, likely degenerative. No fractures. No\nparavertebral edema.\nAdvanced degenerative changes, disc space narrowing, disc osteophyte\ncomplexes, posterior element hypertrophic changes. Probably moderate central\ncanal narrowing C3-C4, C6-C7 levels. Multilevel moderate severe foraminal\nnarrowing, most prominent at the right C3-C4 foramen.\n\nBiapical scarring, mildly asymmetric on the left, refer to chest CT report.", "output": "1. No acute fracture.\n2. Degenerative changes, as above.\n3. 2 mm retrolisthesis C3-C4, likely degenerative.\n4. Biapical subpleural scarring, more prominent on the left." }, { "input": "Alignment is normal. No fractures are identified. There are multilevel\ndegenerative changes, at C2/C3 level, there is bilateral uncovertebral\nhypertrophy, more significant on the right, causing moderate right-sided\nneural foraminal narrowing, additionally articular joint facet hypertrophy is\npresent, mild disc bulging causing anterior thecal sac deformity is identified\n(image 25, series 2 and 3).\n\nAt C3/C4 level, there is uncovertebral hypertrophy and central disc bulging,\ncausing anterior thecal sac deformity, mild bilateral articular joint facet\nhypertrophy is identified.\n\nAt C4/C5 level, bilateral uncovertebral hypertrophy is identified, more\nsignificant on the left, causing mild left neural foraminal narrowing (image\n38, series 2).\n\nAt C5/C6 level, there is disc bulging, slightly asymmetric towards the left,\nbilateral uncovertebral hypertrophy resulting in moderate left and moderate to\nsevere right-sided neural foraminal narrowing (image 43, series 3).\n\nAt C6/C7 level, there is narrowing of the intervertebral disc space and\nspondylosis, causing anterior thecal sac deformity and bilateral neural\nforaminal narrowing (at C7/T1 level, the neural foramina and spinal canal\nappear patent.\n\nArteriosclerotic disease is identified in the right cervical carotid\nbifurcation. A high density collection adjacent to the right a high density\ncollection adjacent to the right body of and ramus of the mandible measures\n2.8 x 3 point 8 cm, there is no evidence of mandibular fracture. The\ntemporomandibular joints appear intact with degenerative changes on the left\njoint.", "output": "1. No acute fracture traumatic malalignment.\n2. A high density collection adjacent to the right body and ramus of the\nmandible measures 2.8 x 3.8 cm. In the setting of trauma these findings are\nmost consistent with a hematoma, however, physical exam is recommended to\nexclude an underlying mass.\n3. No mandible fracture.\n\nRECOMMENDATION(S): Note is made that the anterior aspect of the mandible is\nnot included in the field of view in this examination of the cervical spine,\nif there is clinical concern related with maxillofacial fractures, correlation\nwith dedicated maxillofacial CT is recommended for further characterization." }, { "input": "Diffuse osteopenia is noted. Moderate multilevel degenerative changes are\nseen throughout the thoracolumbar spine with anterior osteophytes and disc\nspace narrowing. There is a stable mild superior endplate compression\ndeformity of T2 vertebral body, unchanged from ___. No\nretropulsion. Additional stable severe anterior wedge compression deformity\nof T6 vertebral body with 5 mm retropulsion causing mild canal narrowing and\nmild flattening of the thecal sac, grossly unchanged from ___ chest\nradiograph. No prevertebral hematoma. Alignment is otherwise normal. There\nis no prevertebral soft tissue swelling.On scout images, anterior wedge\ncompression deformities of L2 and L3, with retropulsion of the L2 superior\nendplate into the spinal canal appears similar to prior CT abdomen pelvis\ndating ___\n\nT1-T5: No spinal canal or neural foraminal narrowing.\nT5-T6: Mild canal narrowing and mild flattening of thecal sac as described\nabove. There is no significant neural foraminal narrowing.\nT6-T7: Mild canal narrowing and mild flattening of thecal sac as described\nabove. There is at least mild bilateral neural foraminal narrowing.\nT7-T12: No spinal canal or neural foraminal narrowing. There is no\nsignificant neural foraminal narrowing.\n\nLimited assessment of the heart is notable for coronary artery calcifications\nand main pulmonary artery dilatation suggestive of pulmonary artery\nhypertension. Limited assessment of the lung apices are notable for\nbilateral dependent atelectasis. Visualized abdomen is notable for left-sided\nparapelvic renal cysts largest measuring 4.1 x 3.7 cm.", "output": "1. Unchanged mild superior endplate compression deformity of T2. No\nretropulsion.\n2. Unchanged severe anterior wedge fracture of T6 vertebral body with 5 mm\nretropulsion causing mild canal narrowing and mild flattening of thecal sac. \nOf note MR is more sensitive in the detection of acute cord injury.\n3. No evidence for acute osseous fracture or malalignment.\n4. Diffuse osteopenia.\n5. Mild main pulmonary artery dilatation suggestive of pulmonary artery\nhypertension." }, { "input": "There is a mildly displaced acute fracture of the spinous process of C7. No\nadditional fracture is identified. There is no prevertebral soft tissue\nswelling. Multilevel, multifactorial degenerative changes are present with\ndisc space narrowing, osteophyte formation, and subchondral cyst formation. \nThere is also uncovertebral and facet hypertrophy causing moderate right\nneural foraminal narrowing at C3-C4 and C4-C5.\n\nThe thyroid gland is unremarkable. There is no cervical lymphadenopathy. \nDense atherosclerotic calcifications are present at the right carotid\nbifurcation. The visualized lung apices are clear.", "output": "1. Acute mildly displaced fracture of the C7 spinous process. No additional\nfracture identified.\n2. Multilevel, multifactorial degenerative changes as described above.\n3. Severe atherosclerotic disease at the right carotid bifurcation." }, { "input": "There is posterior instrumentation at L3-4 level with fusion hardware\nconsistent with rods locked with transpedicular screws, without evidence for\nhardware complication. There is interbody fusion graft at L3-4 with partial\nsolid fusion. There is solid osseous fusion of the right articular pillar at\nL3-4 level. There is adequate distribution of the intrathecal contrast except\nat L4-5 level due to disc protrusion causing severe spinal canal narrowing.\n\nAt L2-3, there is a disc bulge, ligamentum flavum thickening, and facet\nhypertrophy, without spinal canal narrowing. There is mild left neural\nforaminal narrowing.\n\nAt L3-4, the spinal canal is widely patent post decompressive laminectomy. \nThere is mild bilateral neural foraminal narrowing.\n\nAt L4-5, there is a disc bulge, ligamentum flavum thickening, and facet\nhypertrophy that result in severe spinal canal narrowing with crowding of the\nnerve roots within the thecal sac. There is moderate to severe bilateral\nneural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge and facet hypertrophy, without spinal canal\nnarrowing. There is moderate left and mild right neural foraminal narrowing.\n\nThere is atherosclerotic plaque within the abdominal aorta and iliac vessels,\nwithout aneurysm. The kidneys are slightly nodular in contour. Left renal\nexophytic cyst at the superior pole is noted. There is chronic atrophy of the\nlower posterior lumbosacral paraspinal muscles.", "output": "1. L3-4 posterior instrumented fusion, with partial solid osseous fusion at\nthe L3-4 disc and solid osseous fusion of right L3-4 articular pillar. No\nevidence for hardware complication.\n2. Diffuse disc bulge producing contrast filling defect with crowding of the\nnerve roots within thecal sac at L4-5 level, with severe spinal canal\nnarrowing and probable impingement of traversing nerve roots.\n3. Facet hypertrophy results in moderate neural foraminal narrowing at\nbilateral L4-5 and left L5-S1." }, { "input": "There is minimal retrolisthesis of C3 over C4 and C5 over C6, of indeterminate\nage given lack of priors for comparison, but most likely degenerative. Disc\nspace narrowing is most severe at C4/C5 and C5/C6. Posterior disc osteophyte\nat C5/C6 causes mild narrowing of the central canal at this level.No acute\nfracture is seen. There is no prevertebral soft tissue swelling.The imaged\nthyroid gland is grossly homogeneous. The partially imaged lung apices\ndemonstrate respiratory motion, but no obvious focal consolidation.", "output": "1. No acute fracture of the cervical spine. Minimal retrolisthesis of C3 over\nC4 and C5 over C6 of indeterminate age given lack of priors for comparison,\nbut most likely degenerative." }, { "input": "There are numerous fractures throughout the imaged thoracic and lumbar spine. \nThere is minimal vertebral body height loss at T1 through T3 without a\ndiscrete fracture line identified. There is a severe compression deformity at\nT5 with approximately 2 mm of retropulsion along the posterior aspect of\nvertebral body (series 602, image 30). There is a severe compression\ndeformity of T7 with approximately 1 mm of retropulsion along the superior\naspect of the vertebral body. There is a moderate to severe compression\ndeformity of T9 with approximately 1 mm osseous retropulsion along the\ninferior aspect of vertebral body. Mixed linear lucency and sclerosis\nextending through the vertebral body raise the possibility that this is an\nacute or subacute fracture. There is a moderate to severe compression\ndeformity of T10 with approximately 1 mm of retropulsion along the superior\naspect of vertebral body. There is no significant T11 vertebral body height\nloss. However, the vertebral body is heterogeneous and there is a lucent\nfracture line extending through the superior endplate and superior aspect of\nvertebral body into the anterior aspect of the pedicles. There is\napproximately 2 mm of retropulsion along the superior aspect of the vertebral\nbody. There is a severe burst fracture of T12 with approximately 4 mm of\nretropulsion along the superior aspect of vertebral body resulting in at least\nmoderate spinal canal narrowing. There is associated minimal retrolisthesis\nof T11 on T12. there is a moderate compression deformity of L2 with\napproximately 2 mm osseous retropulsion of the superior endplate. There is a\nchronic appearing nondisplaced fracture of the posterolateral right tenth rib.\n\nCardiomegaly is partially imaged. There is severe calcified coronary\natherosclerosis. The thoracic aorta is normal in caliber. There is scattered\natelectasis. No significant pulmonary nodules or consolidations in the\npartially imaged lungs. Small hiatal hernia.", "output": "1. Extensive fractures throughout the imaged thoracic and lumbar spine, some\nprobably chronic, but some acute or subacute.\n2. Acute or subacute compression fractures include T9 and T11.\n3. A probably chronic burst fracture at T12 results in approximately 4 mm of\nretropulsion and at least moderate spinal canal narrowing.\n\nNOTIFICATION: Extensive fractures were acknowledged by the spine team in the\nED dashboard at the time of dictation." }, { "input": "Multilevel degenerative of the lumbar spine are extensive with loss of\nintervertebral disc height, vacuum phenomenon, and Schmorl's nodes. There is\nperhaps mild anterolisthesis of L5 on S1. The spinal canal appears grossly\npatent. No evidence of nerve from oral stenosis. No prevertebral soft tissue\nswelling. The visualized descending abdominal aorta has extensive vascular\ncalcifications. The partially visualized gallbladder appears of calcified\nstones. Irregular cystic structures within the left kidney are noted.", "output": "1. No evidence of acute fracture.\n2. Severe, multilevel degenerative changes in the lumbar spine.\n3. Incidental cholelithiasis, although incompletely imaged.\n4. Extensive abdominal aorta atherosclerosis.\n5. Left renal cysts.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ ACS in personon ___ at 228 am, 1 minutes after discovery of the\nfindings." }, { "input": "There is no acute fracture or malalignment of the cervical spine. There is no\nprevertebral soft tissue swelling. The facet joints are normally aligned.\nThere are mild multilevel degenerative changes. There is partial fusion of\nC2-C3.\n\nThe thyroid and soft tissues of the neck are unremarkable. A right central\ncatheter is partially imaged. The included left lung apex is well aerated.", "output": "No evidence of acute fracture of the cervical spine." }, { "input": "There is minimal anterolisthesis of C2 on C3 and C3 on C4, age indeterminate\nbut no secondary findings to suggest acute malalignment.No acute fractures are\nidentified.Multilevel anterior posterior osteophytes are most severe at C4-5,\nC5-6, and C6-7. There is moderate loss of disc heights C5-6 and C6-7 and mild\nloss of disc heights at C4-5. The vertebral body heights are preserved. \nUncovertebral and facet osteophytes cause mild left neural foraminal narrowing\nat C6-7. No severe central spinal canal stenosis.There is no prevertebral\nsoft tissue swelling.The left thyroid lobe is atrophic. The right thyroid\nlobe appears heterogeneous with a possible 1.9 x 1.6 cm nodule (series 3,\nimage 55). Partially imaged bilateral lung apices are unremarkable.", "output": "1. Minimal anterolisthesis of C2 on C3 and C3 on C4 is age indeterminate but\nno secondary findings to suggest acute component, most likely due to\ndegenerative changes.\n2. No acute fracture.\n3. Mild multilevel degenerative changes of the cervical spine as described in\nthe body of the report.\n4. Possible 1.9 x 1.6 cm right thyroid lobe nodule which non urgent thyroid\nultrasound is recommended if not recently previously performed.\n\nRECOMMENDATION(S): Non urgent thyroid ultrasound is recommended for further\nevaluation if not previously performed." }, { "input": "There is minimal traumatic subluxation at C4-5. There is persistent lucency\nrelated to the right C5 posterior element fracture, slightly less conspicuous\nwhen compared to ___.\n\nThere is no spinal canal or neural foraminal narrowing.\n\nThe minimal T3 vertebral body compression fracture is not imaged.", "output": "Interval reparative change related to the C5 posterior element fracture from\nthe ___ CT, however there is persistent lucency across the\nfracture line." }, { "input": "There is no prevertebral soft tissue swelling. There is no acute fracture or\nsubluxation. Visualized lung apices demonstrate minimal pleural scarring. The\nthyroid is unremarkable.\nAnterior trachea subcutaneous defect, possibly from prior tracheostomy (series\n2, image 61). There is no cervical adenopathy by CT size criteria.", "output": "No evidence of cervical spine fracture." }, { "input": "There is no compression fracture identified. At T12-L1 level vacuum is seen\nwithin the disc. There is no spinal stenosis. At L1-2 endplate sclerosis is\nidentified with disc bulging and moderate narrowing of the right foramen\nwithout spinal stenosis.\n\nAt L2-3 and L3-4 levels. Mild disc bulging seen without spinal stenosis or\nforaminal narrowing.\n\nAt L4-5 diffuse disc bulge and thickening of the ligaments with facet\ndegenerative changes result in moderate spinal stenosis with mild-to-moderate\nbilateral foraminal narrowing.\n\nAt L5-S1 level, disc and endplate degenerative changes seen with facet\ndegenerative changes. There is moderate to severe left and moderate right\nforaminal narrowing due to disc osteophytes and facet degenerative changes.\n\nEvaluation of paraspinal soft tissues demonstrate vascular calcifications.", "output": "-Moderate spinal stenosis at L4-5 level.\n-Bilateral foraminal narrowing at L5-S1 level." }, { "input": "Alignment is normal. No fractures are identified. There is multilevel mild\nto moderate degenerative disease. There is no significant spinal canal\nnarrowing.There is no prevertebral edema. There is redemonstration of an\nincompletely imaged left occipital fracture. There is an associated left\noccipital epidural hematoma, which allowing for differences in technique and\nexamination appears slightly increased in size since prior head CT.\n\nThere is a 2.0 cm hypodense nodule in the right thyroid lobe. The thyroid and\nincluded lung apices are unremarkable.", "output": "1. No acute cervical fracture or subluxation.\n2. Incompletely imaged known left occipital fracture.\n3. Associated left occipital epidural hematoma, which allowing for\ndifferences in technique and examination, appears slightly increased in size\nas compared to prior head CT.\n4. Redemonstration of a left parietal subgaleal hematoma.\n5. 2 cm right thyroid nodule for which further evaluation with a dedicated\nthyroid ultrasound is recommended if not already performed." }, { "input": "Cervical fixation hardware is noted without evidence of hardware\ncomplications. Laminectomy changes are noted. Alignment is normal. No\nfractures are identified.Multilevel degenerative changes are seen throughout\nthe C-spine with endplate sclerosis, anterior osteophyte formation, and disc\nspace height loss, most prominent at C4-C6 There is no prevertebral soft\ntissue swelling.\n\nA calcified thyroid nodule seen in the left thyroid lobe, similar to prior\nexam. Emphysema is noted at the lung apices. In the base of the left\nneck/left shoulder seen best on series 601b, image 39 as well as series 3,\nimage 43, there is a roughly 3.5 x 3.5 x 5.8 cm area of subcutaneous fat\nstranding and nodularity, of unclear etiology.", "output": "1. No acute fracture or vertebral malalignment. No hardware complications.\n\n2. In the base of the left neck/left shoulder there is focal soft tissue\nnodularity with subtle fat stranding, which is of unclear etiology. Recommend\nclinical correlation.\n\nNOTIFICATION: Updated findings from original wet read were communicated to\nthe QA Nurses at 11:53 p.m. on ___ via e-mail." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies. The patient is\nstatus post placement of posterior spinal fusion hardware consisting of\nbilateral vertical rods locked with transpedicular screws from L5-S1. There\nis no evidence of hardware fracture. There is no evidence of perihardware\nlucency. The pedicle screws appear well seated and well positioned, without\nneural foraminal or spinal canal encroachment. There is an interbody spacer\nat L5-S1.\n\nArtifact related to the metallic hardware somewhat obscures immediately\nadjacent structures. Within these confines:\n\nAlignment normal. Mild wedging of L1 is unchanged. Vertebral body heights\nelsewhere in the lumbar spine are preserved. Multilevel superior and inferior\nendplate Schmorl's nodes are noted. The left superior articular facet of S1\nhas been surgically removed (601:43).\n\nNo fracture. 9 mm sclerotic density in the left ilium, likely a bone island\n(301:82). 18 mm nonspecific sclerotic focus, midline sacrum at approximately\nS3 (2:93), without aggressive features, not fully evaluated.\n\nThere are at least moderate background lumbar spine degenerative changes\nincluding multilevel disc height loss, endplate osteophytes, and posterior\nelement hypertrophic changes. Specifically:\n\nT12-L1: There is vacuum disc phenomenon and narrowing of the intervertebral\ndisc space, irregular contour at L1 is consistent with Schmorl's node.\n\nL1-2: There is narrowing of intervertebral disc space posteriorly, irregular\ncontour at the endplates is consistent with Schmorl's node.\n\nL2-3: Mild posterior disc bulge with minimal superimposed midline disc\nprotrusion (301:37), without significant spinal canal narrowing. There is\nmild bilateral neural foraminal narrowing due to the disc bulge.\n\nL3-4: Marked disc height loss. No disc herniation. No spinal canal\nnarrowing. No neural foraminal narrowing.\n\nL4-5: Spinal canal widely patent. Diffuse disc bulge causes mild neural\nforaminal narrowing.\n\nL5-S1: There is an interbody spacer. No spinal canal or neural foraminal\nnarrowing.\n\nTortuous abdominal aorta with aortoiliac arteriosclerotic calcifications are\nseen. Postsurgical changes are noted in the lumbar posterior soft tissues. \nNo focal fluid collection. Prevertebral and paraspinal soft tissues are\notherwise unremarkable. Imaged portion of the abdomen pelvis, within normal\nlimits.", "output": "1. Moderate lumbar spondylosis. Spinal canal widely patent. Neural foraminal\nnarrowing is mild bilaterally at L2-3 and L4-5 levels.\n2. Status post posterior spinal fusion and interbody spacer, L4-5. No\nevidence of hardware complication.\n3. Chronic mild wedge deformity of L1, stable.\n4. Partially visualized 18 mm sclerotic focus in the mid sacrum at\napproximately S3. Although without aggressive features, appearance is\nnonspecific, differential includes low-grade cartilaginous lesion,\nposttraumatic change, bone infarct. Recommend comparison with outside\nhospital prior pelvic imaging; if not available, correlation with serum PSA\nand consideration of further evaluation with bone scan is recommended.\n\nRECOMMENDATION(S): Correlation with outside hospital pelvic imaging, if\navailable (as above). If this is not available, recommend correlation with\nserum PSA and consideration of further evaluation with bone scan." }, { "input": "Alignment is normal. No fractures are identified. No prevertebral soft tissue\nswelling is seen. Partially imaged left maxillary sinus demonstrates mucosal\nthickening.\n\nThe thyroid contains a 0.4 cm left lobe nodule, otherwise within normal\nlimits. Limited views of the lung apices are clear.", "output": "1. No acute fracture or dislocation of the cervical spine. Partially imaged\nleft maxillary sinus demonstrates mucosal thickening with possible aerosolized\ndebris.\n2. Tiny 0.4 cm left thyroid lobe hypodensity. ACR guidelines below.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no acute fracture or traumatic malalignment. Mild chronic rotatory\nsubluxation of the atlantodental articulation is unchanged. 2 mm\nanterolisthesis of C4 on C5 and retrolisthesis of C5 on C6 is unchanged from\nprior CTA examination. Severe loss C5-C6 disc height with endplate sclerosis\nand subcortical cystic change is also similar to prior exam. There is C5-C6\nmoderate canal stenosis and moderate to severe bilateral neural foraminal\nstenosis at this level.There is no prevertebral edema.\n\nA there is biapical pleuroparenchymal scarring. A 2-3 mm right upper lobe\npulmonary nodule (series 2, image 70) is noted. Otherwise, the remainder of\nthe lungs are clear. The thyroid gland is unremarkable. There is no cervical\nlymphadenopathy by size criteria. The visualized aerodigestive tract is\nunremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes most severe at C5-C6 with at least moderate\ncanal stenosis as well as moderate severe bilateral neural foraminal\nnarrowing.\n3. A 2-3 mm right upper lobe pulmonary nodule.\n4. Additional findings described above.\n\nRECOMMENDATION(S): For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "Minimal anterolisthesis C2-C3 is likely degenerative. There are advanced\ndegenerative changes in the cervical spine, with narrowed C3-C4, C4-C5, C5-C6,\nC6-C7 disc spaces, multilevel disc osteophyte complexes, endplate hypertrophic\nchanges. Posterior element degenerative changes. Mild loss of height of C5\nvertebral body is likely degenerative in etiology, there is no paravertebral\nedema. A nondisplaced C7 spinous process fracture appears well corticated, is\nchronic. There is no prevertebral edema. The thyroid and included lung\napices are unremarkable.\n\nThe patient has congenitally short pedicles, consistent with congenitally\nnarrow spinal canal. There is multilevel central canal narrowing, with most\nlikely moderate to severe canal narrowing at C4-C5, C5-C6, C6-C7 levels. \nThere is multilevel moderate to severe foraminal narrowing, most prominent at\nthe right C6-C7 foramen.", "output": "1. Mild anterior wedging of C4 is likely degenerative.\n2. Chronic C7 tip spinous process fracture.\n3. Alignment is normal.\n4. Advanced degenerative changes in the cervical spine, congenitally narrow\nspinal canal, multilevel moderate to severe central canal and foraminal\nnarrowing." }, { "input": "Alignment is atraumatic. No acute fractures are identified.\n\nEvaluation of the spinal cord is limited due to technique.\n\nThere is moderate to severe degenerative changes of the cervical spine at\nmultiple levels, worst at C4 through 7 with vertebral body height and disc\nspace loss.\n\nDisc bulge at C2-3, C3-4 mildly narrow the spinal canal. At C4-5, C5-6, C6-7,\nposterior disc bulge and uncovertebral hypertrophy moderately narrow the\nspinal canal at these levels.\nThere is neuroforaminal narrowing at multiple levels, most notable for\nmoderate to severe neural foraminal narrowing at C4-5 and C6-7 due to\nuncovertebral hypertrophy.\n\nThere is no prevertebral soft tissue swelling. There is luminal thickening of\nthe posterior ethmoid sinuses and multiple mucosal thickening of the left\nmaxillary sinus. The image portion of the lungs are clear.", "output": "1. Moderate to severe degenerative changes of the cervical spine as described\nabove.\n2. No acute fractures." }, { "input": "Alignment is atraumatic. No acute fractures are identified in the thoracic\nspine. Anterior wedging deformity of T11 and T12 are stable since ___. \nThere is no evidence of thoracic spinal canal stenosis. Vacuum phenomenon of\nthe disc spaces are seen at multiple levels, likely from degenerative changes.\nThere is no prevertebral soft tissue swelling. Chronic deformity of left L2\ntransverse process and chronic displaced fracture of left L3 transverse\nprocess are seen. There is bibasilar atelectasis. Right simple renal cyst and\nbilateral nonobstructing renal stones are unchanged since ___.", "output": "1. No acute fracture. Chronic fractures as described above.\n2. Right simple renal cyst, unchanged since ___.\n3. Bilateral nonobstructing renal stones." }, { "input": "Alignment is normal. No acute fractures are identified. There is stable\nappearance of L2 left transverse process deformity and displaced fracture of\nL3 left transverse process. There is no prevertebral soft tissue swelling.\n\nPatient is status post X-STOP procedure per OMR with hardware seen at C3\nthrough 5. There has been interval worsening of the degenerative changes at\nC3 through C5 with endplate changes, and vertebral body and disc space height\nloss. There is severe narrowing of the spinal canal at L3-4, and L4-5 from\nposterior disc bulge, unchanged from ___. There is moderate to severe neural\nforaminal narrowing at left L4-L5, L5-S1 due to facet hypertrophy and left\nparacentral disc bulge, unchanged since ___.\n\nThe simple renal cysts and bilateral nonobstructing renal stones are unchanged\nsince ___.\n\nThere is a right iliac bone island.", "output": "1. Moderate to severe degenerative changes of the lumbar spine, as above.\n2. No acute fracture." }, { "input": "There is no acute fracture or traumatic alignment abnormality. The base of\ndens is intact. There are multilevel degenerative changes with mild to\nmoderate disc space narrowing most pronounced at C5-6 and C6-7 levels. No\nprevertebral edema. No critical central canal or neural foraminal stenosis. \nFacet arthropathy is slightly more pronounced on the left than right. The\nthyroid is unremarkable.", "output": "1. No fracture or traumatic malalignment.\n2. Multilevel degenerative changes as described above." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes notable\nfor intervertebral disc height loss and posterior osteophytes most notably at\nC6-7. Disc bulges at C4-5 and C5-6 contribute to at least mild canal\nnarrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Partially visualized\nchronic left clavicular fracture is noted. Endotracheal tube is identified.", "output": "No cervical spine fracture or malalignment." }, { "input": "Redemonstration of postsurgical changes from L4 and L5 laminectomies and\nposterior lumbosacral spine fusion hardware, with pedicle screws in the L4,\nL5, and S1 levels and adjacent bone grafts. An intervertebral disc spacer is\nseen at the L4-5 level. Small foci of air are compatible with recent surgery. \nNo evidence of hardware related complications.\n\nAlignment is normal. No traumatic fractures are identified. Moderate\ndegenerative changes is noted at the L5-S1 level with vertebral body\nosteophytosis. There is no evidence of severe spinal canal stenosis. Mild\nbilateral neural foraminal narrowing at L5-S1 is unchanged. There is no\nprevertebral soft tissue swelling. Incidental note is made of mild\natherosclerotic calcifications in the distal abdominal aorta.", "output": "Postsurgical changes from L4 and L5 laminectomies and posterior spinal fusion\nof L4 through S1 with no evidence of hardware related complications." }, { "input": "There is no fracture or traumatic malalignment. There are multilevel\nmultifactorial degenerative changes of the cervical spine including disc space\nnarrowing, endplate osteophytes, and uncovertebral hypertrophy most pronounced\nat C4-C5 thru C7-T1. Additionally, there is facet hypertrophic changes worse\non the right at C2-3 and C3-C4. Incidental note is made of the retropharyngeal\ncourse of the common carotid arteries. The thyroid is unremarkable.\n\nThere is partially visualized fullness of the soft palate on the riht and\nposterior tongue on the left.", "output": "1. No acute fracture traumatic malalignment.\n2. Multilevel multifactorial degenerative changes.\n3. Fullness of the soft tissues in the region of the soft palate on the right\nand tongue on the left, for which direct visualization is recommended to\nevaluate for possible lesion or denervation." }, { "input": "Alignment appears unchanged. Minimal spondylolisthesis of C2 on C3 and C3 on\nC4 is unchanged. There is no evidence of fracture, dislocation or bone\ndestruction. No prevertebral soft tissue swelling. Bones appear\ndemineralized. Fairly severe degenerative changes are stable. These include\nmoderate narrowing of the atlanto dens articulation and very similar moderate\nto severe bilateral facet joint degenerative changes at C2-C3 and C3-C4\naccompanied by mild bilateral neural foraminal narrowing at C2-C3, moderate\nright-sided neural foraminal narrowing at C3-C4, and mild left-sided neural\nforaminal narrowing at C3-C4. The C3-C4 interspace is moderately narrowed. \nThe C4-C5 interspace is severely narrowed. There is moderate to severe\nright-sided and moderate left-sided neural foraminal narrowing due to mostly\nto uncovertebral joint osteophytes. The C5-C6 through C7-T1 interspaces are\nfused with shallow posterior osteophytic ridges and anterior osteophytes but\nwithout substantial neural foraminal narrowing. At C5-C6 and C6-C7 there is\nno substantial visible neural foraminal narrowing. Each carotid bulb is\nmedialized and heavily calcified. Visualized lung apices appear clear.", "output": "No evidence of fracture or dislocation. No significant change." }, { "input": "Alignment is normal.No acute fractures are identified. Severe degenerative\nchanges are seen throughout the cervical spine, including disc height loss,\nendplate sclerosis, and osteophyte formation, most significant at C4-C5. It\nhas there is mild anterolisthesis of C7 on T1. There is no significant spinal\ncanal or neural foraminal narrowing. There is no prevertebral soft tissue\nswelling.\n\nThe lung apices are clear. The thyroid gland is unremarkable.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Multilevel severe degenerative disease as described above." }, { "input": "There is no evidence for a fracture. There is a well corticated non fusion\ndefect between the laminae a of C6. There is 2 mm anterolisthesis of C2 on\nC3. There is no evidence for prevertebral soft tissue swelling. There is no\ndisc space widening or distraction of the posterior elements.\n\nAt C4-C5, there is a tiny right paracentral disc protrusion without spinal\ncanal narrowing. No spinal canal narrowing is seen elsewhere in the cervical\nspine.\n\nProminent adenoids, tonsils, and anterior cervical lymph nodes are likely\nrelated to the patient's young age. However, there is also a minimally\nenlarged 1.1 cm left level 5 lymph node on image 3:45 and a top-normal 1.0 cm\nright level 5 lymph node on image 3:46, which may be associated with a\nsystemic process, most commonly a viral infection.\n\nThe thyroid is unremarkable.\n\nIncidental note is made of an accessory azygos fissure in the visualized right\nupper lung. The lung apices are otherwise unremarkable.", "output": "1. No cervical spine fracture.\n2. 2 mm anterolisthesis of C2 on C3 may be secondary to normal ligamentous\nlaxity in an ___ patient. There are no secondary signs of acute\nligamentous injury. However, correlation with any localizing symptoms and any\npoint tenderness is needed.\n3. Prominent adenoids, tonsils, and anterior cervical lymph nodes are likely\nrelated to the patient's young age. However, there is also a minimally\nenlarged 1.1 cm left level 5 lymph node and a top-normal 1.0 cm right level 5\nlymph node, which may be associated with a systemic process, most commonly a\nviral infection.\n\nRECOMMENDATION(S): If the patient has neck pain and/or tenderness related to\nthe C2-C3 level, then MRI is suggested for further assessment of the 2 mm\nanterolisthesis at C2-C3.\n\nNOTIFICATION: Dr. ___ the impression items 2 and 3 and the\nrecommendations above to the ED QA nurses list at 09:24 on ___, 5\nmin after discovery." }, { "input": "There is type 3 fracture level and process identified with the lower fragment\n2 mm posterior to the upper fragment but without significant narrowing of the\nspinal canal. Both fragments are in apposition with mild sclerosis at the\nmargin. The atlanto odontoid space is well maintained. There is osteopenia\nwithout visualized bony structures. There is no spinal canal narrowing with\nmild degenerative changes identified.", "output": "530 or moderate fracture identified with some sclerosis at the margin." }, { "input": "Please note the study is substantially degraded by motion.\n\nThere is a nondisplaced fracture of the posterior arch of C1 vertebral body\nwith sclerotic margins. There is interval increased sclerosis and mild\nimpaction along the margins of of the type 3 dens fracture which extends into\nthe right foramen transversarium. There is approximately 3 mm of anterior\ndisplacement of the dens relative to the C2 vertebral body. There is mild to\nmoderate right neural foraminal stenosis secondary to the fracture. No other\nsite of significant neural foraminal stenosis is seen.\n\nThere is multilevel uncovertebral hypertrophy and facet arthropathy. \nMultilevel disc space height loss, endplate sclerosis and marginal osteophyte\nformation is seen, worse at C 5- 6, C6-7 and C7-T1. There is stable grade 1\nanterolisthesis of C4 on 5. There is mild spinal canal stenosis at C5-6. \nThere is no prevertebral soft tissue swelling.\n\nThere is atherosclerotic calcification of the carotid bulbs. There is a\nchronic appearing fracture the posterior right first rib.", "output": "1. Markedly motion degraded study limiting evaluation for subtle new\nfractures.\n2. Healing nondisplaced fracture of the posterior arch of C1.\n3. Healing mildly impacted type 3 dens fracture, extending into the right\nforamen transversarium with stable 3 mm of anterior displacement of the dens\nrelative to the C2 vertebral body.\n4. Degenerative changes throughout the cervical spine, as described above." }, { "input": "No fractures are identified. There is minimal anterolisthesis of C3 on C4 and\nC7 on T1, similar to prior MRI. No new malalignment. There is multilevel\ndegenerative disease of the cervical spine noting multilevel uncovertebral\njoint hypertrophy, osteophytosis and facet arthropathy resulting in mild canal\nnarrowing, worst at C5-C6 and C6-C7 and moderate neural foraminal narrowing,\nworst at C4-C5 bilaterally and C5-C6 on the left.There is no prevertebral\nedema.\n\nThe lobe left thyroid lobe is surgically removed. The right thyroid lobe is\nheterogeneous without discrete nodule. The lung apices are unremarkable.", "output": "1. No acute cervical spine fracture or malalignment.\n2. Cervical spondylosis." }, { "input": "There are 12 rib-bearing vertebrae. Pathologic comminuted fracture of the T3\nvertebral body with mild loss of height is again seen. The underlying bone\nlesion does not appear lytic or sclerotic, better demonstrated on the\npreceding MRI. Associated soft tissue lesion at this level extending into the\nanterior epidural space and abutting the ventral spinal cord is better seen on\nthe preceding MRI. No additional fractures are seen. Dextroconvex curvature\nof the thoracic spine is noted.\n\nThe patient is intubated with ETT tip in appropriate position. Partially\nvisualized dependent pulmonary opacities in the included bilateral lower lobes\nare nonspecific but compatible with atelectasis.", "output": "Pathologic fracture of T3 vertebral body with mild loss of height. The\nunderlying bone lesion does not appear lytic or sclerotic, and it is better\ndemonstrated on the preceding MRI. Soft tissue mass extending into the\nanterior epidural space and abutting the ventral spinal cord is also better\nassessed on the preceding MRI." }, { "input": "Alignment is normal. No fractures are identified. There is moderate\ndegenerative change, worst at C5-6, with disc space narrowing, endplate\nsclerosis, and moderate spinal canal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No acute fracture.\nNutrient channel left scapula series 2, image 37.. Multilevel degenerative\nchanges, Schmorl's nodes, few benign foci of sclerosis. No prevertebral\nedema.\n\nParaseptal, centrilobular emphysema. 7 mm partially seen ground-glass nodular\nopacity left lung series 2, image 27. Included partially imaged upper abdomen\ndemonstrates significant motion artifact but no acute abnormalities.", "output": "No fracture.\nDegenerative changes thoracic spine.\n7 mm ground-glass nodule left lung, recommendations below.\n\nRECOMMENDATION(S): For an incidentally detected single ground-glass nodule\nbigger than 6mm, CT follow-up in 6 to 12 months is recommended to confirm\npersistence. If persistent, CT follow-up every ___ years until ___ years after\ninitial detection are recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "Minimal retrolisthesis L1-L2. No fracture. No paravertebral edema.\n\nDegenerative changes lumbar spine, multilevel mild diffuse disc bulges. \nLumbar facet arthritis. Multilevel mild central canal narrowing. Moderate\nbilateral L4-5, moderate to severe bilateral L5-S1 foraminal narrowing. No\nsoft tissue abnormality.", "output": "No fracture.\nDegenerative changes, as above." }, { "input": "Mild retrolisthesis of C3 over C4 is likely degenerative in nature. Remainder\nof the alignment is preserved, without traumatic subluxation.No acute\nfractures are identified. There is no prevertebral edema.\n\nModerate degenerative changes are present diffusely, including intervertebral\ndisc height loss, subchondral sclerosis and posterior osteophytosis most\nsevere at C3/4 and C6/7. Mild to moderate central canal narrowing is most\npronounced at C6/7. Digitally, mild-to-moderate bilateral neural foraminal\nnarrowing is most severe on the left at C3/4 and bilaterally at C6/7. Well\ncorticated lucencies through the bodies of C3 and C4 are most likely vascular\nchannels.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Moderate degenerative changes. Mild retrolisthesis of C3 on C4 is likely\ndegenerative in etiology." }, { "input": "No fracture or malalignment is seen in cervical spine. Loss of disc space is\nnoted at C5-6 and C6-7, moderate. No prevertebral edema. There is no\ncritical central canal or neural foraminal stenosis. The lung apices are\nclear. Thyroid gland appears normal. Base of dens is intact.", "output": "No fracture or malalignment. Mild to moderate degenerative disease in the\nlower C-spine." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing. Left central disc protrusion at C5-6 partially\neffaces the ventral CSF. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThe thyroid and lung apices are unremarkable.", "output": "No fracture or malalignment." }, { "input": "Alignment is normal...There is no prevertebral edema. Left neck,\nsupraclavicular soft tissue stranding, likely posttraumatic visualized\nclavicle, ribs are intact. There are subtle fractures of the posterior left\nC5 tubercle and anterior left C6 tubercle of the transverse processes. No\nfracture extension into the foramen transversarium. There is mild edema\ninvolving posterior left sternocleidomastoid. Multilevel mild degenerative\nchanges cervical spine. Minimal anterolisthesis C4-C5. Alignment is\notherwise normal. No CT evidence of significant central canal narrowing. \nThere is multilevel mild central canal narrowing from disc osteophyte\ncomplexes, most prominent at C3-C4 level. Multilevel mild-to-moderate\nforaminal narrowing.\n\nThe thyroid gland is slightly asymmetric. Included lung apices are\nunremarkable. Paranasal sinus disease, better seen on CT head", "output": "Acute fractures of the left C5, C6 anterior and posterior tubercles,\nrespectively, of the transverse processes, without evidence of involvement of\nthe foramen transversarium.\nLeft lower neck soft tissue swelling.\nMinimal anterolisthesis C4-C5 likely degenerative secondary to prominent\nposterior element degenerative changes at this level, clinically correlate.. \nNo prevertebral edema\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 9:58 am, 5 minutes after\ndiscovery of the findings." }, { "input": "Cervical vertebral bodies are maintained in height and alignment. There is no\nfracture. There is straightening of the normal cervical lordosis. \nPrevertebral soft tissues are unremarkable. Multilevel degenerative changes\nare seen with intervertebral disc height loss and uncovertebral joint\nhypertrophy most notably a C2-C3 and C3-C4 multilevel disc bulges are also\nidentified most extensive at C5-C6 which effaces the ventral CSF at this level\nand likely contacts the cord.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or malalignment. Multilevel degenerative changes." }, { "input": "There is grade 1 retrolisthesis of L3 over L4, similar to ___. No\nfractures are identified. There is no prevertebral soft tissue swelling. There\nis no evidence of infection or neoplasm. There is no abnormal enhancement on\npost contrast imaging. There is generalized osteopenia, unchanged since ___.\n\nSevere degenerative changes are identified at multiple levels of the lumbar\nspine.\n\nAt L1-2 there is moderate spinal canal narrowing due to bulging of the disc\nand thickening of the ligamentum flavum.\n\nAt L2-3 there is moderate -severe spinal canal narrowing due to disc bulging\nand marked thickening of the ligamentum flavum. Although the bulge extends\ninto the neural foramina, there does not appear to be compression of the\nexiting nerve roots.\n\nAt L3-4 there is severe spinal canal narrowing due to disc bulge, facet\nosteophytes and profound thickening of the ligamentum flavum. .The disc bulge\nextends into the neural foramina bilaterally, greater on left than right, but\ndoes not appear to compress the exiting nerve roots.\n\nAt L4-5 there is severe spinal canal narrowing due to disc bulge, facet\nosteophytes and thickening of the ligamentum flavum. There is narrowing of\nthe distal right neural foramen with likely compromise of the exiting right L5\nnerve root.\n\nAt L5-S1 there is no spinal canal narrowing. Intervertebral and facet\nosteophytes narrow the neural foramina bilaterally with likely compromise of\nthe exiting L5 nerve roots bilaterally\n\nMetallic hardware is noted at bilateral hips.\n\n1.4 cm exophytic cyst is noted in the mid right kidney. Other subcentimeter\nhypodensities in bilateral kidneys are too small to be characterized. Colonic\ndiverticulosis is noted. Heavy atherosclerotic calcification is noted at the\nabdominal aorta. Bilateral pleural effusions are small.", "output": "1. No evidence of infection is identified. Note that MR imaging is far more\nreliable for detecting spinal infection.\n\n2. Degenerative changes of the lumbar spine.\n3. Colonic diverticulosis.\n4. Small bilateral pleural effusions." }, { "input": "Alignment is anatomic. No acute fractures are identified. There are\nmultilevel degenerative changes notable for intervertebral disc height loss,\nposterior osteophytes and uncovertebral joint hypertrophy. These changes are\nseen to extend from C2-3 through C6-7 result up to mild-to-moderate canal\nnarrowing at C4-5. Mild to moderate foraminal narrowing is also noted on the\nleft at this level as well. Moderate right foraminal narrowing is noted at\nC6-7. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. A well-circumscribed\nlucency in the left C6 facet (401:39) does not demonstrate any suspicious\nfeatures and appears to have fat internal density and is of doubtful clinical\nsignificance.", "output": "No acute fracture or traumatic subluxation." }, { "input": "Horizontal linear sclerosis through the mid C2 vertebral body without any\ndefinite break the cortex or associated prevertebral soft tissue swelling\n(series 602b, image 32) may reflect trabecula, however if focal exam findings\nsuggest injury at this level, further evaluation with MR could be performed to\nexclude acute traumatic non-displaced fracture. Alignment of the cervical\nspine is normal. No prevertebral soft tissue swelling. No loss of vertebral\nbody height. No evidence of spinal canal or neural foraminal stenosis.\n\nVisualized lung apices are clear. Visualized soft tissues of the neck are\ngrossly unremarkable on noncontrast assessment", "output": "1. No definite acute cervical spine fracture.\n\n2. Horizontal linear sclerosis through the mid C2 vertebral body without any\ndefinite break the cortex or associated prevertebral soft tissue swelling\n(series 602b, image 32) may reflect trabecula, however if focal exam findings\nsuggest injury at this level, further evaluation with MR could be performed to\nexclude acute, non-displaced fracture. This additional finding was discussed\nwith Dr. ___ on ___ at 3:11 am (initially paged at 218 am).\n\n3. Normal cervical spine alignment.\n\nCOMMENTS ON ATTENDING REVIEW:\n\nThere is no fracture. The finding described in impression item 2 corresponds\nto the normal fusion site of the odontoid process ossification center.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ in ___ ___ at 2:01 AM, 1 minutes after discovery of the\nfindings.\n\nThe possible C2 finding was discussed by Dr. ___ with Dr. ___\n___ on the telephone on ___ at 3:11 am, 1h after discovery of the\nfindings." }, { "input": "Cervical spine: No acute fractures are identified.There multilevel\ndegenerative changes, worst at C4-C5 and C5-C6, evidenced by disc space\nnarrowing, osteophytosis, and uncovertebral and facet hypertrophy. These\nchanges cause minimal effacement of the ventral thecal sac at C4-C5 and C5-C6.\nNo significant neural foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Prominent cerumen is\nnoted in the bilateral external auditory canals.\n\nThoracic spine: No fractures are identified. Apparent cortical irregularity\nof the right T1 lamina is unchanged dating back to ___ and likely\nrepresents a nutrient channel (___). There is bibasilar consolidation, which\nmay represent atelectasis with aspiration or pneumonia not excluded in the\nproper clinical setting.\n\nLumbar spine: No acute fractures are identified. There is 1-2 mm\nretrolisthesis of L2 on L3, L3 on L4 and L4 on L5, similar to prior\nexamination. No evidence of traumatic malalignment. There is no prevertebral\nsoft tissue swelling. Degenerative loss of disc height is mild to moderate\ndiffusely throughout the lumbar spine with vacuum disc phenomenon at L2-L3 and\nL5-S1. There are disc bulges spanning L1-L2 through L5-S1, similar in size to\nprior examination, demonstrating calcifications. In combination with\nthickening of the ligamentum flavum, the disc bulges results in mild spinal\ncanal narrowing, most prominently noted at the L2-L3 and L3-L4 levels. \nMultilevel neural foraminal narrowing is identified. These are most prominent\nat the left L3-L4 where there is moderate to severe narrowing and at the left\nL5-S1 where there is severe narrowing, similar to prior examination. \nVisualized prevertebral paraspinal soft tissues are grossly unremarkable.", "output": "1. No evidence of acute fracture or malalignment of the cervical, thoracic or\nlumbar spine.\n2. Multilevel degenerative changes of the imaged spine, most prominently noted\nin the lumbar spine where there is left L5-S1 severe neural foraminal\nnarrowing.\n3. Additional findings as described above." }, { "input": "Cervical spine: No acute fractures are identified.There multilevel\ndegenerative changes, worst at C4-C5 and C5-C6, evidenced by disc space\nnarrowing, osteophytosis, and uncovertebral and facet hypertrophy. These\nchanges cause minimal effacement of the ventral thecal sac at C4-C5 and C5-C6.\nNo significant neural foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Prominent cerumen is\nnoted in the bilateral external auditory canals.\n\nThoracic spine: No fractures are identified. Apparent cortical irregularity\nof the right T1 lamina is unchanged dating back to ___ and likely\nrepresents a nutrient channel (___). There is bibasilar consolidation, which\nmay represent atelectasis with aspiration or pneumonia not excluded in the\nproper clinical setting.\n\nLumbar spine: No acute fractures are identified. There is 1-2 mm\nretrolisthesis of L2 on L3, L3 on L4 and L4 on L5, similar to prior\nexamination. No evidence of traumatic malalignment. There is no prevertebral\nsoft tissue swelling. Degenerative loss of disc height is mild to moderate\ndiffusely throughout the lumbar spine with vacuum disc phenomenon at L2-L3 and\nL5-S1. There are disc bulges spanning L1-L2 through L5-S1, similar in size to\nprior examination, demonstrating calcifications. In combination with\nthickening of the ligamentum flavum, the disc bulges results in mild spinal\ncanal narrowing, most prominently noted at the L2-L3 and L3-L4 levels. \nMultilevel neural foraminal narrowing is identified. These are most prominent\nat the left L3-L4 where there is moderate to severe narrowing and at the left\nL5-S1 where there is severe narrowing, similar to prior examination. \nVisualized prevertebral paraspinal soft tissues are grossly unremarkable.", "output": "1. No evidence of acute fracture or malalignment of the cervical, thoracic or\nlumbar spine.\n2. Multilevel degenerative changes of the imaged spine, most prominently noted\nin the lumbar spine where there is left L5-S1 severe neural foraminal\nnarrowing.\n3. Additional findings as described above." }, { "input": "Alignment is normal. No fractures are identified. Mild multilevel\ndegenerative changes are noted in cervical spine most notable at C2-C3 through\nC5-C6. There is no significant canal or foraminal narrowing.There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or prevertebral edema." }, { "input": "Alignment is normal. No fractures are identified.Again seen are mild\nmultilevel degenerative changes throughout the cervical spine, most notable at\nC2-3 through C5-6, similar to prior.There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.", "output": "No acute fracture or traumatic subluxation of the cervical spine." }, { "input": "There is mild 2 mm retrolisthesis of C6 on C7, likely secondary to chronic\ndegenerative change. Alignment is otherwise maintained. No fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nMild degenerative changes are noted of the cervical spine, with loss of\nintervertebral disc height, worst at C6-C7, endplate sclerosis and vertebral\nbody osteophytosis. Two areas of soft tissue calcification are noted in the\nposterior neck (602b:31)\n\n There is no prevertebral soft tissue swelling.There is no lymphadenopathy by\nCT criteria. The thyroid is grossly unremarkable. The imaged lung apices are\nclear.", "output": "1. Mild degenerative changes of the cervical spine, as described above,\nwithout evidence of spinal canal or neural foraminal stenosis.\n2. Soft tissue calcifications seen in the posterior neck (series 602b, image\n31), which may represent fat necrosis or injection granulomas." }, { "input": "Alignment is normal. No acute fractures are identified. Minimal height loss\nof the C6 vertebral body is likely chronic/degenerative in nature. Multilevel\ndegenerative changes the cervical spine are mild. Mild central canal\nnarrowing multilevel foraminal narrowing, most prominent and probably severe\nat the right C3-C4 foramen.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\nMedial deviation of the left true vocal cord is suggested, exam through the\nlarynx is motion degraded. Local cord paresis should be excluded.\nThe imaged thyroid gland is unremarkable. The lung apices are clear.", "output": "1. No acute fracture or traumatic subluxation.\n2. Mild multilevel degenerative changes.\n3. Suggestion of left vocal cord paresis, images through the larynx are motion\ndegraded. Clinical correlation, and direct visualization recommended if\nindicated.\n\nRECOMMENDATION(S): The impression and recommendation above was entered by Dr.\n___ on ___ at 09:00 into the ED department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "No fracture or traumatic malalignment. Multilevel degenerative changes are\nmost severe at the levels of C1/C2 on the left, C5-6 and C6-7, were there is\ndisc height loss and anterior osteophytosis. There is unchanged mild\nanterolisthesis at C4 upon C5 and mild retrolisthesis at C5 upon C6 level,\nlikely degenerative in nature. Uncovertebral joint hypertrophy is seen at\nmultiple levels as well. The prevertebral soft tissues are unremarkable. \nThyroid gland has multiple nodules, measuring up to 1 cm on the left. Lung\napices are clear.", "output": "1. No fracture or traumatic malalignment. Multilevel multifactorial\ndegenerative changes throughout the cervical spine as described above\n2. Multinodular thyroid gland." }, { "input": "Postoperative changes reflecting laminectomy at L4 and L5 with posterior\nfusion spanning L4 through S1. There are pedicle screws at L5 and S1 on the\nright and L4, L5 and S1 on the left. There is a fracture involving the right\ntransverse process at L4 which is likely iatrogenic. The left L4 pedicle\nscrew is also associated with a subtle fracture through the transverse process\nof L4.a the pedicle screws at L5 and S1 appear well-positioned. Bone graft\nmaterial is seen along the laminectomy site. Pars defects are noted at L5\nbilaterally. There is again noted to be a grade 1 anterolisthesis of L5 on S1\nwith significant degenerative disease at this level including disc space\nnarrowing, endplate sclerosis and small endplate cysts with mild spur\nformation. The remainder of the disc levels are well preserved. There is a\nfluid collection within the soft tissues posterior to the level of surgery\nlikely representing a postop seroma. A small amount of gas within this\ncollection reflect postop status. Please note superinfection is impossible to\nexclude at this level.\n\nThe imaged portion of the abdomen/pelvis is unremarkable. No large hematoma\nis seen.", "output": "1. Postop laminectomy and posterior spinal fusion from L4 through S1 with\npostoperative changes as described. Postop fluid collection at the surgical\nbed noted likely organizing blood products, difficult to exclude\nsuperinfection.\n2. Fractures involving the L4 bilateral transverse process likely iatrogenic,\nmay contribute to symptoms of pain." }, { "input": "There is multilevel degenerative changes and moderate cervical spondylosis,\nmost prominent at C5-C6. There is mild anterolisthesis of C3 on C4 and\nminimal anterolisthesis of C4 on C5. Partial fusion of right C2-C5 facet\njoints. No fractures are identified.There is no significant canal or\nforaminal narrowing.There is no prevertebral edema.\n\nThe thyroid gland is enlarged and contains a calcification and a approximately\n1 cm hypodensity in the left lobe. Included lung apices are unremarkable.", "output": "1. No evidence of acute fracture of the cervical spine.\n2. Anterolisthesis is may be secondary to degenerative changes. However\nwithout prior imaging, if there is concern for ligamentous injury MRI is more\nsensitive.\n3. Enlarged thyroid with 1 cm hypodensity in the left lobe. Correlation with\nthyroid function tests is recommended." }, { "input": "No acute fracture is seen. Subtle anterolisthesis of C4 on C5 is unchanged\nfrom prior MRI. Multilevel degenerative disc disease is noted, most\npronounced at C5-6, C6-7 and C7-T1 with significant disc space narrowing. \nRight greater than left facet arthropathy is is most pronounced C3-4 and C4-5\nlevels. Neural foraminal narrowing is moderate to severe at C5-6 bilaterally.\nUncovertebral joint hypertrophy is also noted at multiple levels in the mid\ncervical spine. Lung apices are grossly clear. The thyroid is unremarkable. \nNo prevertebral edema.", "output": "1. No acute fracture. Stable mild anterolisthesis of C4 on 5.\n2. Multilevel degenerative changes, detailed above." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThere is minimal degenerative disc disease with sclerosis at the\nanteroinferior endplates of T12 and L4. Mild atherosclerotic calcifications\nare seen within the inferior abdominal aorta.\n\nThere is a partially visualized fat containing retroperitoneal lesion adjacent\nto the left psoas muscle, which is better evaluated on the pelvic CT with the\nsame date.", "output": "1. No acute fracture or malalignment.\n2. Partially visualized fat containing retroperitoneal lesion adjacent to the\nleft psoas muscle, better evaluated on the pelvic CT with the same date." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThe thyroid and lung apices are within normal limits. There is no cervical\nlymphadenopathy.", "output": "No evidence of acute fracture or malalignment." }, { "input": "There is no acute fracture or alignment abnormality. There is no prevertebral\nsoft tissue swelling. There are multilevel degenerative changes of the\ncervical spine, particularly at C5-C6 for a posterior disc osteophyte complex\nindents the thecal sac. Limited, non-contrast appearance of the included soft\ntissues is unremarkable. Calcification is extensive at the right carotid\nbulb. No concerning abnormality is seen in the included upper lungs.", "output": "No evidence of acute cervical spine fracture or subluxation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Within the limitations of this noncontrast exam, there is no\nevidence of infection or neoplasm. A 6 mm hypodensity is noted in the left\nlobe of thyroid gland. Bilateral maxillary sinus mucosal thickening is noted,\nas is a mucous retention cyst in the left maxillary sinus.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "Alignment is maintained. There is mild retrolisthesis of the C4-C5 vertebral\nlevel, unchanged since ___. No fractures are identified. Mild\ndegenerative changes are seen along the cervical spine. There is multilevel\nmild vertebral canal narrowing due to posterior osteophyte formation and\nposterior disc bulges, most pronounced at the C3-C4 level with resultant\nflattening of the spinal cord. There is multilevel uncovertebral and facet\njoint arthropathy without evidence of high-grade neural foraminal stenosis. \nThere is no prevertebral soft tissue swelling. Atherosclerotic calcifications\nare seen at the bilateral carotid bifurcations. Calcifications and a 8 mm\nhypodensity is seen in the right thyroid lobe, similar to the prior exam in\n___. The lung apices appear clear.", "output": "No acute fracture or traumatic malalignment" }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or malalignment." }, { "input": "Again seen is a fracture through the base of the dens, extending into the left\nvertebral foramen, which has minimally increased in its degree of displacement\nfrom the study done on ___. Multilevel degenerative change most\nsignificant at C6-C7 is stable. There is no evidence of spinal canal or neural\nforaminal narrowing. There is no significant prevertebral soft tissue swelling\nidentified.", "output": "Previously described fracture through the base of the dens which extends into\nthe left vertebral foramen has increased in its degree of displacement from\nthe prior study. If there is concern for vascular injury, consider CTA for\nfurther evaluation.\n\nNOTIFICATION: These findings were communicated to Dr. ___ telephone\nat 14:50 on ___ by Dr. ___ at the time of discovery." }, { "input": "There is anterolisthesis of C2 on C3 and C5 on C6, and approximately 2 mm of\nanterolisthesis of C3 on C4 and C4 on C5. No fractures are\nidentified.Multilevel degenerative changes are seen, most extensive at C3-4\nand C5-6 and notable for moderate to severe neural foraminal narrowing at\nthese levels as well as facet osteophytes and partial fusion.There is no\nprevertebral edema.\n\nThe thyroid and included lung apices appear normal.", "output": "1. No evidence of fracture or traumatic subluxation.\n2. Multilevel anterolisthesis is most likely related to severe multilevel\ndegenerative change, though no prior is available for comparison." }, { "input": "No alignment abnormalities identified. No fractures are identified.There are\nmultilevel moderate to severe degenerative changes including anterior and\nposterior osteophytosis, endplate sclerosis, and intervertebral space\nnarrowing from C3-C7, (series 602, image 39).There is moderate to severe\nspinal canal stenosis and bilateral neural foraminal narrowing, most\npronounced at C5-6 and C6-7. There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm.\n\nLeads from a deep brain stimulator device course along the left neck. A 15 mm\nthyroid hypodense nodule is demonstrated. Imaged lung apices demonstrate\nminimal scarring.", "output": "1. No acute fracture or subluxation.\n2. Multilevel moderate to severe degenerative changes, with moderate to severe\nspinal canal and bilateral neural foraminal narrowing, worse at C5-6 and C6-7.\n3. 15 mm left thyroid hypodense nodule. See recommendations below.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on the\ntelephone on ___ at 2:04 pm." }, { "input": "Normal alignment. No fracture. No prevertebral edema.\n\nMultilevel degenerative changes, disc space narrowing, disc osteophyte\ncomplexes, posterior element hypertrophic changes. Mild-to-moderate central\ncanal narrowing C4-C5 level. Probable moderate to severe foraminal narrowing\nat the left C4-C5, left C5-C6 foramina.\n\nDiffusely enlarged thyroid gland, no discrete nodule, consider thyroiditis.\n\nSymmetric enlarged soft tissue at the base of ___ represent reactive\nchange.. Fullness at the posterior right oropharynx may represent volume\naveraging of the deviated uvula and soft palate. Direct visualization\nrecommended.", "output": "1. No acute findings.\n2. Prominent soft tissue at the tongue base may represent reactive lingual\ntonsils. Asymmetric fullness right oropharynx. Direct visualization\nrecommended.\n3. Suggestion of thyroiditis.\n\nRECOMMENDATION(S): Direct visualization of the oropharynx." }, { "input": "The cervical vertebral body heights and alignment are well maintained without\nfracture or malalignment. The prevertebral soft tissues are unremarkable.\nThere are mild multilevel degenerative changes with disc space narrowing most\nprominent at C5/C6 and C6/C7. Anterior and posterior osteophytes are noted of\nthe same levels. Posterior osteophytes at these same levels minimally indent\nthe ventral thecal sac. There is mild multilevel uncovertebral and facet\njoint arthropathy. The thyroid is unremarkable. Hypoventilatory changes are\nseen in the lung apices.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is no evidence of cervical fracture or subluxation. There is no\nprevertebral soft tissue swelling. CT is not able to provide intrathecal\ndetail comparable to MRI, however the visualized outline of the thecal sac\nappears unremarkable.\n\nThe thyroid gland is normal. The lung apices are clear.", "output": "Normal study" }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture. \nMild, multilevel degenerative changes are noted throughout the cervical spine\nin without critical spinal canal stenosis. Intervertebral disc space heights\nare grossly maintained. No acute alignment abnormality is identified. There\nis no prevertebral soft tissue abnormality.\n\nThe thyroid is grossly unremarkable in appearance. No lymphadenopathy is\npresent by CT size criteria. The visualized lung apices are clear.", "output": "No evidence of acute fracture or malalignment." }, { "input": "Cervical vertebral body heights and alignment are well maintained without\nevidence of fracture or malalignment. The prevertebral soft tissue is\nunremarkable. There are minimal degenerative changes. The neural foramina\nappear grossly patent. There is focally increased facet joint hypertrophy at\nC7/T1 on the left with mild narrowing of the associated left foramen\ntransversarium. Though CT resolution of the thecal sac is limited, the\ncontours appear preserved. The imaged lung apices are clear. The thyroid is\nunremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "No evidence of acute cervical spine fracture. Overall alignment of the\ncervical spine is similar to ___. Multilevel degenerative changes in the\ncervical spine are moderate to severe, progressed since ___. Mild loss of C4\nvertebral body height may be slightly progressed since the prior exam. Mild\nloss of C5 and C6 vertebral body heights is similar to ___. Mild\nretrolisthesis of C5 on C6 and minimal anterolisthesis of C7 on T1 appears\nsimilar to prior, likely degenerative. No significant neural foraminal\nstenosis. Multiple levels of broad-based central disc bulges from C3-C4\nthrough C6-C7 indent the anterior thecal sac. No prevertebral soft tissue\nswelling. No suspicious osseous lesions for malignancy. Partial\nopacification of some of the right mastoid air cells with suggestion of a\nsmall amount of debris and/or fluid in the right middle ear cavity is slightly\nworse since ___.", "output": "1. No evidence of acute cervical spine fracture.\n2. Multilevel degenerative changes, progressed since ___, including mild\nbroad-based disc bulges indenting the anterior thecal sac." }, { "input": "Alignment of the cervical spine is normal. There is a comminuted minimally\ndisplaced fracture through the left lateral mass of C1 (series 2: Image ___,\n15). There is no significant prevertebral soft tissue swelling. There are\nmultilevel degenerative changes including uncovertebral hypertrophy and disc\nosteophyte complexes which cause multilevel neural foraminal narrowing, most\npronounced on the left at C4-C5 and C5-C6. The visualized lung apices are\nclear, and the thyroid gland is unremarkable. There is no cervical\nlymphadenopathy.", "output": "Comminuted mildly displaced fracture through the left lateral mass of C1." }, { "input": "Alignment of the cervical spine is normal. There is no acute fracture or\nprevertebral soft tissue swelling. A comminuted fracture through the the left\nlateral mass of C1 is again noted with mild interval healing seen anteriorly\n(series 2:image 15). The fracture line is still well seen. There is no\nsignificant spinal canal narrowing. Uncovertebral hypertrophy and facet\narthropathy causes moderate neuroforaminal narrowing narrowing at C4-C5 and\nC5-C6. The thyroid gland is unremarkable, and the visualized lung apices are\nclear. There is extensive atherosclerotic calcification along the bilateral\ninternal carotid arteries.", "output": "No acute fracture or traumatic malalignment. Re-demonstration of a chronic\ncomminuted fracture through the left lateral mass of C1." }, { "input": "Trace anterolisthesis of C2 on C3, probably chronic given adjacent\ndegenerative changes. The cervical spine is otherwise well aligned. No\nevidence of acute fracture. Apparent vertebral body height loss of C3, C4,\nC5, and C6 appears chronic. Heterogeneous sclerosis of the same levels is\nprobably related to the associated degenerative changes. No prevertebral soft\ntissue swelling.Moderate multilevel anterior, posterior, uncovertebral, and\nfacet osteophytosis. Mild to moderate multilevel intervertebral disc height\nloss. Prominent osteophytes and disc bulges or protrusions result in as much\nas mild spinal canal narrowing. There is mild left neural foraminal narrowing\nat C2-C3, moderate bilateral neural foraminal narrowing at C3-C4, severe\nbilateral neural foraminal narrowing at C4-C5, severe bilateral neural\nforaminal narrowing at C5-C6.\n\nThere is all longitudinal left temporal bone fracture with patchy mastoid air\ncell and middle ear opacification. The ossicles appear intact. The carotid\ncanal appears intact.", "output": "1. No evidence of acute cervical spine fracture or malalignment.\n2. Longitudinal left temporal bone fracture extending through the tegmen\nmastoid. The ossicles and carotid canal appear intact. Recommend further\nevaluation with dedicated temporal bone CT.\n3. Moderate cervical spine osteoarthritis with as much as mild spinal canal\nnarrowing and severe neural foraminal narrowing as detailed in the findings.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on 16 ___ at 07:09 am, less than\n5 minutes after discovery of the findings." }, { "input": "Alignment is normal. No fractures are identified.Mild cervical spine\ndegenerative changes with loss of disc height, under vertebral osteophytes and\nfacet hypertrophy, worst at C5-6. There is no prevertebral soft tissue\nswelling.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Mild cervical spine degenerative changes, worst at C5-6." }, { "input": "Mild reduction in height of the C6 vertebral body is unchanged. There is no\nacute fracture or malalignment. Minimal degenerative changes are noted, worse\nat C4/5, C5/6, and C6/7 with anterior and posterior osteophytic spurring.\nThough the CT resolution of the thecal sac is limited, the contours appear\npreserved. The prevertebral soft tissue is unremarkable. The imaged portion\nof the thyroid is unremarkable. There is trace scarring at the left lung apex.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Stable degenerative\ndisease as compared with recent prior exam. Loss of lordosis is noted. No\nprevertebral edema. The aerodigestive tract appears patent. Lung apices are\nclear. Thyroid gland appears normal. Small bilateral C7 ribs are noted. Mild\ndextroscoliosis of the cervical spine is noted.", "output": "No acute fracture or malalignment." }, { "input": "No fracture or acute subluxation is identified within the cervical spine.\nThere is no abnormal prevertebral soft tissue swelling. Degenerative changes\nare most pronounced at the C5/C6 with prominent posterior osteophytes and disc\nbulging, resulting in mild effacement of the thecal sac, and narrowing of the\ncervical canal. Additional prominent posterior osteophyte at the C4/C5 level\nwith disc bulge, similarly results in mild effacement of the thecal sac and\nnarrowing of the cervical canal. Lung apices are clear. The thyroid gland is\nunremarkable. Bilateral prominent lymph nodes at the jugulodigastric chains\nis suggestive of lymphadenopathy, this finding is nonspecific, please\ncorrelate clinically.", "output": "No fracture or acute subluxation. Note is made of bilateral prominent lymph\nnodes, suggestive of lymphadenopathy as described above. Cervical degenerative\nchanges, most notable C4/C5 and C5/C6 levels." }, { "input": "Thoracic spine: No compression fracture or alignment abnormality. Minimal\nendplate spurring is noted in the mid to upper thoracic spine. The visualized\noutline of the thecal sac is unremarkable. The imaged portions of the chest\nare unremarkable.\n\nLumbar spine: There is evidence of prior laminectomy at L4 with posterior rods\nand pedicle screws traversing L4/L5. Discectomy at L4-5 and L5-S1 is again\nnoted. With unchanged postoperative appearance and no signs of hardware\nrelated complication. No fracture or alignment abnormality. There is a\npartially visualized left external iliac vein stent.", "output": "No fracture or alignment abnormality. Post spinal fusion at L4-L5 without\nevidence of hardware related complication." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are again seen, notable for intervertebral disc height loss, posterior\nosteophytes and uncovertebral joint hypertrophy throughout the cervical spine,\nsimilar compared to prior. These changes result in up to moderate canal\nnarrowing at C3-4 and moderate two severe canal narrowing at C4-5. There is\nalso severe bilateral foraminal narrowing at this level as well. There is no\nprevertebral edema.\n\nThe included lung apices are unremarkable. Calcification again noted within\nthe left lobe of the thyroid. Atherosclerotic calcifications noted at the\ncarotid bulbs bilaterally. Intraluminal debris seen at the right lateral\naspect of the upper trachea.", "output": "Degenerative changes without fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. Diffuse degenerative\nchanges of the cervical spine are again seen, with multilevel loss of disc and\nvertebral height, anterior and posterior osteophytes and uncovertebral\nhypertrophy.\n\nC2-C3: A disc osteophyte complex is seen bilateral uncovertebral and facet\nhypertrophy. There is mild spinal canal narrowing with moderate right and\nsevere left foraminal narrowing. This is stable.\n\nC3-C4: A disc osteophyte complex is seen with bilateral uncovertebral and\nfacet hypertrophy. There is moderate spinal canal narrowing with moderate\nright and severe left foraminal narrowing. This is stable.\n\nC4-C5: A disc osteophyte complex is seen with bilateral uncovertebral and\nfacet hypertrophy there is severe spinal canal narrowing with severe bilateral\nforaminal narrowing. This is stable.\n\nC5-C6: A disc osteophyte complex is seen with bilateral uncovertebral and\nfacet hypertrophy there is moderate spinal canal narrowing with severe\nbilateral foraminal narrowing. This is stable.\n\nC6-C7: A disc osteophyte complex is seen with bilateral facet hypertrophy. \nThere is mild spinal canal narrowing with moderate bilateral foraminal\nnarrowing. This is stable\n\nAt the craniocervical junction new erosive changes are identified at the\nposterior aspect of the odontoid process and at the odontoid tip as well as\nanteriorly along the odontoid C1 articulation. There is also slight increased\nthickness of the ligaments posterior to the odontoid process.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nCalcified atherosclerotic changes of the bilateral common carotid and internal\ncarotid arteries are seen. A multinodular goiter is again seen with a stable\n7 mm calcified nodule in the left thyroid lobe.", "output": "1. Stable moderate to severe cervical spondylosis, worst at C4-5, as above\nwhere severe spinal stenosis and deformity of the thecal sac is seen.\n2. Progression of erosive degenerative changes at the atlanto odontoid joint.\n3. Stable multinodular goiter." }, { "input": "The cervical vertebral body heights and alignment are grossly maintained,\nhowever, there is severe multilevel intervertebral disc height loss, with\nmixed sclerotic and cystic endplate changes, anterior and posterior\nhypertrophic endplate changes, and bone-on-bone apposition with anterior\nposterior osteophytic bridging.\n\nThere is deformation and indentation of the spinal cord, most severe at C4-C5\nand mild-to-moderate at C3-C4, C5-C6, and C6-C7.\n\nThere is no prevertebral soft tissue swelling. No finding to suggest\ninfection or neoplasm.\n\nC2-C3: Posterior disc osteophyte complex and facet joint hypertrophy result in\nmild spinal canal narrowing, and mild to moderate left and mild right neural\nforaminal narrowing.\n\nC3-C4: Posterior disc osteophyte complex and facet and uncovertebral joint\nhypertrophy result in flattening of the anterior aspect of the spinal cord,\nmoderate spinal canal narrowing, and severe left and moderate to severe right\nneural foraminal narrowing.\n\nC4-C5: Posterior disc osteophyte complex and facet and uncovertebral joint\nhypertrophy result in flattening and deformity of the spinal cord, severe\nspinal canal narrowing, and severe left and moderate to severe right neural\nforaminal narrowing.\n\nC5-C6: Posterior disc osteophyte complex and facet and uncovertebral joint\nhypertrophy result in flattening of the anterior aspect of the spinal cord,\nmoderate spinal canal narrowing, and severe bilateral neural foraminal\nnarrowing.\n\nC6-C7: Posterior disc osteophyte complex and facet and uncovertebral joint\nhypertrophy result in partial effacement of the ventral CSF space, moderate\nspinal canal narrowing, and moderate bilateral neural foraminal narrowing.\n\nC7-T1: Minimal disc bulge. No significant spinal canal or neural foraminal\nnarrowing.\n\nOther: There are a number of cervical chain lymph nodes, but otherwise no\nlymphadenopathy by CT size criteria. There are atherosclerotic calcifications\nof the carotid arteries bilaterally. The thyroid gland is heterogeneous in\nappearance and contains low-density nodules, largest measures 1.8 x 1.4 cm in\nthe left thyroid lobe and also coarse calcification.", "output": "1. Severe multilevel multifactorial degenerative disc disease as described\nabove, most severe at C4-C5 level, with posterior disc osteophyte complex and\nfacet hypertrophy resulting in flattening and deformity of the spinal cord.\n2. Multinodular thyroid. Consider nonemergent further evaluation with thyroid\nultrasound.\n\nRECOMMENDATION(S): Thyroid nodules. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The findings were discussed with ___ by ___\n___, M.D. on the telephone on ___ at 3:10 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "The cervical spine alignment is normal. Focal area of low attenuation at C6\nvertebral body on the right, measuring approximately 6 x 6 mm in transverse\ndimension, probably is consistent with fat deposit or hemangioma. No acute\ncervical spine fractures are identified.Mild multilevel degenerative changes\nare seen, without severe spinal canal or neural foraminal stenosis.There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No evidence of acute cervical spine fracture or traumatic malalignment." }, { "input": "Postsurgical changes are seen following laminectomies of the L2-L5 level. \nThere are no obvious erosive changes seen in the osseous structures to suggest\nosteomyelitis. Alignment is maintained.No acute fractures are\nidentified.There is no prevertebral soft tissue swelling. Moderate\natherosclerotic calcifications are noted. Otherwise, the visualized portions\nof the abdomen and pelvis are unremarakble.", "output": "Postsurgical changes are unchanged following laminectomies of the L2-L5 level.\nThere are no obvious erosive changes seen in the osseous structures to suggest\nosteomyelitis. CT lacks sensitivity for osteomyelitis, however." }, { "input": "Patient is status post L1-5 laminectomy. Posterior drain terminates at the\nlaminectomy site at L1-2 level. Grade 1 retrolisthesis of L1 over L2 and L5\nover S1 are unchanged. Expected postoperative changes are noted including\nsoft tissue stranding at the laminectomy site and several small foci of air at\nthe laminectomy site at L4-5 level. No large hematoma is identified.\nSmall foci of air in the prevertebral soft tissue, anterior to L2 vertebral\nbody and posterior to the aorta are likely postsurgical.\nDegenerative changes of the lumbar spine were better evaluated on prior MR,\nincluding severe left and moderate right neural foraminal narrowing at L4-5\nand moderate to severe bilateral neural foraminal narrowing at L5-S1 .\n1.6 cm nodule is noted in the right adrenal gland, stable since ___. \nPolycystic kidneys are partially imaged.", "output": "1. Expected postoperative changes are noted related to status post L1-5\nlaminectomy. No large hematoma is identified." }, { "input": "The bones are demineralized. No concerning focal bone lesion is seen. \nVertebral body heights are preserved. Alignment is normal.\n\nThe cerebellar tonsils are normally positioned. There is no spinal canal\nnarrowing at the craniocervical junction. There is ligamentous ossification\nin the anterior atlantoaxial joint with narrowing of the anterior atlantoaxial\ndistance.\n\nC2-C3: Small central disc protrusion indents the ventral thecal sac but does\nnot appear to contact the spinal cord. Left facet arthropathy is present, but\nCT no significant neural foraminal narrowing is seen.\n\nC3-C4: Small central disc protrusion indents the ventral thecal sac and\napproaches the ventral spinal cord, though the ventral cord does not appear\ndeformed, and it is not clear whether cord contact is present. There are\nbilateral uncovertebral osteophytes and left facet osteophytes, with mild\nright and moderate left neural foraminal narrowing.\n\nC4-C5: A small central disc protrusion indents the ventral thecal sac and\napproaches but does not appear to deform the ventral spinal cord. It is not\nclear whether any cord contact is present. There are bilateral uncovertebral\nand left greater than right facet osteophytes, with mild bilateral neural\nforaminal narrowing.\n\nC5-C6: Shallow broad-based central disc protrusion minimally indents the\nventral thecal sac without evidence for spinal cord contact. There are small\nbilateral uncovertebral osteophytes and right greater than left facet\nosteophytes, with moderate bilateral neural foraminal narrowing.\n\nC6-C7: Broad-based central disc protrusion with overlying endplate\nosteophytes indent the ventral thecal sac. Evaluation of spinal canal detail\nat this level is limited due to artifact from the shoulder girdles. It is not\nclear whether the ventral spinal cord is remodeled. At least mild to moderate\nspinal canal narrowing is present. Bilateral uncovertebral osteophytes causes\nmild to moderate right and moderate left neural foraminal narrowing.\n\nC7-T1: A small disc bulge is present without significant spinal canal\nnarrowing. There is left facet arthropathy with moderate to severe left\nneural foraminal narrowing.\n\nT1-T2: No spinal canal or neural foraminal narrowing is seen.\n\nThere is mild pleural/parenchymal scarring at the visualized lung apices.\n\nPartially visualized right thyroid lobe is unremarkable. No tissue is seen in\nthe visualized portion of the left thyroid bed, suggesting of the left thyroid\nlobe may be either atrophic or surgically absent. No enlarged cervical lymph\nnodes are seen on noncontrast evaluation.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma in the posterior fossa. No abnormalities are seen on limited\nassessment. Visualized lower portions of the maxillary sinuses and partially\nvisualized mastoid air cells are well aerated.", "output": "Multilevel cervical spondylosis. Spinal canal narrowing is most extensive at\nC6-C7, where it is at least mild-to-moderate; it is not clear whether the\nventral spinal cord is remodeled. Multilevel neural foraminal narrowing, as\ndetailed above." }, { "input": "Alignment is normal. No fractures are identified. Mild disc space narrowing\nwith endplate irregularity, and anterior and posterior osteophytes are noted\nat the L5-S1 level with a small disc bulge at this level noted. Additionally,\nbilateral facet hypertrophy is noted at multiple levels with mild\nuncovertebral spurring. No significant central canal or neural foraminal\nstenosis is identified. There is no prevertebral soft tissue swelling. There\nis no evidence of infection or neoplasm.\n\nAtherosclerotic calcifications are noted within the imaged aorta and iliac\narteries. Remaining soft tissue structures are unremarkable.", "output": "No fracture or malalignment. Mild degenerative changes, most pronounced at\nL5-S1." }, { "input": "No evidence of acute fracture or traumatic malalignment. There is chronic\nminimal retrolisthesis of C2 over C3 with minimal anterolisthesis of C3 over\nC4 and mild retrolisthesis of C4 over C5. The alignment is otherwise normal. \nMulti level, severe degenerative disease of the cervical spine is noted with\nsignificant loss of disc height, most prominent at C2-3 and C4-5. No\nprevertebral soft tissue swelling. No evidence of infection or neoplasm.", "output": "1. No acute fracture. Subtle alignment abnormalities likely chronic.\n2. Severe degenerative changes of the cervical spine, most notable at C2-3 and\nC4-5." }, { "input": "Reversal of the cervical lordosis is unchanged.No acute fractures are\nidentified. The previously seen epidural hyperdense collection has resolved. \nMild hyperdensity along the posterior aspect of C4 and C5 most likely\ncorresponds to ligamentous flavum thickening, which is also causing mild\nspinal canal narrowing at these level.\n\nAt the C1-C2 and C2-C3 levels, there is no spinal canal narrowing or neural\nforaminal stenosis.\n\nAt C3-C4, there is no spinal canal narrowing. Severe uncovertebral and facet\njoint hypertrophy on the right cause severe narrowing of the write neural\nforamina. Mild left uncovertebral hypertrophy causes mild left neural\nforamina narrowing.\n\nAt C4-C5, mild spinal canal narrowing due to thickening of the ligamentous\nflavum and a posterior disc osteophyte complex. Mild uncovertebral\nhypertrophy and facet arthropathy causes mild right and moderate left neural\nforaminal stenosis.\n\nAt C5-C6, mild spinal canal narrowing due to thickening of the ligamentous\nflavum and a posterior disc osteophyte complex. Uncovertebral hypertrophy\ncauses mild bilateral neural foraminal stenosis.\n\nAt C6-C7, there is no spinal canal narrowing. Bilateral uncovertebral\nhypertrophy causes mild right and moderate left neural foraminal stenosis.\n\nAt C7-T1, there is no spinal canal narrowing or neural foraminal stenosis.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. Punctate calcification the left submandibular gland,\nwhich is nonspecific but of unlikely clinical significance. Atherosclerotic\ndisease noted.", "output": "1. Interval resolution of the cervical epidural hematoma.\n2. Chronic multilevel degenerative changes, which have not significantly\nprogressed compared to prior study." }, { "input": "There is no evidence of acute fracture or dislocation. The prevertebral and \nparaspinal soft tissues are normal. There is incomplete fusion or fracture\nthrough the anterior arch of C1, unchanged. Grade 1 anterolisthesis of C7 on\nT1 is also chronic. Erosive lesion at the posterior cortex of CT (___) is\nstable. Left lateralization of the dens between the lateral masses of C1 is\nchronic.\n\nThere are multilevel multifactorial degenerative changes maximally resulting\nin moderate central canal narrowing at C5-C6 4 and severe neural foraminal\nnarrowing on the right at C4-C5 and bilaterally at C6-C7.\n\nThere is mild scarring, partially visualized in the right lung apex. The\nthyroid is unremarkable. There are atherosclerotic calcifications at the\nbifurcations of the common carotid arteries.", "output": "No evidence of acute fracture dislocation. Multiple chronic findings including\nmoderate to severe degenerative change as detailed above." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes noted\nat C5-6 and C6-7 with intervertebral disc height loss and uncovertebral joint\nhypertrophy. No significant canal narrowing. These levels are notable for\nmild bilateral foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. There are minimal\ndegenerative changes with small disc bulges at C3-4 and C4-5 contacting the\nanterior surface of the spinal cord. The neural foramina appear normal. \nThere is no prevertebral soft tissue swelling.\n\nThe visualized lung apices appear normal. The visualized thyroid appears\nnormal.", "output": "No evidence of fracture or subluxation.\nMinimal degenerative disc disease." }, { "input": "Alignment is normal. No fractures are identified.There is mild multilevel\ndegenerative changes of the cervical spine most significant from C4 through\nC7.There is no prevertebral edema. Partially imaged right maxillary sinus is\nopacified.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture of the cervical spine.\n2. Mild multilevel degenerative changes of the cervical spine most significant\nfrom C4 through C7." }, { "input": "Alignment is normal. No fractures are identified. Facet arthropathy and\nuncovertebral hypertrophy cause severe right-sided and mild left-sided neural\nforaminal stenosis at C5-C6. Posterior osteophyte combined with a disc bulge\nat this level causes moderate spinal canal stenosis. There is no prevertebral\nsoft tissue swelling. Visualized lung apices and thyroid gland are\nunremarkable.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Degenerative changes at C5-C6 result in moderate spinal canal and severe\nright neural foraminal stenosis." }, { "input": "The vertebral bodies are normal in height. Sagittal alignment is similar to\nthe previous MRI with minimal retrolisthesis of C3 on C4 and C4-C5 noted, as\nseen previously. Since the previous examination, there has been posterior\ndecompression with evidence of laminectomy at the C3, C4, C5, and C6 levels as\nwell as placement of posterior surgical devices at the C3 through C6 levels. \nSurgery appears recent with stranding and gas in the surgical site as well as\nskin staples. No fracture is demonstrated. Facet and uncovertebral joint\nosteophytes are present at multiple levels, causing multilevel neural\nforaminal stenosis which appears severe on the left at the C4-C5 level, severe\non the right at C5-C6, as well as severe bilaterally at C7-T1. Multilevel\nmoderate neural foraminal stenosis, including on the right at C4-C5, and left\nat C5-C6. Other than paraspinal soft tissue changes which appear\npostsurgical, the soft tissues are unremarkable. The included lung apices are\nclear other than mild dependent atelectasis.", "output": "1. Postsurgical changes from posterior decompression at the C3 through C6\nlevels.\n2. No fracture is demonstrated.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "The bones are demineralized. No displaced fracture is seen. Vertebral body\nheights are preserved. There is 3 mm anterolisthesis of C4 on C5 and 3 mm\nanterolisthesis of C7 on T1 without evidence for disc space widening or\ndistraction of the posterior elements. Evaluation for prevertebral edema is\nsomewhat limited by prominent anterior endplate osteophytes from C3-C4 through\nC6-C7, some of which demonstrate well corticated chronic fractures, as well as\nossification of the anterior longitudinal ligament from C4 through C6. No\nclear evidence for prevertebral edema is seen.\n\nDisc protrusions and endplate osteophytes mildly to moderately indent the\nventral thecal sac from C2-C3 through C7-T1. There is severe multilevel\nuncovertebral and facet arthropathy, causing substantial neural foraminal\nnarrowing at multiple levels bilaterally.\n\nThere is noncalcified pannus posterior to the odontoid process mildly\nnarrowing the spinal canal at C1, as well as well-defined lucencies within the\nodontoid process, compatible with sequela of inflammatory arthropathy.\n\nPartially visualized intracranial hemorrhage is better assessed on the\nconcurrent head CT. Small mucous retention cysts are noted in the visualized\nportions of the maxillary sinuses. Carotid artery calcifications are noted. \nEndotracheal and orogastric tubes are partially visualized. Centrilobular\nemphysema is noted at right greater than left lung apices. Mild biapical\npleural/parenchymal scarring is also present. The thyroid is diffusely\nheterogenous without evidence for nodules exceeding 1 cm; no sonographic\nfollow-up is required according to the ACR guidelines.", "output": "1. Demineralized bones without evidence for displaced fracture..\n2. 3 mm anterolisthesis of C4 on C5 and 3 mm anterolisthesis of C7 on T1,\nprobably degenerative, though there are no comparison exams to confirm\nchronicity.\n3. Multilevel degenerative disease with mild to moderate spinal canal\nnarrowing and advanced multilevel neural foraminal narrowing.\n4. Noncalcified pannus posterior to the odontoid process mildly narrowing the\nspinal canal at C1, as well as well-defined lucencies within the odontoid\nprocess, compatible with sequela of inflammatory arthropathy.\n5. Partially visualized intracranial hemorrhage is better assessed on the\nconcurrent head CT.\n6. Emphysema in the included upper lungs." }, { "input": "Minimal 2 mm anterolisthesis is seen at C3 on C4, C4 on C5, and T1 on T2,\nlikely degenerative.No acute fracture is seen.\n\nModerate degenerative changes of the cervical spine, most prominent at C4-C5\nand C5-C6 levels with osteophytosis. This results in mild narrowing of the\nspinal canal at the corresponding levels. Mild bilateral facet degenerate\nchanges are also seen. Mild right neural foraminal narrowing at the C7-T1\nlevel. No prevertebral soft tissue swelling. Images lung apices are\nunremarkable. Incidental note is made of a 2.7 cm right thyroid hypodense\nlesion.", "output": "1. No acute fractures. Subtle misalignments most likely reflect chronic\ndegenerative disease.\n2. 2.7 cm right thyroid cystic lesion. In the absence of prior workup,\nultrasound follow-up may be obtained.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is mild retrolisthesis of C3 on C4, likely degenerative in nature though\nno priors are available for comparison. There is no acute fracture or\nprevertebral soft tissue swelling. There is multilevel degenerative change\nincluding disc height loss, endplate irregularity and posterior disc\nosteophyte complexes which cause severe spinal canal narrowing at C4-C5 and\nC5-C6. There is also severe bilateral neural foraminal narrowing at multiple\nlevels including C3-C4, C4-C5 and C5-C6. The thyroid gland is heterogeneous\nand enlarged includes multiple coarse calcifications seen in the bilateral\nthyroid lobes. The visualized lung apices are clear, and there is no cervical\nlymphadenopathy.", "output": "1. No acute fracture. Degenerative changes as described above causing canal\nnarrowing, most pronounced at C4-C5 and C5-C6.\n2. Heterogeneous and enlarged thyroid gland. Recommend clinical correlation." }, { "input": "Alignment is normal. No fractures are identified.Moderate to severe multilevel\ndegenerative changes are most pronounced from C4-5 through C6-7 with\nintervertebral disc space narrowing, endplate irregularity, and anterior and\nposterior osteophyte formation. Multilevel mild to moderate central canal\nstenosis is most pronounced at C5-6 due to a posterior osteophyte. \nAdditionally, moderate neural foraminal stenosis is seen on the left at C3-4\nand bilaterally at C5-6 due to the presence of uncovertebral spurring and\nfacet arthropathy.There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nVisualized thyroid gland and lung apices are unremarkable.", "output": "1. No acute fracture or malalignment.\n2. Moderate to severe cervical spondylosis with moderate central canal and\nbilateral neural foraminal stenosis at C5-6." }, { "input": "No acute fractures are identified. There is no evidence of significant spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.Carotid bulb calcifications are seen bilaterally. The the left\nthyroid lobe is heterogeneous with small hypodensities, measuring up to 1.0\ncm.", "output": "No acute fractures or traumatic malalignment." }, { "input": "There is no traumatic malalignment. There is stable 3 mm retrolisthesis of C5\nover C6. No acute fractures are identified.Again seen is mild-to-moderate\nmultilevel degenerative changes of the cervical spine, worst at C5 through C7.\nAt C5-6, there is mild-to-moderate narrowing of the spinal canal due to\nposterior central disc protrusion and subluxation. There is no significant\nspinal canal narrowing or neural foraminal narrowing at other levels. There is\nno prevertebral soft tissue swelling. The visualized lung apices are clear. \n1.1 cm hypodensity in the left lobe of the thyroid is unchanged since ___.", "output": "1. No traumatic malalignment or acute fracture.\n2. Mild degenerative changes resulting in mild-to-moderate narrowing of the\nspinal canal at C5-6." }, { "input": "Alignment is anatomic.No acute fracture or traumatic dislocation. Mild\nmultilevel degenerative changes with intervertebral disc space narrowing and\nosteophyte formation, most prominent at C5-C6, where there is mild spinal\ncanal and right neural foraminal narrowing. No evidence of critical spinal\ncanal or neural foraminal stenosis.There is no prevertebral soft tissue\nswelling.", "output": "1. No acute fracture or traumatic dislocation.\n2. Mild multilevel degenerative changes, as detailed above." }, { "input": "No evidence of traumatic malalignment. No evidence of acute traumatic\nfractures. There is no prevertebral soft tissue swelling. At the level of the\nC5 and C6 there are well corticated punctate calcifications at the anterior\ninferior endplates which are likely chronic in etiology. Evaluation of the\nsuperior cervical spine is somewhat limited secondary to streak artifact\nlikely from dental amalgams. There is no evidence of infection or neoplasm. \nMultilevel degenerative changes are seen including facet hypertrophy and\nuncovertebral osteophyte formation. Neural foraminal narrowing is seen most\nprominent on the left at the level of C5. The visualized thyroid gland is\nunremarkable. The visualized lungs are clear. There is no prominent cervical\nlymphadenopathy.", "output": "1. No evidence of traumatic malalignment or acute fracture.\n2. Multilevel chronic appearing degenerative changes as described above." }, { "input": "There is no significant change and alignment compared to ___. No\nacute fracture or traumatic malalignment is identified.\n\nMild to moderate degenerative changes of the cervical spine is again seen,\nworse at C4-5 through C6-7, with disc space loss, anterior and posterior\nosteophytosis. There is mild-to-moderate spinal canal narrowing at C5-6 due\nto central disc protrusion and to posterior osteophytes. There is moderate to\nsevere neural foraminal narrowing, right worse than left at C5-6 due to\nuncovertebral hypertrophy.There is no evidence of critical spinal canal\nstenosis. There is no prevertebral soft tissue swelling.\n\nThe thyroid appears normal. Minimal calcifications are noted at the carotid\nbulbs bilaterally. The visualized lungs are grossly clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes of the cervical spine, not significantly changed since\n___." }, { "input": "Alignment is normal. No fractures are identified.There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nMild degenerative changes throughout the cervical spine. Small posterior\nintervertebral osteophytes and small disc bulges result in mild central canal\nnarrowing, most pronounced at C5-6, but no high-grade spinal canal stenosis. \nMild neural foraminal stenosis at C4-5 and C5-6 bilaterally due to\nuncovertebral osteophytes.\n\nThe thyroid is enlarged and heterogeneous with multiple hypodense nodules\nmeasuring up to 1.2 cm on the right. The partially visualized lung apices are\nclear. No cervical lymphadenopathy.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Multinodular thyroid gland, but no nodules meeting CT criteria for\nultrasound follow-up.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Vertebral body height and alignment is maintained. Intervertebral disc height\nappears normal. There is multilevel uncovertebral hypertrophy. No\nsignificant osseous neural foraminal narrowing is identified. There is no\nevidence of a large disc bulge. The spinal canal appears patent.\n\nLimited evaluation of the brain and soft tissues about the skull base\ndemonstrate no significant abnormality.\n\nThere is bilateral mucosal thickening in the maxillary sinuses.\nNote is made of a 5 mm metallic fragment centered in the left paraspinal\nmusculature, consistent with the patient's known bullet fragment.\n\nThe lung apices are clear. The thyroid gland is unremarkable.", "output": "1. Mild multilevel degenerative changes of the cervical spine without evidence\nof significant spinal canal stenosis or osseous neural foraminal narrowing.\n2. Bullet fragment centered in the left paraspinal musculature.\n3. Bilateral maxillary sinus disease." }, { "input": "Dental almalgam streak artifact limits study.\n\nAgain seen is erosion of the anterior C7 by a 2.7 x 2.6 x 5.9 cm (previously\n2.7 x 2.7 x 5.8 cm) lytic soft tissue mass centered at the level of the\nthoracic inlet on the right and arising from the right longus coli muscle. \nThe mass extends at least ___ from anterior to posterior into the C7 vertebral\nbody. There is extension of the mass into the right vertebral foramen with at\nleast 270 degree encasement and rightwards mass-effect of the patent right\nvertebral artery. There is likely tumor extension into the right vertebral\nforamen and right neural foramina at C6-C7.\n\n\nNo additional masses are identified.\n\nAlignment is normal. No fractures are identified. There is no evidence of\nspinal canal stenosis. There is no additional prevertebral soft tissue\nswelling. There is no evidence of infection. A 0.8 x 0.6 cm right thyroid\nlobe nodule is noted. Left sphenoid sinus mucous retention cyst versus polyp\nis noted.\n\nVisualized lung apices are notable for a 0.7 x 0.5 cm right apical spiculated\npleural based mass (2:90) arising from and in communication with the soft\ntissue mass centered at C7 which is new since prior examination.\n\nAgain is noted and enlarged right level IIa lymph node measuring up to 1.2 x\n0.9 cm (see 3: 47), with numerous nonspecific lymph nodes throughout the neck\nbilaterally, some of which correspond to FDG avid lymph nodes on recent PET-CT\nstudy. Bilateral temporomandibular joint degenerative changes are noted.", "output": "1. Dental almalgam streak artifact limits study.\n2. 2.7 cm soft tissue mass arising from the right longus coli muscle, centered\nlevel of thoracic inlet with erosive destruction of anterior and mid C7\nvertebral body, as well as right vertebral foramen, with encasement of patent\nright vertebral artery. There is likely extension into the right vertebral\nforamen and right neural foramina at C6-C7, not well visualized on current\nstudy. If clinically indicated, contrast cervical spine MRI may be obtained\nfurther evaluation.\n3. New 0.7 cm right apical spiculated pleural-based mass extending from the\nright paraspinal soft tissue mass.\n4. No acute fracture or acute malalignment.\n5. Right cervical enlarged lymph node corresponding to FDG avid lymph node\nseen on recent PET-CT.\n6. Additional subcentimeter nonspecific lymph nodes throughout the neck\nbilaterally, some of which are noted to be FDG avid on recent PET-CT.\n7. Nonspecific 8 mm right thyroid nodule. If clinically indicated, thyroid\nultrasound may be obtained further evaluation.\n8. No definite T1 vertebral body mass identified." }, { "input": "Lytic soft tissue lesion destroying the anterior aspect of C7 vertebral body\nand right vertebral foramen with associated soft tissue mass that extends to\nright upper lobe is better characterized on CT cervical spine performed on\nsame day. No T1 lesion is identified.\n\nA 1.5 x 1.4 cm (03:30) (previously 1.5 x 1.3 cm) lytic soft tissue lesion\narising from the posterior left fifth rib with extension to the posterior\naspect of T4 vertebral body causing mild cortical irregularity is unchanged\nsince prior FDG PET where was found to be FDG avid.\n\nAlignment is normal. There is no evidence of spinal canal bony stenosis. \nThere is no evidence of infection.\n\nT1-2: 0.5 x 0.5 cm (3:9) sclerotic T1 lesion is stable. No spinal canal or\nneural foraminal narrowing.\n\nT2-3 through T5-6: No spinal canal and neural foraminal narrowing.\n\nT6-7: 0.8 x 0.6 cm (03:47) sclerotic lesion is stable. No spinal canal or\nneural foraminal narrowing.\n\nT7-8: 1.2 x 0.9 cm (03:50) stable sclerotic lesion. No spinal canal or\nneural foraminal narrowing.\n\nT8-T9: No spinal canal or neural foraminal narrowing.\n\nT9-T10: 2 sub cm densely sclerotic lesions within the T10 vertebral body and\nleft pedicle are stable. No spinal canal or neural foraminal narrowing.\n\nT11-T12: Stable 1.3 x 0.7 cm dense sclerotic lesion along the right pedicle. \nNo spinal canal or neural foraminal narrowing.\n\nPartial visualization of the abdomen demonstrates a large soft tissue mass\nencasing the celiac axis, better characterized on FDG PET from ___.", "output": "1. Lytic soft tissue lesion destroying anterior aspect of C7 vertebral body\nand right vertebral foramen, with extension to right upper lobe is better\ncharacterized on CT cervical spine performed on same day.\n2. No T1 vertebral body lesion.\n3. 1.5 cm lytic soft tissue lesion arising from posterior left fifth rib at\ncostovertebral junction, with extension the posterior T4 vertebral body,\nunchanged in appearance and found to be FDG avid on ___ prior FDG\nPET-CT.\n4. Indeterminate multilevel osseous sclerotic lesions, as described. While\nsome lesions may represent bone islands, sclerotic metastatic lesions are not\nexcluded on the basis examination. Recommend attention on followup imaging.\n5. Limited evaluation of large soft tissue mass encasing celiac axis, better\ncharacterized on ___ FDG PET-CT.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 7:22 ___, 5 minutes after discovery of\nthe findings." }, { "input": "Alignment is normal. No fractures are identified.Moderate to severe\nmultilevel degenerative changes are noted throughout the cervical spine, with\nmultiple moderate vertebral canal narrowing, most pronounced at at C6-C7\nsecondary to posterior osteophytosis. Neural foraminal narrowing bilaterally\nat multiple levels is moderate to severe and also seen secondary to\nuncovertebral and facet arthrosis, worse at C6-C7.There is no prevertebral\nedema.\n\nA 2.6 cm hypodense nodule is seen in the left thyroid lobe (3:59). A 0.8 cm\nhypodense nodule seen in the right thyroid lobe (03:59). The included lung\napices are unremarkable.", "output": "1. No acute fracture or subluxation.\n2. Thyroid nodules, as described above. If not already performed, recommend\nnonurgent outpatient thyroid ultrasound for further characterization.\n3. Moderate to severe degenerative changes of the cervical spine, worse at\nC6-C7.\n\nRECOMMENDATION(S): Thyroid ultrasound for impression # 2." }, { "input": "Alignment is normal. No fractures are identified.Multilevel moderate to\nsevere degenerative changes are seen throughout the cervical spine with\nintervertebral disc height loss, and posterior osteophyte formation, most\npronounced at C6-C7. Multilevel central canal stenosis is moderate at C4-5\nand C5-6. In addition, moderate to severe foraminal narrowing is demonstrated\nbilaterally at multiple levels secondary to uncovertebral and facet arthrosis,\nworst at C3-C4, C4-C5 C5-C6, and C6-C7. There is no prevertebral edema.\n\nA 2.6 cm hypodense nodule in the left lobe of the thyroid (series 3: Image 53)\nis grossly unchanged from prior exam dated ___. Previously\ndescribed subcentimeter hypodense nodule in the right thyroid lobe is not\ndefinitively visualized. The included lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate to severe cervical spondylosis.\n3. Unchanged 2.6 cm left thyroid lobe hypodense nodule. Follow-up thyroid\nultrasound is suggested if not previously performed.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "No fracture or acute subluxation is identified throughout the cervical spine. \nThere is no prevertebral soft tissue swelling. The thyroid gland is\nunremarkable. Lung apices are clear. Scattered subcentimeter nonspecific\nlymph nodes are noted throughout the neck bilaterally.", "output": "1. No acute cervical subluxation or fracture.\n2. Scattered cervical nodes do not meet CT size criteria for pathology,\nnonspecific, likely reactive." }, { "input": "There is no acute fracture. Vertebral bodies are maintained in height. There\nare multiple lucencies in the bones most notable at the levels of degenerative\nchanges for example there is a 5 mm lesion at the superior endplate of C5 (602\nb: 26). While these could be due to degenerative changes and osteopenia,\nunderlying lytic lesion is not entirely excluded.\n\nThere is anterolisthesis of C3 on C4 which could be accounted for by extensive\nleft-sided facet joint hypertrophy. The C2- C3 facet joints are fused, likely\ndegenerative. Degenerative changes most notable for intervertebral disc height\nloss and uncovertebral joint hypertrophy is most extensive at C5-6 and C6-7\nwhere there is moderate right foraminal narrowing at these levels. Posterior\nosteophytes at C5-C6 efface the ventral CSF and may contact the ventral aspect\nof the cord. There is no prevertebral soft tissue abnormality.\n\nThe thyroid is unremarkable. Pleural-based scarring seen at the lung apices\nbilaterally.", "output": "1. Degenerative changes without acute fracture.\n2. Anterolisthesis of C3 on C4 likely degenerative in nature although\nclinical correlation is suggested.\n3. Lucent lesions may be due to combination of osteopenia and degenerative\nchanges although infiltrative process is not entirely excluded, to be\ncorrelated clinically. If desired MRI could be performed on an outpatient\npatient basis to further characterize." }, { "input": "The study is limited secondary to motion degradation.\n\nAlignment is anatomic. No acute fractures are identified. There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Bilateral apical pneumothoraces are more\ncompletely evaluated on chest CT obtained concurrently. The patient is noted\nto be intubated.", "output": "1. No evidence of an acute fracture or traumatic malalignment.\n 2. Bilateral pneumothoraces. Please see chest CT obtained concurrently for\ncomplete characterization." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Moderate facet\narthropathy is noted at C2-3 and C7-T1 on the right side. Disc spaces are\npreserved. No prevertebral edema. The aerodigestive tract appears patent.\nLung apices are clear. Thyroid gland appears normal.", "output": "No fracture or malalignment." }, { "input": "Dental amalgam streak artifact limits study.\n\nVertebral body alignment is preserved. The visualized osseous structures are\nosteopenic. No fractures are identified.No significant spinal canal\nnarrowing. Facet arthropathy causes moderate neural foraminal narrowing at\nthe right C2-3 level and right C7-T1 levels.There is no prevertebral soft\ntissue swelling.\n\n OTHER:\nImaged lung apices are clear. Thyroid gland is preserved. Atherosclerotic\nvascular calcifications are seen in bilateral carotid bifurcations.", "output": "1. Dental amalgam streak artifact and osteopenia limits study.\n2. Within limits of study, no definite evidence of acute fracture or traumatic\nmalalignment.\n3. Multilevel cervical spondylosis as described, without definite evidence of\nmoderate or severe bony vertebral canal narrowing." }, { "input": "Alignment is preserved. There is diffuse osteopenia. No acute fractures are\nidentified. There is no evidence of significant spinal canal stenosis. There\nis moderate neural foraminal narrowing at the right C2-3 and right C7-T1\nlevels due to facet arthropathy. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. Degenerative changes are\nmost pronounced at the C5-C6 level with intervertebral disc space narrowing,\nendplate sclerosis, and osteophyte formation. Osteophytes at the C5-C6 and\nC6-C7 minimally efface the ventral CSF space. There is no significant canal\nnarrowing. There is no prevertebral soft tissue swelling.\n\nBiapical pleural parenchymal scarring is mild and symmetric. Left thyroid\nlobe is not identified. On the right, minimal thyroid tissue is identified.", "output": "No acute cervical fracture or subluxation. Minimal degenerative changes most\npronounced at the C5-C6 level." }, { "input": "The imaged cervical vertebral bodies are normally aligned. Vertebral body\nheights are relatively preserved.There is no evidence of fracture. There is\nno prevertebral fluid. The facet joints are normally aligned without evidence\nof widening. There is moderate to severe multilevel cervical spine\ndegenerative change. There is multilevel spinal canal narrowing which is most\npronounced (severe) at C4-5 due to bulky posterior intervertebral osteophytes,\nlikely flattening the thecal sac at this level although this is not well\nvisualized by CT (3, 43). Other levels show more mild spinal canal narrowing.\nThere is bilateral moderate to severe neural foraminal narrowing at C4-5 (3,\n42), C5-6 (3, 48), and C6-7 (3, 55) due to uncovertebral osteophytosis and\nfacet arthropathy. There are no worrisome focal lytic or sclerotic osseous\nlesions are identified. There is no cervical lymphadenopathy. The partially\nimaged lung apices are clear.", "output": "1. No CT evidence of acute cervical spine fracture or malalignment.\n2. Moderate to severe multilevel cervical spine degenerative change, causing\nsevere C4-5 spinal canal and moderate to severe bilateral neural foraminal\nnarrowing at multiple levels, as above." }, { "input": "Alignment is anatomic. No acute fractures are identified.Severe multilevel\ndegenerative changes include intervertebral disc space narrowing,\nosteophytosis, and posterior disc bulges and protrusions, worst at C6-C7, at\nwhich level there is moderate vertebral canal and mild neural foraminal\nnarrowing. There is no prevertebral soft tissue swelling.There is no cervical\nlymphadenopathy by size criteria. The visualized lung apices are grossly\nclear.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Severe multilevel degenerative changes including resultant multilevel\nvertebral canal narrowing, worst and moderate at C6-C7." }, { "input": "Alignment is normal. No fractures are identified.Minimal anterior osteophytic\nspurring is seen involving the anterior inferior C5 and C6 vertebral bodies. \nThere is no significant canal or foraminal narrowing.There is no prevertebral\nedema.\n\nClips are seen in the right neck compatible with prior partial thyroidectomy\non the right. The remaining left thyroid gland appears unremarkable. \nCalcified granulomas are noted in bilateral lung apices.", "output": "No fracture or malalignment. No prevertebral edema." }, { "input": "There is ossification of the anterior longitudinal ligament and partial\nankylosis from T3-T4 through T7-T8 vertebral body. Severe kyphosis of the\nthoracic spine with apex at T7 vertebral body is seen with increased AP\ndiameter of the chest. No malalignment. Mild to moderate multilevel\ndegenerative changes are noted with loss of disc height, osteophyte formation,\nand vacuum phenomenon. No fractures are identified. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.No suspicious osseous lesions are noted.\n\nMultiple calcified granulomas are noted in bilateral lungs, the largest\nmeasuring 0.4 cm (2; 41) in the right upper lobe. Calcified splenic\ngranulomas also demonstrated. There are prominent right para-aortic lymph\nnodes, which do not meet CT size criteria for lymphadenopathy (2; 37).", "output": "1. No fracture identified and no malalignment.\n2. Severe kyphosis of the thoracic spine with ossification of the anterior\nlongitudinal ligament and partial ankylosis of T3-T4 through T7-T8 vertebral\nbodies.\n3. Bilateral calcified granulomas within the lungs, similar to prior. \nProminent right para-aortic lymph nodes." }, { "input": "Minimal anterolisthesis of C5 on C6 is age indeterminate, likely degenerative\nin etiology. No fractures are identified.There are multilevel degenerative\nchanges, worst and moderate at the C3-4 level where there is minimal central\ncanal narrowing due to hypertrophic endplate changes. Additionally, neural\nforaminal narrowing is worst and moderate at the bilateral C3-4 level due to\nuncovertebral and facet hypertrophy. There is no prevertebral soft tissue\nswelling.The thyroid is heterogeneous without discrete nodule. There is a\ncoarse calcification within the left thyroid lobe, probable 1.7 cm nodule.\n\nThe visualized lung apices are grossly clear.", "output": "1. No fracture.\n2. Degenerative changes cervical spine.\n3. 1.7 cm thyroid nodule.\n\nRECOMMENDATION(S): Thyroid nodule.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges are present. There is no evidence of high-grade spinal canal\nstenosis. Uncovertebral and facet joint hypertrophy results in severe right\nC3-4 neural foraminal narrowing. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nMultiple bilateral thyroid nodules are noted, largest measuring 13 mm and\ncontains a punctate focus of calcification.", "output": "1. No evidence of acute fracture or subluxation.\n2. Bilateral thyroid nodules, largest on the left measures 13 mm and contains\na punctate focus of calcification. These can be evaluated by ultrasound on a\nnon urgent basis if clinically indicated." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges particularly decreased disc height between C4-C5 and C5-C6. No\nsignificant spinal canal or neural foraminal stenosis is seen. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nInterlobular septal thickening and ground-glass opacities seen in both apices\nof the lungs. Patient is intubated and an enteric tube is also placed.", "output": "1. No fractures. Normal alignment. Multilevel degenerative changes without\nspinal canal or neural foraminal stenosis.\n2. Bilateral apical interlobular septal thickening and ground-glass opacities\nsuggesting pulmonary edema." }, { "input": "Dental amalgam insert go hardware streak artifact limits study.\n\nThere is minimal focal lordosis about the C6-7 level, possibly due to partial\nfusion of the C5-6 vertebral bodies and C4-5 left facet joints, unchanged. \nOtherwise, alignment is preserved. No fractures are identified. C5 vertebral\nbody probable bone island is noted. There is no prevertebral soft tissue\nswelling.\n\nMultilevel degenerative changes are worst and moderate about the C3-4, C4-5,\nand C5-6 levels where there is minimal central canal narrowing. Neural\nforaminal narrowing is worst and moderate at the bilateral C4-5 level due to\nuncovertebral and facet hypertrophy.\n\nThe thyroid is heterogeneous and contains multiple hypodense nodules measuring\nup to 0.6 cm.\n\nAtherosclerotic vascular calcifications are present.\n\nSoft tissue densities are noted within bilateral external auditory canals\nwhich may represent cerumen.\n\nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", "output": "1. Dental amalgam and surgical hardware streak artifact limits study.\n2. Within limits of study, no evidence of acute cervical spine fracture.\n3. Grossly stable multilevel cervical spondylosis as described.\n4. Heterogeneous thyroid with nodules measuring up to 6 mm. If clinically\nindicated, consider thyroid ultrasound for further evaluation." }, { "input": "Laminectomy defects are seen from L3-L5. Moderate to severe 2 column\ncompression fractures are noted involving the L3 and L4 vertebral bodies with\nbony retropulsion of approximately 6 mm into the spinal canal at L3 and\napproximately 5 mm of retropulsion at L4. There is evidence of prior\nvertebroplasty of an L5 chronic compression fracture. Grade 1 anterolisthesis\nof L2 on L3 is demonstrated. There is no prevertebral soft tissue swelling. \nMultilevel mild degenerative changes are present without critical central\ncanal narrowing.\n\nT12 moderate to severe compression fracture is again noted, possibly acute,\nand described on the chest CT obtained the same day.\n\nModerate atherosclerotic disease is seen in the aorta. Hypodensities\nscattered in the liver are not completely characterized, but may represent\ncysts.", "output": "1. No definite acute fracture.\n2. Status post L3 through L5 laminectomies. Chronic appearing 2 column\nvertebral body compression fractures of L3 and L4 with retropulsion of bony\ncomponents as described. Status post vertebroplasty of the L5 vertebral body.\n3. Mild grade 1 L2 on L3 anterolisthesis, of indeterminate chronicity.\n4. Please see report of chest CT obtained the same day for details regarding\nthe T12 vertebral body fracture.\n\nRECOMMENDATION(S): If there is concern for acute fracture, MRI may be\nconsidered." }, { "input": "Evaluation is somewhat limited by motion.\nThere is mild anterolisthesis of C3 on C4 and mild retrolisthesis of C5 on C6\nwhich are likely degenerative in nature. No prevertebral soft tissue\nswelling. There are moderate to severe multilevel degenerative changes, worst\nat C5-6, with loss of intervertebral disc height, endplate sclerosis and\nsubchondral cysts, and anterior and posterior osteophyte formations. No\nfractures are identified. There is multilevel moderate spinal canal\nnarrowing, most pronounced at C5-C6. Mild bilateral neural foraminal\nnarrowing due to uncovertebral spurring facet hypertrophy is also noted at\nmultiple levels.\n\nSeveral punctate calcifications are seen in the left thyroid gland. The\ninterlobular septa are smoothly thickened in the imaged lung apices.", "output": "1. No fracture or prevertebral soft tissue swelling.\n2. Moderate to severe cervical spondylosis with mild C3 on C4 anterolisthesis\nand C5 on C6 retrolisthesis, likely degenerative in etiology.\n3. Smooth septal thickening in the lung apices is suggestive of fluid\noverload." }, { "input": "There is a mild dextrocurvature. Thoracic vertebral body height is\nmaintained. Alignment in the sagittal plane is mainteined. There is diffuse\nosseous demineralization with mild heterogeneous density, however, no apparent\nlytic lesions are identified.\n\nMultilevel anterior and lateral bridging osteophytes are noted. The\nintervertebral discs have normal height and signal intensities. Mild disc\nherniation is noted at T11-T12. There is no other disc herniation, or\nsignifican spinal canal or neural foraminal stenosis. The posterior elements\nand paraspinal soft tissues are normal.\n\nThere is 4mm left lower lobe pulmonary nodule (series 2, image 33). Lung\nbases demonstrate dependent changes.", "output": "1. Multilevel degeneratives changes superimposed upon diffuse osseous\ndemineralization without evidence of fracture, or lytic or sclertoic lesion.\n2. Left lower lobe 4mm pulmonary nodule.\n3. Please see separately dictated report of concomitantly performed CT L-Spine\n___." }, { "input": "In comparison with the prior MRI examination, there is interval worsening in\nthe previously noted compression fracture at L1 vertebral body, additionally\nthere is expansion an lytic appearance on the right pedicle at this level (19:\n3), the left pedicle appears intact, correlation with MRI of the lumbar spine\nis advised if clinically warranted.\n\nThere is diffuse osteopenia, combined with heterogeneous density throughout\nthe lumbar vertebral bodies, consistent with metastatic involvement, there is\ninterval height loss at the superior endplate of L4, compatible with\ncompression fracture, there is no evidence of retropulsion at this level.\n\nVascular arthrosclerotic calcifications are visualized in the abdominal aorta\nand iliac arteries, and a focal area of low attenuation is noted on the right\nkidney, likely consistent with a para-renal cyst, partially evaluated in this\nexamination and previously demonstrated by MRI of the lumbar spine.", "output": "1. Interval worsening in the previously noted compression fracture at L1\nvertebral body, with heterogeneous and lytic appearance, involving the right\npedicle, the left pedicle appears intact, correlation with MRI of the lumbar\nspine is recommended if clinically warranted.\n\n2. Interval height loss at the superior endplate of L4, suggestive of\ncompression fracture, apparently new since the prior MRI in ___.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ phone call on ___ at 5:10 ___, 15 minutes after discovery of the\nfindings.\n\nEXAMINATION: CT L-SPINE W/O CONTRAST\n\nCT of the lumbar spine without contrast.\n\nINDICATION: ___ year old woman with metastatic ovarian cancer and new L1 and\nL4 compression fractures on PET (done at ___- disc requestion) // assess for\nnew spine compression fractures of signs of spine instability assess for\nnew spine compression fractures of signs of spine" }, { "input": "No acute fracture of cervical spine. There is loss of disc height, facet\njoint hypertrophy and osteophyte formation at the C4/5 and C5/6 levels. No\ncritical neural foraminal or central canal narrowing. No prevertebral edema.\nThe aerodigestive tract appears patent. Lung apices are clear. Thyroid gland\nappears normal. Minimal mucosal thickening of the left maxillary sinus is\nseen.", "output": "1. No acute fracture or malalignment.\n2. Mild to moderate degenerative changes of the cervical spine." }, { "input": "Alignment is normal.No acute cervical spine fractures are identified. Mild to\nmoderate, multilevel degenerative changes, including intervertebral disc\nheight narrowing, endplate sclerosis, and osteophyte formation, are most\nprominent within the lower cervical spine. Mild central canal narrowing is\nmost prominent at C3-C4 and C5-C6. Mild neural foraminal narrowing at C5-C6. \nThere is no prevertebral soft tissue swelling.Nuchal ligament calcifications. \nThe imaged lung apices are unremarkable. The thyroid appears unremarkable. \nBilateral cervical nodes are prominent, but not pathologically enlarged.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Mild to moderate, multilevel degenerative changes." }, { "input": "There is moderate-to-severe multilevel degenerative changes of the spine\nincluding minimal anterolisthesis of C5 over C6. There is at least moderate\nspinal canal narrowing at multiple levels secondary to disc-osteophyte\ncomplexes projecting posteriorly. No fractures are identified. There is no\nevidence of infection or neoplasm.\n\nThere is minimal asymmetric enlargement of the left lingual tonsil (series 2,\nimage 26 and series 601, image 9).", "output": "1. Degenerative changes of the spine without acute fracture or subluxation.\n2. Minimal asymmetrically enlarged left lingual tonsil. Correlate with\nphysical examination and clinical history.\n\nRECOMMENDATION(S): Clinically correlate apparent left lingular tonsillar\nenlargement." }, { "input": "Numbering of the thoracic spine is provided on series 602b, image 27.\n\nThere is no acute fracture or traumatic malalignment. No prevertebral edema. \nThere is no critical spinal canal or neuroforaminal stenosis.\n\nImaged mediastinal nodes are not pathologically enlarged, measuring up to 8 mm\nin the subcarinal station (3:57). A fluid level is noted in the mid esophagus\n(3:44), which can be seen in the setting of reflux/esophagitis. Included\nupper abdominal structures are grossly unremarkable.", "output": "1. No acute thoracic spine fracture or malalignment.\n2. Fluid level noted in the mid esophagus. Recommend correlation for symptoms\nof esophagitis/reflux." }, { "input": "There is no acute fracture or malalignment. No prevertebral edema.\nDegenerative changes are minimal, with tiny anterior osteophytes, most\npronounced along the superior endplate of L5. No critical spinal canal or\nneuroforaminal stenosis.\n\nIncidental note is made of a densely rim calcified structure in the left lower\npelvis that measures up to 5.6 x 5.8 cm. On the frontal scout image, there is\nalso a smaller rim calcified structure in the right hemipelvis, measuring\napproximately 4.3 x 4.1 cm.", "output": "1. No acute lumbar spine fracture or traumatic malalignment.\n2. Two partially imaged rim calcified structures in the pelvis, which may\nrepresent calcified fibroids or adnexal lesions. Further evaluation with a\nnonurgent pelvic ultrasound is recommended, if not recently performed\nelsewhere.\n\nRECOMMENDATION(S): Correlation with prior pelvic imaging. If no prior\nstudies are available for comparison, a pelvic ultrasound is recommended on a\nnonurgent basis." }, { "input": "Alignment is normal. No fractures are identified. Mild multilevel\ndegenerative changes of the cervical spine with anterior and posterior\nosteophytes, endplate sclerosis, uncovertebral joint hypertrophy and disc\nspace narrowing centered at C5-C6. There is mild spinal canal narrowing at\nC5-C6 with mild right and moderate left neural foraminal narrowing. No\nprevertebral soft tissue swelling. Retropharyngeal course of the common and\ninternal carotid arteries is noted bilaterally.The thyroid and lung apices are\nclear.", "output": "1. No acute fracture or acute malalignment.\n2. Mild multilevel degenerative changes of cervical spine with mild spinal\ncanal narrowing and mild right and moderate left neural foraminal narrowing at\nC5-C6." }, { "input": "There is no acute fracture or malalignment within the cervical spine. \nSignificant degenerative disease is noted at the level of the skullbase and\natlanto dens interval. There is no prevertebral edema or hematoma. \nMultilevel degenerative disc disease spans C5 through T1 with endplate\nosteophytes and disc space narrowing most pronounced at C6-7 level. There is\nno critical central spinal canal or neural foraminal narrowing. Imaged lung\napices are clear. The thyroid gland appears unremarkable.", "output": "No fracture or malalignment. Multilevel degenerative disease as described." }, { "input": "There is straightening of normal cervical spine lordosis with mild\nretrolisthesis of C3 on C4, likely degenerative in nature.No fractures are\nidentified.There are moderate degenerative changes throughout the cervical\nspine with complete loss of disc height at C3-4 and multilevel facet and\nuncovertebral hypertrophy, most pronounced at C2-3. Mild multilevel central\ncanal stenosis is most pronounced at C3-4. Bilateral neural foraminal\nnarrowing is most pronounced at C3-4, and C5-6 due to uncovertebral spurring. \nThere is no prevertebral soft tissue swelling.Biapical pleuroparenchymal\nopacities likely represent chronic scarring. Heterogeneity of the thyroid\ngland is noted diffusely without evidence of dominant nodule.", "output": "1. No evidence of acute fracture.\n2. Moderate degenerative changes throughout the cervical spine, most\npronounced at C3-4. Mild retrolisthesis of C3 on C4 is likely degenerative in\netiology.\n3. Heterogeneous thyroid gland suggestive multinodular thyroid goiter without\ndominant nodule.\n4. Biapical pleuroparenchymal scarring." }, { "input": "There is posterior subluxation of C1 on C2 on the right (602b:23) which is\nmost likely rotational. There is also minimal 2 mm anterolisthesis of C3 on\nC4 and C4 on C5. Alignment of the cervical spine is otherwise unremarkable. \nNo acute fractures are identified. No prevertebral soft tissue swelling. \nMultilevel degenerative changes are noted throughout the cervical spine\nincluding anterior/ posterior osteophytes, uncovertebral hypertrophy and loss\nof intervertebral disc space height. Facets are fused at C3-C4 bilaterally. \nWithin the limitations of this noncontrast study, there is no evidence of\ninfection.\n\nThyroid gland is enlarged, and contains coarse calcifications on the right. \nVisualized lung apices are clear.", "output": "1. No acute fracture or traumatic malalignment in the cervical spine. No\nprevertebral soft tissue swelling.\n2. Diffusely enlarged thyroid gland with coarse calcifications on the right\nextending into the superior mediastinum. Nonurgent thyroid ultrasound is\nrecommended for further evaluation.\n\nRECOMMENDATION(S): Thyroid ultrasound for further evaluation of enlarged\nthyroid gland." }, { "input": "Vertebral body heights are maintained and there is no acute fracture. \nIntervertebral disc space heights are maintained. No acute alignment\nabnormality is identified. There is no prevertebral soft tissue abnormality.\n\nThe thyroid is grossly unremarkable in appearance. No lymphadenopathy is\npresent by CT size criteria. The visualized lung apices are clear.", "output": "No evidence of acute cervical fracture or malalignment." }, { "input": "There is mild degenerative disease of the cervical spine. However, the\nalignment is normal, there is no acute fractures seen. The vertebral body\nheights and intervertebral disc spaces are preserved.\n There is no evidence of spinal canal or neural foraminal stenosis. There is\nno prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThe limited evaluation of the bilateral lung apices is notable for biapical\nscarring (left greater than right). The visualized portion of the thyroid\ngland is notable for a 9 mm right hypodense nodule within the right lobe of\nthe thyroid gland. ___ College of Radiology guidelines do not recommend\nultrasound evaluation for incidental thyroid nodules of this size.", "output": "1. There is mild degenerative disease of the cervical spine, however there is\nno acute malalignment or fracture seen. The vertebral body heights and\nintervertebral disc spaces are preserved. There is no vertebral canal nor\nneural foraminal narrowing. There is no prevertebral soft tissue swelling. \nThere is no evidence of infection or neoplasm.\n2. The limited evaluation of the bilateral lung apices is notable for \nbiapical scarring (left greater than right).\n3. 9 mm right thyroid nodule." }, { "input": "Alignment is anatomic. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. There is no cervical\nlymphadenopathy by size criteria. The visualized aerodigestive tract is\nunremarkable.", "output": "No acute traumatic fracture or malalignment of the cervical spine." }, { "input": "Alignment is normal. Severe wedge compression deformity of the anterior\nvertebral body of T5 with greater than 80% vertebral body height loss ,\npreviously characterized as pathologic height loss on the MR total spine dated\n___. At the T5-T6 level, there is 4 mm of bony retropulsion. Spinal\ncanal and neural foraminal narrowing are grossly unchanged since ___\nand are better characterized on the MR total spine dated ___. No\nprevertebral soft tissue swelling.\n\nThe visualized lungs demonstrate no nodularity or focal consolidation. There\nis mild bibasilar atelectasis. The left kidney demonstrates enhancement and\nthe kidneys bilaterally demonstrate bilateral nephrograms which are reflective\nof prior intravenous contrast administration.", "output": "1. Severe wedge compression deformity of the T5 vertebral body, previous\ncharacterized as pathologic height loss on MR total spine dated ___. \nNo change in the extent of vertebral body height loss at T5 when compared to\nprior. No new fractures are demonstrated.\n2. 4 mm bony retropulsion at the level of T5, unchanged since ___.\n3. Spinal canal and neural foraminal narrowing are grossly unchanged since ___ and are better characterized on MR total spine dated ___." }, { "input": "Patient is status post T5 laminectomy and posterior fixation of T3-T7\nbilaterally. The inter pedicular screws of T6 on the right slightly outside\nof the vertebral body (series 2, image 45). The inter pedicular screws on the\nleft of T3-4, ___ abut into the vertebral canal and likely extends into the\nepidural space. A surgical drain is noted entering into the vertebral canal\nat the T5 level. The T5 level spinal canal narrowing has been decompressed,\nwith air seen within the thecal sac. Unchanged extent of the T5 compression\ndeformity without substantial retropulsion. Hyperdense embolization material\nis noted in the T4, T6 and T7 vertebral bodies as well as along the epidural\nspace and a few radiculo-medullary arteries.\n\nNo large fluid collection is demonstrated. Soft tissue stranding and\nsubcutaneous emphysema are noted at the surgical site consistent recent\nresection. No pneumothorax.\n\nNo acute fracture is demonstrated.\n\nNote is made of previously administered contrast entering the collecting\nsystem of the bilateral kidneys, which is asymmetric however this may be due\nto elapsed time from imaging.\n\nThere are a few scattered indeterminate pulmonary nodules, better described on\nCT chest of ___. Mild hydroureteronephrosis is identified. Contrast\nwithin the bilateral renal collecting systems is identified. There is\nasymmetric enhancement of the left collecting system with wedge like regions\nof enhancement of the renal parenchyma compatible with known history of\nobstructive hydroureter nephrosis. Scattered nonobstructive calcifications\nare identified in the bilateral kidneys.", "output": "1. Status post T5 laminectomy, and tumor decompression with posterior fixation\nspanning T3-T7 bilaterally as described above. Improvement in previously\ndemonstrated high-grade spinal canal narrowing at T5. No large postoperative\nfluid collection.\n2. Obstructive hydroureteronephrosis, unchanged from prior exam. Additional\nfindings described above." }, { "input": "Alignment is normal. No fractures are identified. The vertebral body heights\nare preserved. Mild multilevel degenerative changes are noted with anterior\nand posterior osteophytes, mild disc height loss, and uncovertebral and facet\narthropathy at C5-6 and C6-7. Mild left neural foraminal narrowing is\ndemonstrated at C5-6 and C6-7. Posterior osteophyte and disc bulge cause mild\nspinal canal stenosis at C5-6.There is no prevertebral soft tissue\nswelling.The thyroid is heterogeneous with vague hypodense nodule measuring\napproximately 8 mm with punctate calcifications in the right thyroid lobe\n(3:69). Bilateral lung apices are unremarkable. Endotracheal and enteric\ntubes are noted within the trachea and esophagus, respectively.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild-to-moderate degenerative changes at C5-6 and C6-7.\n3. Heterogeneous thyroid gland with vague nodule in the right thyroid lobe\nmeasuring up to 11 mm, but does not require imaging follow-up per ACR criteria\ngiven size" }, { "input": "Alignment is normal.Similar to the prior study there is a compression\ndeformity of the T6 vertebral body without significant retropulsion with\napproximately 30% loss of height (504:45). No other fracture is identified. \nThere is no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.Moderate to large nonhemorrhagic pleural\neffusions bilaterally have increased compared with the prior study. A 1.3 cm\nright thyroid nodule does not meet size criteria for sonographic evaluation\n(05:13).", "output": "1. Short interval stability of the T6 vertebral body compression fracture\nwithout significant retropulsion.\n2. Interval increase in bilateral nonhemorrhagic moderate to large pleural\neffusions.\n3. Please see separately submitted report of CT of the lumbar spine from the\nsame date for findings below T12." }, { "input": "Alignment is unchanged in comparison to the prior study dated ___. \nAgain seen is an L1 compression deformity, unchanged in severity or\nmorphology. There is 2 mm of retropulsion. In addition, a L4 burst fracture\nwith approximately 5 mm bony retropulsion into the spinal canal is\nrevisualized. This fracture is similar in morphology in comparison to the\nprior exam and the degree of bony retropulsion is unchanged. There is\nmoderate spinal canal stenosis at this level as well as moderate to severe\nright and moderate left neural foraminal narrowing.\n\nIncidental note is made of layering calcified gallstones. There is diffuse\ncalcified atherosclerotic plaque. Prominent retroperitoneal lymph nodes are\nnot enlarged by CT size criteria.", "output": "1. L4 burst fracture with approximately 5 mm bony retropulsion into the spinal\ncanal. Similar in overall appearance ___. There is associated\nmoderate spinal canal narrowing and moderate to severe right and moderate left\nneural foraminal narrowing.\n2. L1 compression deformity, unchanged in appearance.\n3. Please refer to the separately dictated CT of the thoracic spine for full\ndescription of the thoracic findings." }, { "input": "There is no evidence of fracture or traumatic malalignment. There is no\nevidence of prevertebral soft tissue swelling. There is no significant neural\nforaminal or spinal canal narrowing.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No acute cervical spine fractures are identified.Small\nanterior osteophytes are noted from C4-C7. The vertebral body heights are\npreserved. There is moderate loss of disc heights C5-6 with endplate\nirregularity and a subchondral cyst. No high-grade spinal canal stenosis. \nUncovertebral and facet osteophytes cause mild bilateral neural foraminal\nnarrowing at C5-6. There is no prevertebral edema.\n\nThe thyroid is unremarkable. Bilateral lung apices demonstrate ground-glass\nopacity with interlobular septal thickening with anterior to posterior\ngradient, consistent with pulmonary edema. Foci of air is noted in the anti\ndependent portion of the right internal jugular and subclavian veins, likely\nrelated to intravenous catheter.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine, worst at C5-6.\n3. Pulmonary edema, better evaluated on same day chest CTA." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "No fracture or traumatic malalignment." }, { "input": "There is no acute fracture or vertebral malalignment. Degenerative changes\nare noted throughout the C-spine, most prominent at C6-7 with endplate\nsclerosis and disc space narrowing. There is no evidence of spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm.", "output": "No acute fracture or vertebral malalignment." }, { "input": "There is no evidence for fracture or dislocation. Mild anterior widening of\nthe C6-C7 interspace with a partly bridging anterior osteophyte is most likely\nto be a chronic process. No soft tissue reaction is demonstrated. Otherwise\nthe alignment is within normal limits. Soft tissue structures are\nunremarkable otherwise. There is moderate to severe facet arthropathy\ninvolving the left C4-C5 facet. Moderate calcification is noted along each\ncarotid bulb. The course of the common carotid arteries is relatively medial\nand tortuous.", "output": "No evidence of fracture dislocation. Mild inter widening at C6-C7; although\nmost likely an incidental finding in probably chronic, further imaging could\nbe considered if there is any corresponding clinical concern regarding the\npossibility of anterior ligamentous injury." }, { "input": "There is 2 mm anterolisthesis of C2 over C3, 2 mm retrolisthesis of C3 over\nC4, 4 mm anterolisthesis of C4 over C5 and 3 mm anterolisthesis of C7 over T1.\nThese alignment changes are most likely degenerative. However, no prior exam\nis available to establish chronicity. No acute fracture or frank dislocation\nis seen. Identified.Moderate to severe degenerative changes of the cervical\nspine is noted with vertebral body height loss, severe disc space loss, and\nlarge anterior and posterior osteophytosis, worse at C3-4, C5-6 and C6-7. \nEvaluation of spinal canal is somewhat limited due to hardware artifact,\nespecially at C4. However, moderate to severe spinal canal narrowing is most\nnotable at C3-4, C5-6 and C6-7 due to above mentioned degenerative changes. .\nThere is no prevertebral soft tissue swelling. Vascular calcifications at the\nbilateral carotid bulbs are noted. The visualized portion of the lungs are\nmostly clear.", "output": "1. No acute fracture or dislocation.\n2. 2 mm anterolisthesis of C2 over C3, 2 mm retrolisthesis of C3 over C4, 4 mm\nanterolisthesis of C4 over C5 and 3 mm anterolisthesis of C2-7 over T1, likely\ndegenerative.\n3. Moderate to severe spinal canal narrowing is most notable at C3-4, C5-6 and\nC6-7, which may predispose patient to spinal cord injury." }, { "input": "Alignment is normal. No acute fractures are identified.Sclerotic focus in the\nmedial right first rib likely represents a bone island, and measures 1.6\ncm.There is no prevertebral edema.\n\nThe imaged thyroid gland is grossly homogeneous, though not well assessed on\nthis study. No focal consolidation is seen in the partially imaged lung\napices.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No acute fractures are identified. Focal chronic\ncalcification of the posterior ligament at the level of C6 vertebral body. \nThere is no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no spondylolisthesis. There is an acute nondisplaced fracture through\nthe right transverse process of C6 (2:45, 602b:33). There is also an acute\nnondisplaced fracture through the right transverse process of T1 (601b:28).\nThere is marked prevertebral soft tissue swelling anterior to the vertebral\ncolumn from C1 to lower C5. In the setting of trauma, this is worrisome for\nanterior longitudinal ligament injury. Correlation with an MRI examination is\nrecommended.\n\nThe nasogastric tube is noted to be coiled within the upper esophagus.", "output": "1. Acute nondisplaced fracture of the right transverse process of C6 and T1.\n2. Extensive prevertebral soft tissue swelling concerning for ligamentous\ninjury. Evaluation with MRI is recommended.\n3. Malpositioned nasogastric tube in the upper esophagus.\n\nNOTIFICATION: The case was discussed with the trauma surgery team in person\nat the time of interpretation." }, { "input": "C-spine:\nNo acute fracture or traumatic malalignment is identified. There is minimal\nretrolisthesis C5 on C6 and C6 on C7, likely degenerative. There are no\nsuspicious osteoblastic or lytic lesions. The atlantodental interval is within\nnormal limits.\n\nThere are mild multilevel degenerative changes of the cervical spine,\nincluding facet joint and uncovertebral hypertrophy, osteophytosis, and loss\nof intervertebral disc space, which is most prominent at C5-6 and C6-7.. \nThere is no evidence of high-grade spinal canal narrowing. There is\nmultilevel moderate neural foraminal narrowing, most prominent on the right at\nC5-6.\n\nOther bones:\nNo fractures identified in visualized portions of the clavicles, scapula, and\nribs.\n\nSinuses: The visualized portion of the paranasal sinuses, mastoid air cells,\nand middle ear cavities are clear.\n\nSoft tissues: There is no prevertebral soft tissue swelling. There is no soft\ntissue stranding or masses.\n\nThyroid: The thyroid appears unremarkable.\n\nLungs: Visualized portions of the lungs are normal\n\nLymph nodes: There is no lymphadenopathy by CT size criteria.\n\nVessels: No atherosclerosis of the visualized portions of the aorta, branches\ncommon carotid arteries.", "output": "1. No acute fracture or traumatic malalignment is identified.\n2. Mild multilevel degenerative changes of the cervical spine, as above.\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "There is no evidence of acute fracture or traumatic malalignment of the\ncervical spine. The bones diffusely are markedly heterogeneous with mixed\nlytic and sclerotic lesions compatible with extensive osseous metastatic\ndisease. There is no prevertebral soft tissue swelling. Moderate\ndegenerative changes are demonstrated with intervertebral disc space\nnarrowing, anterior and posterior osteophyte formation, with small disc bulges\nresulting in mild central canal narrowing, worse at C5-6. No significant\nneural foraminal stenosis is identified. The thyroid is enlarged and\nheterogeneous with punctate right lobe calcifications without a discrete\nnodule. Scarring is noted within the lung apices.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Extensive osseous metastatic disease.\n3. Heterogeneous thyroid gland for which correlation with thyroid function\ntests is recommended" }, { "input": "No acute fracture is identified. Multilevel degenerative disease of the\ncervical spine including loss of disc height, uncovertebral osteophytes, and\nfacet hypertrophy without critical canal narrowing are seen. Mild\nanterolisthesis of C6 on C7 is seen, likely degenerative in origin. \nElsewhere, vertebral bodies are preserved in alignment. There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No fracture.\n2. Mild anterolisthesis of C6 on C7, likely degenerative. Correlate\nclinically.\n\nNOTIFICATION: Updated wet read was discussed by Dr. ___ with Dr. ___ at\n13:30 on ___." }, { "input": "Evaluation is somewhat limited due to patient positioning. There is\nstraightening of the usual cervical lordosis. Alignment is otherwise normal.\nNo acute cervical spine fractures are identified. There is no critical spinal\ncanal stenosis. There is no prevertebral soft tissue swelling. Multilevel\ndegenerative changes throughout the C-spine are severe and more significant\nfrom C3/C4 through C6/C7 levels, consistent with anterior and posterior\nspondylosis, causing anterior thecal sac deformity and probably moderate to\nsevere spinal canal narrowing, please note that CT is not able to provide the\nsame anatomical detail as MRI. The lung apices are clear, the thyroid gland\nappears unremarkable. Vascular arteriosclerotic calcifications are visualized\nin the carotid arteries. The visualized aspect of the paranasal sinuses shows\nmild mucosal thickening in the sphenoid sinus and right maxillary sinus,\npartially evaluated in this examination.", "output": "1. Evaluation is somewhat limited due to patient positioning. No acute\ncervical spine fracture or traumatic malalignment.\n\n2. Multilevel multifactorial severe degenerative changes throughout the\ncervical spine." }, { "input": "There is no abnormality of the prevertebral soft tissues. No fracture is\nidentified. There is straightening of the normal cervical lordosis. Alignment\nis otherwise normal. There is marked ossification of the posterior\nlongitudinal ligament causing severe spinal canal narrowing from the levels of\nC2 through C5. Additionally, there is ossification of the anterior\nlongitudinal ligament. There are also moderate degenerative changes with disc\nspace narrowing, facet hypertrophy, and uncovertebral hypertrophy causing\nmultilevel moderate bilateral neural foraminal narrowing.\n\nThere is no cervical lymphadenopathy. Mild atherosclerotic calcifications are\nnoted at the bifurcation of the bilateral common carotid arteries. There is a\n7 mm hypodense nodule in the right lobe of the thyroid gland. The thyroid is\notherwise unremarkable. There is a 3 mm subpleural right apical pulmonary\nnodule (3, 62) and 3 mm left perifissure pulmonary nodule (3, 65). The apices\nof the lungs are otherwise clear.", "output": "1. No evidence of fracture. Ossification of the anterior and posterior\nlongitudinal ligament, the latter causing severe multilevel spinal canal\nnarrowing. This predisposed the patient to spinal cord injury in the setting\nof minimal trauma. If there is clinical concern for spinal cord injury, an MRI\nis recommended.\n2. 7 mm right thyroid nodule.\n3. Two sub-4-mm pulmonary nodules. Please see the chest CT for further\nrecommendations." }, { "input": "There is no traumatic malalignment. No acute fractures seen. There is\nmild-to-moderate degenerative changes of the cervical spine with moderate to\nsevere spinal canal narrowing and bilateral neural foraminal narrowing at\nC3-4, C4-5, C6-7 and C7-T1 due to uncovertebral hypertrophy and disc bulge,\nwhich somewhat remodels the cord at those levels. There is no prevertebral\nsoft tissue swelling. There is a 3 mm nodule in the left upper lobe (3:72).", "output": "1. No traumatic malalignment or acute fracture.\n2. 3 mm nodule in the left upper lobe. For incidentally detected single solid\npulmonary nodule smaller than 6 mm, no CT follow-up is recommended in a\nlow-risk patient, and an optional CT in 12 months is recommend in a high-risk\npatient." }, { "input": "There is no traumatic malalignment. 3 mm posterior subluxation of L2 over L3\nand L3 over L4, 2 mm posterior subluxation of L4 over L5 and 4 mm posterior\nsubluxation of L5-S1 are stable from ___ acute fractures seen.\nSince ___, there is interval progression of pre-existing\ndegenerative changes of the lumbar spine, now moderate. For example, there is\nfurther loss of disc space, most notable at L2-L3 and L3-L4. Endplate\nsclerosis at L2-L3 are more pronounced. Schmorl's node at L3 are more\nprominent on today's exam. Mild to moderate spinal canal narrowing is worst\nat L1-L2, L2-L3 due to disc bulge. Neural foraminal narrowing is mild\ntomoderate at right L2-3, L3-4 and L5-S1 and left L4-L5 and L5-S1. There is\nno prevertebral soft tissue swelling.", "output": "1. Interval some worsening of degenerative changes in the lumbar spine, now\nmild to moderate with multilevel disc space loss and mild to moderate spinal\ncanal and neural foraminal narrowing as noted above.\n2. No acute fracture or traumatic malalignment." }, { "input": "Trace anterolisthesis of C2 on C3 and C3 on C4 is unchanged from ___.\nNo acute fractures are identified.Mild multilevel degenerative changes are\nseen, most extensive at C3-4 and C5-6 and notable for loss of intervertebral\ndisc space.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Mild scarring is noted in the imaged lung\napices.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no prevertebral soft tissue swelling. There is no evidence of\ncervical spine fracture. There are moderate multilevel multifactorial\ndegenerative changes most pronounced at the C4 - C6 levels anterior\nosteophytes and disc space narrowing. Alignment is maintained. The lung apices\nare clear. There is no adenopathy by CT size criteria.", "output": "No evidence of cervical spine fracture. Moderate multi-level degenerative\nchanges." }, { "input": "There is no fracture or acute malalignment of the cervical spine. The\nprevertebral soft tissues are unremarkable.\n\nMild multilevel degenerative changes are present throughout the cervical\nspine, most prominent at the C6-7 levels, where there is disc space narrowing,\nend-plate sclerosis, and vacuum disc phenomenon. Multilevel small anterior\nosteophytes are also present, most notable at the C5 level, and multilevel\nbilateral facet arthropathy is noted, including at the C2-3 level.\n\nThere is no lymphadenopathy. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable.", "output": "No fracture or acute malalignment of the cervical spine. Mild multilevel\ndegenerative changes, as described above." }, { "input": "There is no acute fracture or subluxation of the cervical spine. There is no\nprevertebral soft tissue swelling or hematoma. There is mild degenerative\njoint change, including intervertebral disk space narrowing at C5-6. There\nare multilevel uncovertebral osteophytes and facet joint hypertrophy,\nresulting in mild neural foraminal narrowing which is worst at C5-6. There is\nno critical central spinal canal narrowing.\n\nLeft temporomandibular joint degenerative change and bilateral carotid bulb\ncalcifications are incidentally noted.", "output": "No acute fracture or subluxation." }, { "input": "No acute fracture or traumatic malalignment is seen. Lordosis is maintained. \nDegenerative changes at the atlanto dens junction as well as degenerative disc\ndisease at C6-7 noted. Mild posterior disc bulges are noted at C3-4, C4-5,\nC5-6 and C6-7 though there is no significant impingement on the thecal sac. \nNo prevertebral edema. No significant neural foraminal stenosis. The lung\napices are clear. The thyroid gland appears normal. Carotid bulb\ncalcifications noted. Base of dens is intact.", "output": "No fracture or traumatic malalignment." }, { "input": "Dextro convex scoliosis of the lumbar spine with apex at L2-L3 is\nre-identified. 2 mm right lateral listhesis of L2 on L3 and L3 on L4 is\nunchanged from prior radiograph. There is 7 mm grade 1 anterolisthesis of L5\non S1. Loss of disc height spanning T10-T11 through L3-L4 and L4-L5 is\nsevere, demonstrating vacuum disc phenomenon. Moderate loss of disc height\nwith vacuum disc phenomenon is noted at L4-L5. There is no suspicious blastic\nor lytic osseous lesion, noting subcortical cystic changes in the L5-S1\nendplates and facets.\n\nAs described on prior MRI, from T11-T12 through L3-L4, there are small disc\nbulges with intervertebral osteophytes as well as facet arthropathy which\nresults in mild spinal canal and neural foraminal narrowing, most prominent at\nL3-L4.\n\nL4-L5: A disc bulge with punctate calcification and mild thickening of the\nligamentum flavum does not significantly narrow the spinal canal. Facet\narthropathy results in mild to moderate bilateral neural foraminal narrowing.\n\nL5-S1: The disc is uncovered secondary to anterolisthesis. Facet arthropathy\nand degenerative changes results in moderate spinal canal narrowing. There is\nsevere bilateral neural foraminal narrowing secondary to facet arthropathy.\n\nAtherosclerotic calcification of the abdominal aorta and iliac vessels is\nidentified, with short-segment fusiform aneurysm of the right common iliac\nartery (series 5, image 110) measuring 2 cm in diameter. There is also\nectasia of the infrarenal abdominal aorta just prior to the iliac bifurcation\nmeasuring approximately 2.1 cm (series 5, image 88). Otherwise, the remainder\nthe visualized prevertebral and paraspinal soft tissues are unremarkable.", "output": "1. Grade 1 anterolisthesis of L5 on S1 with severe facet arthropathy,\nresulting in severe bilateral neural foraminal narrowing.\n2. Incidentally noted is short segment fusiform aneurysm of the right common\niliac artery measuring approximately 2 cm in diameter (series 5, image 110)\nand ectasia of the infrarenal abdominal aorta just prior to the iliac\nbifurcation measure approximately 2.1 cm. Images from prior CT abdomen and\npelvis with contrast of ___ were not available for comparison at\nthe time of this dictation. Comparison when available is recommended. \nAlternatively this could be further evaluated with ultrasound." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThere is a right supraclavicular hematoma with acute fracture through the\nright mid and distal clavicle.\n\nThe thyroid and included lung apices are unremarkable. Air noted in the left\ninternal jugular vein likely from recent instrumentation.\n\nThere is a left occipital and occipital condyle fracture, better seen on CT\nhead.", "output": "1. Acute fracture through the right mid and distal clavicle with a right\nsupraclavicular hematoma.\n2. No cervical spine fracture or prevertebral edema.\n\nNOTIFICATION: The findings were discussed with ___ from trauma team, M.D.\nby ___, M.D. on the telephone on ___ at 12:01 am, 5 minutes after\ndiscovery of the findings." }, { "input": "No fractures or traumatic malalignment identified. There is no prevertebral\nsoft tissue swelling. There is no significant evidence of spinal canal or\nneural foraminal narrowing. The lung apices are clear. The thyroid is normal.\nThere is mild mucosal thickening in the sphenoid sinus on the right.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Alignment is preserved.No acute fractures are identified. Degenerative\nchanges include loss of intervertebral disc height, osteophytosis and\nsubchondral sclerosis. There is moderate-severe neural foraminal narrowing\nwhich is most severe at C ___ on the right. There is narrowing of the central\ncanal at C6/C7, on the left, and moderate central canal narrowing C3 through\nC6, due to posterior disc osteophyte calcification of posterior longitudinal\nligament is demonstrated.There is no prevertebral soft tissue swelling. \nPartially imaged very superior lung apices are grossly clear. The imaged\nthyroid gland is homogeneous.", "output": "1. No acute fracture or traumatic subluxation.\n2. Chronic degenerative changes as described above." }, { "input": "No spondylolisthesis.There is a small avulsion fracture of the anterior\ninferior endplate at C4. There are nondisplaced fractures involving the right\nC5 transverse process, right C5 pedicle, and C5 spinous process. The\ntransverse process fracture extends into the transverse foramen. Adjacent\nprevertebral soft tissue swelling is minimal. Posterior osteophytes at C3-C4\nand C4-C5 result in moderate to severe spinal canal narrowing. Uncovertebral\nosteophytes and facet hypertrophy result in as much as moderate to severe\nneural foraminal narrowing, most pronounced on the right at C4-C5 and on the\nleft at C6-C7. There is no significant prevertebral soft tissue swelling.\n\nImaged lung apices and thyroid gland are unremarkable.", "output": "1. Right C5 transverse process, right C5 pedicle, and C5 spinous process\nfractures. The transverse process fracture extends into the transverse\nforamen. Recommend neck CTA to assess for injury to the right vertebral\nartery.\n2. Probable small C4 anterior inferior endplate avulsion fracture.\n3. Moderate cervical spine degenerative changes with moderate to severe spinal\ncanal narrowing at C3-C4 and moderate to severe neural foraminal narrowing\nworst on the right at C4-C5 and on the left at C6-C7.\n\nRECOMMENDATION(S): Recommend neck CTA to assess for injury to the right\nvertebral artery." }, { "input": "Alignment is normal. No fractures are identified.Small disc bulge at C4-5\nresults in flattening of the ventral thecal sac. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm. Imaged\nthyroid gland and lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is redemonstration of ___ fracture of the C1 vertebral body with\ninterval bony bridging compared to prior. There is continued lateral\ndisplacement of the lateral masses of C1.\n\nAgain seen, is a comminuted fracture through the base of the odontoid process,\nwithout significant healing compared to prior.\n\nNo new fracture seen. Vertebral body alignment is similar to prior. There is\nno evidence of infection or neoplasm. There is no evidence of critical spinal\ncanal narrowing.\n\nThere is diffuse osteopenia and multilevel degenerative changes, most\npronounced at C4-5 and C5-6 levels. Dense calcifications are noted within the\ncarotid arteries bilaterally. There is minimal scarring at the lung apices.\nDense opacification of the right sphenoid sinus better demonstrated on the\nconcurrent head CT.", "output": "1. ___ type 1 fracture of the C1 vertebral body, with interval healing\ncompared to prior, but iwth continued displacement of lateral masses of C1.\n2. No significant interval healing of the comminuted type II odontoid\nfracture.\n3. No new cervical spine fracture identified. Unchanged alignment.\n4. See concurrent head CT ___ # ___ for description of sinuses and\nbrain structures." }, { "input": "Alignment is unchanged since ___. There is mild anterolisthesis\nof C7 on T1. Fracture of the left superior articular facet of C3 (02:30) is\nunchanged since ___. Chronic fractures of C1 and C2 and\nassociated extensive callus formation/ossification are unchanged since prior. \nNonunion of the dens fracture is similar compared to prior as well. Superior\nendplate depression of T2 is also unchanged. No acute fractures are\nidentified. Multilevel degenerative changes are similar to prior. There is no\nprevertebral soft tissue swelling.", "output": "1. Unchanged chronic fractures of C1 and C2.\n2. Unchanged fracture of the left superior articular facet of C3.\n3. No acute fracture or traumatic malalignment." }, { "input": "Minimal anterolisthesis C7-T1, likely degenerative. No prevertebral edema. \nNo fracture. Mildly prominent ventral epidural space, not hyperdense, likely\nprominent venous plexus, no hyperdensity to suggest acute epidural hematoma.\n\nMultilevel degenerative changes, disc space narrowing, disc osteophyte\ncomplex. Probably moderate central canal narrowing C5-C6 level. Multilevel\nmoderate to severe foraminal narrowing.\nNormal neck soft tissues. Degenerative changes left TMJ. VP shunt. Left ear\ndevice in place. Left supraclavicular soft tissue swelling, likely\nposttraumatic, probable small inferior sternocleidomastoid hematoma. Left\nclavicle is not covered medially to assess for fracture or dislocation.", "output": "1. No acute spine fracture.\n2. Probable prominent venous epidural plexus upper cervical spine.\n3. Left supraclavicular soft tissue swelling, likely posttraumatic. Consider\nassessment of medial left clavicle and sternoclavicular joint.\n4. Multilevel degenerative changes, as above.\n\nRECOMMENDATION(S): Assessment of medial left clavicle, sternoclavicular joint\nif indicated." }, { "input": "Unchanged minimal anterolisthesis of C7 on T1, likely degenerative. Otherwise,\nalignment is normal. No fractures are identified.Moderate spinal canal\nnarrowing is noted at C5-C6 and C6-C7 in the setting of disc bulge. \nMild-to-moderate multilevel degenerative changes including uncovertebral\nhypertrophy and facet arthropathy contribute to moderate right neural\nforaminal narrowing at C5-C6 (2:36). There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No evidence of acute bony fracture or traumatic subluxation.\n2. Multilevel mild-to-moderate degenerative changes as described above,\nlargely unchanged." }, { "input": "Alignment is normal. No fractures are identified.There is no prevertebral\nedema. There are multilevel changes of degenerative disease with no spinal\ncanal narrowing at C2-3 or C3-4. There is left neural foraminal narrowing at\nC3-4.\nAt C4-5, uncovertebral osteophytes produce mild bilateral neural foraminal\nnarrowing. A disc bulge and perhaps midline protrusion encroach on the spinal\ncord.\nAt C5-6, there is a disc bulge and perhaps midline disc protrusion encroaching\non the spinal cord. Uncovertebral and facet osteophytes produce severe right\nneural foraminal narrowing and mild left neural foraminal narrowing.\nAt C6-7, intervertebral osteophytes and ligamentum flavum thickening mildly\nnarrow the spinal canal and encroach on the spinal cord. The right neural\nforamina appears normal. Uncovertebral and facet osteophytes produce severe\nleft neural foraminal narrowing.\nAt C7-T1 and the included portions of the upper thoracic spine, there is no\nspinal canal or neural foraminal narrowing.\n\nLeft clavicle deformity is partially visualized. Visualized lung apices are\nnormal.\n\nThe thyroid gland is heterogeneous. There is a 1.0 cm right thyroid hypodense\nnodule.", "output": "1. No evidence of cervical fracture or malalignment.\n2. Partially visualized left clavicle deformity.\n3. Heterogeneous thyroid with a 1 cm right lobe nodule." }, { "input": "Dental amalgam streak artifact and mild motion limits study.\n\nAlignment is normal.There is diffuse osteopenia limiting assessment for subtle\nnondisplaced fractures. Moderate multilevel degenerative changes are noted. \nPosterior disc osteophyte complexes at C2-3, C3-4, C4-5, and C6-7 results in\nmild spinal canal narrowing. There is mild neural foraminal narrowing at C3\non the right, C4 on the right, and C5 bilaterally. There is no prevertebral\nsoft tissue swelling. Within the limits of this noncontrast study, there is no\nevidence of infection or neoplasm within the limits of a noncontrast study.\n\nThe right mandibular molar tooth is missing a crown and demonstrates\nperiapical lucency concerning for periapical cyst versus abscess (602b:16).", "output": "1. Dental amalgam streak artifact, mild motion and diffuse osteopenia limits\nstudy.\n2. No evidence of acute fracture traumatic malalignment.\n3. Moderate multilevel degenerate degenerative changes are noted with\nmultilevel mild spinal canal and neural foraminal narrowing.\n4. Right mandibular molar tooth is missing a crown and demonstrates\nperiodontal disease." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. Mild multilevel degenerative changes are present with\nmild to moderate left neural foraminal narrowing at C5-6 level. There is no\nevidence of spinal canal narrowing. There is no evidence of lymphadenopathy. \nThe lung apices and the airways are clear.", "output": "No acute fracture or traumatic malalignment. Mild degenerative changes, more\nsignificant at C5/C6 level." }, { "input": "Alignment is unchanged with mild C5 on C6 retrolisthesis and C7 on T1\nanterolisthesis.No fractures are identified.Moderate degenerative changes most\nsignificant at C5-C6 and C6-C7 with disc height loss, endplate osteophytes and\nsubchondral sclerosis. Moderate central canal narrowing at C5-C6. \nMild-to-moderate neural foraminal narrowing at C5-C6 and C6-C7.There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nBiapical lung scarring is noted. Hypodense 1.6 x 1.4 cm right thyroid nodule.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate cervical degenerative changes. Mild multilevel subluxation is\nlikely degenerative in etiology and unchanged.\n3. 1.6 cm right thyroid nodule.\n Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Minimal retrolisthesis of C5 on C6 and 2 mm anterolisthesis of C7 on T1 is\nunchanged dating back to ___. No evidence of traumatic malalignment.\nOverall moderate degenerative changes are most significant at C5-6 and C6-7\nwith intervertebral disc height loss, endplate osteophytes, and uncovertebral\njoint hypertrophy, with resulting mild neural foraminal narrowing at these\nlevels. There is resulting mild canal narrowing at C5-6. Degenerative\nchanges are not substantially changed compared to the study from ___.\nThere is no prevertebral edema.\n\nThere is a 2.0 x 1.5 cm hypoattenuating nodule in the right thyroid lobe.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Moderate cervical degenerative change, including multilevel mild\nsubluxation, overall unchanged compared to the prior study from ___.\n3. 2.0 cm right thyroid lobe nodule. While there are no suspicious features\nby CT, given the size, this should be evaluated with follow-up non-emergent\nthyroid ultrasound.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no acute fracture, traumatic malalignment or prevertebral soft tissue\nswelling. The vertebral body heights are maintained. There is diffuse\nsclerosis of multiple vertebral bodies and the posterior elements compatible\nwith osseous metastatic disease. Areas of lucency are noted in the posterior\naspect C7 and T1. There multilevel degenerative changes with grade 1\nanterolisthesis of C7 on T1 likely degenerative. There is disc space narrowing\nat multiple levels but no significant canal narrowing. Areas of sclerosis are\nalso noted in the clavicles bilaterally and in the ribs. The visualized soft\ntissues demonstrate calcifications at the carotid bifurcations bilaterally.\nThe thyroid gland is unremarkable. The lung apices are clear. Left mastoid\naircells are partially opacified.", "output": "1. No acute fracture or traumatic malalignment.\n2. Diffuse sclerosis involving the cervical spine, ribs and clavicles\ncompatible with metastatic disease. Recommend clinical correlation for history\nof malignancy such as prostate cancer.\n3. Mild multilevel degenerative changes." }, { "input": "There is no acute fracture or traumatic malalignment. Thin flowing\nsyndesmophytes are seen throughout the cervical spine compatible with\nankylosing spondylitis. There is no significant canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nVisualized thyroid gland and lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Ankylosing spondylitis." }, { "input": "Thin flowing syndesmophytes bilaterally throughout the thoracic spine indicate\nankylosing spondylitis. A transversely oriented fracture through the superior\nendplate of T9 extends to the bilateral lamina and spinous process in an\noblique fashion with distraction of fracture fragments anteriorly. Additional\nminimally displaced fracture through the right posterior ninth rib is\ndemonstrated. No subluxation is present. There is mild associated\nprevertebral soft tissue swelling at T8-T9. No significant spinal canal or\nneural foraminal stenosis is identified. There is no evidence of infection or\nneoplasm.\n\nEsophagus appears somewhat patulous throughout with a small amount of fluid. \nVisualized lungs demonstrate mild atelectasis in the dependent aspects of both\nlower lobes.", "output": "1. Anteriorly distracted transversely oriented fracture through the superior\nendplate of T9 with extension through the posterior elements, as seen on\nrecent MRI. Findings are compatible with a hyperextension injury.\n2. Additional minimally displaced fracture of the right posterior ninth rib.\n3. Ankylosing spondylitis of the thoracic spine.\n4. Patulous esophagus which could suggest esophageal dysmotility." }, { "input": "Thin flowing bilateral syndesmophytes are seen throughout the lumbar spine\nwith fusion of the sacroiliac joints compatible with ankylosing spondylitis. \nNo acute fracture or subluxation identified.Mild left-sided neural foraminal\nnarrowing is seen at L4-5 and L5-S1 due to facet hypertrophy. There is no\nevidence of high-grade spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nMild aortic vascular calcifications are visualized. The imaged portion of the\nkidneys is grossly unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Ankylosing spondylitis." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges are seen, including intervertebral disc height loss, posterior\nosteophytes and uncovertebral joint hypertrophy most notable at C5-C6 where\nthere is mild canal and mild to moderate right foraminal narrowing. Disc\nbulges at C2-3 through C4-5 which partially efface the ventral CSF. There is\nno prevertebral edema.\n\nA mucous retention cyst is seen in the partially visualized right maxillary\nsinus. The thyroid and included lung apices are unremarkable.", "output": "Degenerative changes without acute fracture or traumatic malalignment." }, { "input": "Grade 1 anterolisthesis of L4 on L5. There is also right lateral subluxation\nof L3 on L4 and a mid lumbar dextroscoliosis. Vertebral bodies are maintained\nin height. There is no fracture. Multilevel degenerative changes are noted\nincluding intervertebral disc height loss with vacuum disc phenomenon\nspecifically at L2-3, L3-4, and L5-S1. Multilevel facet joint hypertrophy is\nalso noted. Disc bulges at L2-3 and L3-4 contribute to mild canal narrowing\nand moderate bilateral foraminal narrowing at these levels\n\nAtherosclerotic calcifications noted in the abdominal aorta. Other included\nretroperitoneal soft tissues are unremarkable.", "output": "Degenerative changes without fracture or traumatic malalignment." }, { "input": "Mild degenerative disc disease with no evidence of fracture or subluxation.\nOsteopenia present possibly due to osteoporosis. Some fluid present in the\nsphenoid and maxillary sinuses. CT is not able to provide intrathecal detail\ncomparable to MRI of the visualized outline of the thecal sac appears\nunremarkable.", "output": "Mild degenerative disc disease without evidence of fracture or subluxation.\n\nNOTIFICATION: Dr. ___ @ 220 pm" }, { "input": "Mild degenerative disc disease with no evidence of fracture or subluxation.\nOsteopenia possibly due to osteoporosis. Small bilateral pleural thickening\npresent. CT is not able to provide intrathecal detail compare wall MRI of the\nvisualized colon of the thecal sac appears unremarkable. No lymphadenopathy is\npresent by CT size criteria.", "output": "1. Mild degenerative disc disease without evidence of fracture or subluxation\n\n2. Small bilateral pleural thickening\n\nNOTIFICATION: ___ @ 220 pm" }, { "input": "Alignment is normal. No fractures are identified.There is no prevertebral soft\ntissue edema. Mild degenerative changes are noted in the cervical spine with\nsome loss of intervertebral disc space and osteophyte formation.\n\nThere is multilevel posterior osteophyte and disc bulges causing\nmild-to-moderate vertebral canal narrowing with flattening of the spinal cord,\nworst at the C7-T1 level. There is no significant neural foraminal stenosis. \nThere is no evidence of infection or neoplasm. The visualized lung apices\nappear clear. There is a 9 mm hypodensity with calcifications in the right\nthyroid lobe. A subcutaneous sebaceous cyst is incidentally seen in the right\nupper back.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C5-6 and notable for loss of\nintervertebral disc height, loss vertebral body height, anterior and posterior\nosteophytosis, and uncovertebral and facet hypertrophy. There is fusion of\nthe right C2-3 facet joints. There is no significant spinal canal\nnarrowing.There is no prevertebral edema. The thyroid is unremarkable. \nIncluded lung apices show biapical scarring.", "output": "Multilevel degenerative changes of the cervical spine without acute fracture\nor traumatic malalignment." }, { "input": "No traumatic malalignment. No fractures are identified.Mild multilevel\ndegenerative changes are seen, most pronounced at C5-C6 and notable for\nposterior disc osteophyte complex resulting in mild canal narrowing. There is\nmild left neural foraminal narrowing at C3-4 and C4-5. There is no\nprevertebral edema.\n\nThere are paraseptal and centrilobular emphysematous changes in the lung\napices. The thyroid gland is unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "No evidence of traumatic malalignment or acute fracture. No prevertebral soft\ntissue edema. Anterior osteophytes are similar comparison to the CTA head and\nneck dated ___. Additional multilevel degenerative changes including\nfacet osteophytosis is noted.\n\nKnown right rib fractures, right pneumothorax, trace air within the\nmediastinum and right lung parenchymal contusion and effusion are better\nassessed on the concurrently performed CT torso.\n\n12 x 9 mm focal area of low attenuation in the right thyroid lobe, and a\nposterior exophytic 12 x 8 mm nodule extends from the posterior right thyroid\nlobe, similar in comparison to prior (03:52, 03:55).", "output": "1. No evidence of traumatic malalignment, acute fracture or prevertebral\nedema.\n2. Known right rib fractures, right pneumothorax, trace air within the\nmediastinum and right lung parenchymal contusion and effusion are better\nassessed on the concurrently performed CT torso.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema. Retropharyngeal\ncourse of of the cervical ICAs is noted.\n\nThe thyroid and included lung apices are unremarkable. Right-sided\nlaryngocele is incidentally noted.", "output": "No cervical spine fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified.There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nModerate degenerative disc disease throughout the cervical spine. Small\nposterior intervertebral osteophytes, but no high-grade spinal canal stenosis.\nThere is also multilevel neural foraminal stenosis due to a combination of\nuncovertebral and facet osteophytes, most severe at C5-6 on the right.\n\nNote is made of a retropharyngeal course of the internal carotid arteries. \nMinimal pleuroparenchymal scarring at the bilateral lung apices. No cervical\nlymphadenopathy. No thyroid nodules.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Multilevel multifactorial moderate degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.Uncovertebral and left facet\njoint osteophytes results in severe narrowing of the left neural foramina at\nC5-6. There is no spinal canal narrowing.There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.", "output": "No evidence of fracture, malalignment, or prevertebral soft tissue\nabnormality." }, { "input": "There is mild retrolisthesis of L1 on L2 and mild anterolisthesis of L5 on S1,\nunchanged since the prior CT.No fractures are identified.Degenerative changes\nthroughout the lumbar spine are moderate to severe, denoted by narrowing of\nthe disc space, endplate sclerosis, and marginal osteophyte formation. There\nis no severe spinal canal or neural foraminal narrowing.There is no\nprevertebral soft tissue swelling.\n\nIncidental note is made of mild to moderate atherosclerotic calcifications\ninvolving the distal abdominal aorta into the iliac arteries.", "output": "1. No evidence of lumbar spinal fracture or traumatic malalignment.\n\n2. Moderate to severe degenerative changes in the lumbar spine, as detailed\nabove." }, { "input": "Alignment is normal. No acute fractures are identified.There are mild\nmultilevel degenerative changes of the cervical spine worse where there is\ndiffused disc height loss and small anterior and posterior intervertebral\nosteophytes. No cysts significant spinal canal narrowing. Uncovertebral and\nfacet hypertrophy cause moderate to severe neural foraminal narrowing at\nseveral levels, worst at the bilateral C5-6 levels.There is no prevertebral\nsoft tissue swelling.Imaged lung apices are clear. Thyroid gland is\nunremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes as described above." }, { "input": "No acute fracture or traumatic malalignment of the cervical spine is\nidentified. There is no prevertebral soft tissue swelling. There is no\nsignificant neural foraminal narrowing or spinal canal stenosis. Other acute\ninjuries of the occipital bone and facial bones are better characterized on\nconcurrent CTs.\n\nThe thyroid gland is unremarkable. Visualized lung apices are clear. There\nis no cervical lymphadenopathy.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "There is no evidence of fracture or malalignment. There is no prevertebral\nsoft tissue swelling.\n\nMultilevel multifactorial moderate degenerative changes are seen throughout\nthe cervical spine, with anterior and posterior osteophytosis, however there\nis no evidence of significant thecal sac narrowing. The thyroid is normal. \nThere is no evidence of cervical lymphadenopathy. The visualized apices of the\nlungs are clear. Vascular arteriosclerotic calcifications are seen in the\nleft cervical carotid bifurcation.", "output": "No cervical spine fractures identified." }, { "input": "No significant interval change. The alignment of the cervical spine similar\nto the prior exam. No fracture. No prevertebral soft tissue swelling. \nMultilevel degenerative changes are again noted and most prominent at C5\nthrough C7. There is mild mucosal thickening of the maxillary sinuses.", "output": "1. No cervical spine fracture or malalignment.\n2. Multilevel degenerative changes of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. The thyroid\nis unremarkable. The lung apices are clear.", "output": "No cervical spine fracture." }, { "input": "The examination is motion degraded. Within these confines:\n\nNo acute fractures in the cervical spine. There is a compression deformity\ninvolving greater than 50% loss of height of the T4 vertebral body, with\napproximately 2 mm retropulsion (602b:21). 2 mm anterolisthesis of C4 on C5\nmay be degenerative in nature, although should be correlated clinically if\nthere is concern for ligamentous injury.\n\nNo significant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. Allowing for prominent respiratory motion\nartifact, the visualized lung apices are clear. Atherosclerotic calcification\nof the bilateral carotid bifurcations are noted. The thyroid gland is\natrophic.", "output": "1. No acute fracture in the cervical spine.\n2. Age indeterminate T4 vertebral body compression deformity with 2 mm\nretropulsion.\n3. 2 mm anterolisthesis of C4 on C5 is almost certainly degenerative in\nnature, although should be correlated clinically if there is concern for\nligamentous injury at this level." }, { "input": "Dental amalgam streak artifact limits evaluation at C2 level.\n\nAlignment is anatomic. No fractures are identified. Mild degenerative\nchanges cervical spine. No significant central canal narrowing. Multilevel\nprobably mild foraminal narrowing.\n\nThe thyroid is unremarkable. Scarring is noted in the bilateral lung apices. \n4 cm x 1.3 cm lipoma along the posterior margin of the left\nsternocleidomastoid, no worrisome features.", "output": "No acute findings.\nLeft neck lipoma." }, { "input": "Overall alignment of the cervical spine is normal. No evidence of an acute\ncervical spine fracture. Mild loss of C4 through C7 vertebral body heights\nare similar to the prior exam. Superior endplate deformity of the T2\nvertebral body appears similar to the prior MRA from ___. No\nprevertebral soft tissue swelling. Multilevel degenerative changes in the\ncervical spine are moderate.\n\nBilateral neural foraminal narrowing may be slightly progressed since ___:\nLeft C5-C6 and C6-C7 neural foraminal narrowing is severe. Left C7-T1 neural\nforaminal narrowing is mild. Right C5-C6 and C6-C7 neural foraminal narrowing\nis moderate to severe.\n\nMild broad-based disc bulge at C6-C7 indents the anterior thecal sac.\n\nPartially imaged lung apices appear clear. Surgical clips are seen in the\nthyroid bed.", "output": "1. No evidence of acute cervical spine fracture.\n2. Multilevel degenerative changes in the cervical spine, slightly progressed\nsince ___ as above." }, { "input": "There is mild straightening of the cervical spine likely due to positioning. \nNo acute fractures are identified. Unchanged mild superior endplate height\nloss at T2. There is enlargement of the left C5 transverse foramen which is\nlikely developmental (series 2, image 47). There is mild to moderate\nmultilevel degenerative changes of the cervical spine with mild central canal\nnarrowing, most pronounced at C2-3, C3-4, and C6-7 due to posterior disc\nbulges. Additionally, there is multilevel moderate to severe neural foraminal\nstenosis, most pronounced bilaterally at C5-6 and on the left at C6-7. There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThe included lung apices are unremarkable. Bilateral thyroid lobes are not\nvisualized which may secondary to previous thyroidectomy with multiple\nsurgical clips at the thyroid fossa.", "output": "1. No acute cervical spine fracture or alignment abnormality.\n2. Mild to moderate multilevel degenerative changes of cervical spine." }, { "input": "There is straightening of the normal cervical lordosis, likely due to position\nwithin a cervical collar. No traumatic malalignment is seen. There is no\nacute fracture noted, and no prevertebral soft tissue swelling is seen. \nMultilevel degenerative changes are noted including disc height loss, most\npronounced at C5-C6, C6-C7 and C7-T1. There is mild central canal stenosis\ndue to posterior disc osteophyte complex, most notable at C3-C4 C4-C5 and\nC5-C6. Will vertebral hypertrophy and posterior disc osteophytes causes\nbilateral neural foramina in cough, most notable at C3-C4.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild-moderate multilevel degenerative changes of the cervical spine." }, { "input": "Noncontrast head CT:\nThere is no evidence of fracture, acute large vascular territory infarction,\nhemorrhage, intracranial mass or edema. There is ventricular and sulcal\nprominence, consistent with involutional changes. There are scattered\nperiventricular and subcortical white matter hypodensities that are\nnonspecific, however likely represent sequela of chronic small vessel ischemic\ndisease.\n\nThere is a mucous retention cyst in the left maxillary sinus, and mild mucosal\nthickening of the right maxillary sinus and paranasal sinuses. The patient\nappears to be status post lens surgery. Otherwise the orbits are normal\nappearing.\n\nNoncontrast CT of the cervical spine:\nThere is mild anterolisthesis of C3 on C4, possibly degenerative in etiology. \nNo fractures are identified.There are severe degenerative changes of the\ncervical spine including intervertebral disc space narrowing, endplate\nsclerosis and cysts, anterior and posterior osteophytosis, uncovertebral\nhypertrophy and facet arthropathy. At the levels of C4-C5, C5-C6, and C6-C7\ncalcified posterior disc bulges and protrusions are seen within the spinal\ncanal, resulting in severe spinal stenosis, and impingement upon the spinal\ncord, worst at the C4-C5 level. Multilevel mild-to-moderate bilateral neural\nforaminal narrowing, there is no high-grade neural foraminal stenosis. There\nis no prevertebral edema.\n\nIncidentally noted is a tiny left ___ duct sialolith. Visualized\nthyroid gland is slightly heterogeneous with a 5 mm hypodense nodule. Imaged\nlung apices are clear. Proximal esophagus demonstrates mild wall thickening\nand is patulous.", "output": "1. No acute cervical spine fracture.\n2. Severe degenerative changes of the cervical spine with severe spinal\nstenosis, most pronounced at the C4-C5 level. Please see recommendations\nbelow.\n3. Mild C3 on C4 anterolisthesis is likely degenerative in etiology.\n4. No acute intracranial abnormality on the head CT.\n\nRECOMMENDATION(S): Patients with severe spinal canal stenosis are prone to\nspinal cord injury, even in the setting of minor trauma. Please correlate\nclinically with neurologic signs and symptoms of cord injury.\n\nIf there is persistent clinical concern for spinal cord injury, MRI of the\ncervical spine can be obtained." }, { "input": "Lumbar stabilization hardware at L4-L5 appears grossly intact and results in\nsuboptimal evaluation of the lower lumbar spine and sacrum secondary to\nartifact. Within these limitations there is no evidence of traumatic\nmalalignment of the lumbar spine. Vertebral body heights are grossly\nmaintained. There is partial osseous fusion of T12 and L1. No acute\nfractures are identified. No severe central canal stenosis is identified.. A\n2.7 x 2.4 cm hypodensity in the right upper pole kidney is incompletely\nevaluated, but likely represents a simple renal cyst. Sclerosis of the sacral\nala is consistent with patient's known history of sacral insufficiency\nfractures.", "output": "1. No evidence of acute fracture or traumatic malalignment of the lumbar\nspine. Vertebral body heights are grossly maintained.\n2. Sclerosis of the sacral ala is consistent with patient's known history of\nsacral insufficiency fractures.\n3. Lumbar stabilization hardware at L4-L5 appears grossly intact." }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture. \nIntervertebral disc space heights are maintained. Minimal calcification of\nthe anterior disc annulus is noted at the C4-5, C5-6, and C6-7 levels. No\nacute alignment abnormality is identified. There is no prevertebral soft\ntissue abnormality.\n\nThe thyroid is grossly unremarkable in appearance. There is no cervical\nlymphadenopathy. The visualized lung apices are clear.", "output": "No evidence of acute fracture or malalignment." }, { "input": "No evidence for a fracture. Vertebral body heights are preserved. Alignment\nis normal. No evidence for prevertebral edema.\n\nEvaluation of the spinal canal and neural foramina is limited by CT compared\nto MRI. Allowing for these limitations, the following observations are made:\n\nC2-C3: Small central disc protrusion without significant spinal canal\nnarrowing. Mild left neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nC3-C4: Central disc herniation extends slightly above and below the disc\nspace, mildly indenting the ventral thecal sac. Mild right and moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC4-C5: Right paracentral disc protrusion with endplate osteophytes mildly\nindent the ventral thecal sac. Moderate to severe right and moderate left\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC5-C6: Broad-based central disc protrusion with endplate osteophytes\nmoderately narrow the spinal canal. Moderate to severe, right greater than\nleft neural foraminal narrowing by uncovertebral and facet osteophytes.\n\nC6-C7: Disc protrusion with endplate osteophytes, larger on the left than\nright, cause mild right and moderate left spinal canal narrowing. Moderate to\nsevere right and moderate left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC7-T1: No spinal canal or neural foraminal narrowing is seen.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormality is seen on limited assessment. The\nthyroid gland is grossly unremarkable. Visualized lung apices are clear.", "output": "1. No fracture subluxation.\n2. Multilevel cervical degenerative disease. Spinal canal stenosis is\nmoderate at C5-C6 and on the left at C6-C7, and mild at other levels. \nModerate to severe neural foraminal narrowing at several levels, as detailed\nabove. MRI could provide further detail if clinically warranted." }, { "input": "There are 12 rib-bearing vertebrae. There is minimal anterior wedging of T6\nand T7 vertebral bodies. No acute fracture lines are seen.\n\nEvaluation of the spinal canal by CTs limited compared to MRI. There is a\nright paracentral disc herniation at T7-T8, mildly remodeling the ventral\nspinal cord, images 3:53 and 602:32. There is a smaller right paracentral\ndisc protrusion with overlying endplate osteophytes at T8-T9, minimally\nindenting the ventral thecal sac with unclear relationship to the spinal cord.\nThere is a mild disc bulge at T11-T12 without significant spinal canal\nnarrowing.\n\nVisualized thyroid gland is grossly unremarkable. There is mild dependent\natelectasis in the visualized portions of the lungs. There is a small hiatal\nhernia.", "output": "1. Right paracentral disc herniation at T7-T8 mildly remodels the ventral\nspinal cord.\n2. Smaller right paracentral disc protrusion with overlying endplate\nosteophytes at T8-T9 minimally indents the ventral thecal sac with unclear\nrelationship to the spinal cord.\nThe above findings may be better assessed by MRI if clinically warranted.\n\nNOTIFICATION: Preliminary report in PACS by Dr. ___ ___\nat 05:29 stated \"normal study. No significant spinal canal or neural\nforaminal stenosis. The final interpretation was emailed to the ED QA nurses\nlist by Dr. ___ at 15:27 on ___, per departmental protocol." }, { "input": "Again seen is grade 2 anterolisthesis of the L4 on L5 vertebral bodies,\nsimilar in appearance compared to ___. There are new superior\nendplate deformities of the T12, L1, L2, and L3 vertebral bodies, of\nindeterminate chronicity but new compared to ___.\n\nThe T12 fracture includes a retropulsed fragment that mildly encroaches on the\nspinal canal.\n\nThere is no canal or foraminal encroachment at L1-2.\n\nAt L2-3, mild bulging of the disc slightly encroaches on the spinal canal.\n\nAt the L3-4 level, there is mild disc bulge without significant spinal canal\nstenosis or neural foraminal narrowing. There is prominent bilateral facet\nosteophyte formation.\n\nDisc bulge at L4 on L5 anterolisthesis results in severe spinal canal stenosis\nand moderate to severe right neural foraminal narrowing with contact of the\nexiting nerve root at this level.\n\nAt L5-S1, a disc bulge produces moderate-severe spinal canal narrowing and\nnarrowing of the left neural foramen with apparent contact with the exiting\nleft L5 nerve root.\n\nThere is no prevertebral soft tissue swelling. Within the limitations of this\nnoncontrast exam, there is no evidence of infection or neoplasm.", "output": "1. Superior endplate deformities of the T12, L1, L2, and L3 vertebral bodies,\nof indeterminate chronicity but new compared to ___.\n2. Unchanged grade 2 degenerative anterolisthesis of the L4 on L5 vertebral\nbodies compared to ___.\n3. Severe spinal canal stenosis and moderate to severe right neural foraminal\nnarrowing with contact of the exiting nerve root at the L4-5 level. \nModerate-severe spinal canal stenosis at L5-S1.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\n___ on the telephoneon ___ at 3:45 ___, 30 minutes after discovery of\nthe findings." }, { "input": "Alignment is normal.There is an age-indeterminate, possibly acute on chronic,\ntype 2 dens fracture at the C2 vertebral level (602b:21). No other fracture\nis identified. There is no evidence of spinal canal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of acute infection or\nneoplasm. Mild multilevel degenerative changes are seen in the cervical spine\nwith uncovertebral hypertrophy at the left C5 and C6 vertebral levels and\nright C3 and C4 vertebral level.", "output": "1. Age-indeterminate, possibly acute on chronic, type 2 dens fracture at the\nC2 vertebral level. MRI may be helpful in assessing acuity. No other fracture\nis identified.\n2. Mild multilevel degenerative changes are seen in the cervical spine with\nuncovertebral hypertrophy at the left C5 and C6 vertebral levels and right C3\nand C4 vertebral level. No evidence of central canal stenosis." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Thyroid gland\nis homogeneous in attenuation throughout. There is a locule of air along the\nright lateral aspect of the upper trachea at the thoracic inlet (3:61).", "output": "1. No evidence of fracture or malalignment.\n2. Single locule of air along the right upper paratracheal border is noted. \nWhile direct communication with the tracheal lumen is not visualized, this\nlocation is typical for a tracheal diverticulum." }, { "input": "There are no fractures identified. There is no prevertebral soft tissue\nswelling. There are severe degenerative changes of the cervical spine with\nfusion of the C3-4 vertebral bodies. There is mild retrolisthesis of C4-5 with\ndisc space widening at this region. There is endplate sclerosis and inferior\nand superior endplate irregularity of C4-5, also likely degenerative. Facet\narthropathy is noted in the upper cervical spine. There is no evidence of\ncritical spinal stenosis. There is no evidence of infection or neoplasm.\n\nThe lung apices are clear. The thyroid is unremarkable. There is no adenopathy\nby CT size criteria.", "output": "1. No evidence of cervical spine fracture.\n2. Abnormal alignment of the cervical spine including disc space widening of\nC4-5 and mild retrolisthesis of this level, is most likely degenerative in\nnature, given severe degenerative changes in this region.\n3. Severe degenerative changes with near-complete fusion of the C3-4 and\ninferior and superior endplate irregularity at the C5-6." }, { "input": "No acute fractures or traumatic malalignment. Severe multilevel\nmultifactorial degenerative changes are seen throughout the cervical spine,\nwith fusion of the C3-4 vertebral bodies. Mild retrolisthesis of C4-5 with\ndisc space widening of this region is stable and likely degenerative.\nMultilevel facet arthropathy is seen in the upper cervical spine. The\nprevertebral soft tissues are unremarkable. The thyroid gland is normal. The\nlung apices are clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Severe multilevel, multifactorial degenerative change." }, { "input": "The thoracic vertebral bodies are normal in height and alignment. To the\nextent that the contents of the spinal canal can be evaluated, no high-grade\ncanal stenosis is seen. There are multilevel degenerative changes including\nlateral syndesmophytes in the lower thoracic spine and anterior flowing\nosteophytes compatible with diffuse idiopathic skeletal hyperostosis.\n\nEvaluation of the lung parenchyma is limited due to respiratory motion, but\nthere is dependent atelectasis bilaterally. Note is made of a borderline left\nlower paratracheal lymph node measuring 11 mm in short axis (3:46). The\nincluded portions of the thyroid are unremarkable.", "output": "1. No fracture. Diffuse idiopathic skeletal hyperostosis.\n2. Borderline mediastinal lymph node. Comparison with priors would be helpful\nto establish stability." }, { "input": "The vertebral bodies are normal in height and alignment. To the extent that\nthe contents of the spinal canal can be evaluated, no high-grade canal\nstenosis is seen. There are mild multilevel degenerative changes including\nsyndesmophytes at L2-3 and L3-4. There are also moderate degenerative changes\nof the bilateral sacroiliac joints. There is no lytic or blastic lesion\nworrisome for malignancy. The abdominal aorta is normal in caliber, but there\nare atherosclerotic calcifications.", "output": "1. No fracture. Mild multilevel degenerative disc disease.\n2. Moderate bilateral sacroiliac degenerative changes." }, { "input": "There is unchanged mild anterolisthesis of C3 on C4, C5 on C6, and C7 on T1,\nas well as unchanged mild kyphotic curvature of the cervical spine. There is\nno acute subluxation. No fractures are identified. There is no evidence for\nprevertebral edema. Disc protrusions and endplate osteophytes indent the\nventral thecal sac at multiple levels with apparent severe spinal canal\nstenosis at C6-C7, and at least moderate spinal canal stenosis from C3-C4\nthrough C5-C6. There is multilevel neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nThere is minimal pleural/parenchymal scarring at the left lung apex.\n\nAgain seen is a 1.0 cm left thyroid nodule containing a calcification. The\n___ College of Radiology guidelines suggest that in the absence of risk\nfactors for thyroid cancer, no further evaluation is recommended.", "output": "No evidence for an acute fracture. No acute subluxation. Multilevel\ndegenerative disease." }, { "input": "There is no acute fracture or traumatic malalignment. There is minimal loss of\nposterior vertebral body height of C4. There is no prevertebral soft tissue\nswelling. There are no significant degenerative changes. Nasogastric tube\ncoils in the nasopharynx and subsequently descends into the esophagus. An\nendotracheal tube is noted. There is opacification of the airway in the region\nof the vocal folds, which likely represents fluid and blood within the airway.\nThere is no evidence of airway injury. The lung apices are clear. The thyroid\nis unremarkable. Multiple scattered cervical lymph nodes are noted, none of\nwhich are pathologically enlarged.", "output": "No definite acute fracture or traumatic malalignment. If there is high\nclinical concern for a subtle acute injury, cervical spine MR can be obtained." }, { "input": "No fractures are identified. There is no critical canal narrowing. There is no\nprevertebral edema. There are severe multilevel degenerative changes\nthroughout the imaged cervical spine. There is minimal anterolisthesis of C2\non C3.\n\nThe thyroid and included lung apices are unremarkable. Imaged portion of the\nparanasal sinuses demonstrates a mucous retention cyst in the right maxillary\nsinus.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is mild anterolisthesis of C3 on C4.No fractures are identified.There is\nmultilevel degenerative changes, most notable at C5-C6 and C6-C7 with loss of\ndisc space, osteophyte formation, facet hypertrophy, and uncovertebral\nhypertrophy resulting in mild-to-moderate spinal canal stenosis and bilateral\nmoderate neural foraminal narrowing. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.\n\nPatient is intubated. There is significant amount of aerosolized secretions\nwithin the oral and nasopharyngeal cavity and supraglottic region.", "output": "No evidence of acute fracture. Mild anterolisthesis of C3 on C4, likely\ndegenerative.\n\nET tube partially visualized. Significant amount of aerosolized secretions\nare noted in the aerodigestive tract superior to the vocal cords." }, { "input": "There is no acute cervical fracture or cervical malalignment. There is no\nprevertebral soft tissue swelling or edema. Multilevel degenerative changes\nare most severe at the C3-C4, C4-C5, and C5-C6 levels with loss of\nintervertebral disc space, endplate sclerosis and endplate irregularity. \nThere is mild retrolisthesis of C5 with respect to C6, degenerative in\netiology. There is no evidence of severe spinal canal stenosis. Lung apices\nare clear. The thyroid gland appears mildly heterogeneous with bilateral\nsubcentimeter nodules. Note is made of prominent carotid bulb atherosclerotic\ncalcifications, left greater than right. There is no cervical adenopathy.", "output": "1. Multilevel degenerative changes without acute fracture.\n\n2. Heterogeneous appearance of the thyroid with subcentimeter nodules could\nbe correlated with thyroid function test." }, { "input": "The cervical vertebral body heights and alignment are well maintained. The\nprevertebral soft tissue is unremarkable. There is no significant\ndegenerative change. Though CT resolution of thecal sac is limited, the\ncontours appear preserved. Endotracheal tube and upper enteric tube are\npartially visualized. Fluid layering within the posterior nasopharynx is\nsecondary to intubation. The thyroid is unremarkable. The imaged lung apices\nare clear.", "output": "No cervical spine fracture or malalignment." }, { "input": "No definite evidence of acute fracture identified. There is a well-corticated\nfracture fragment at the anterior aspect of the inferior endplate of C5,\ncompatible with fracture of anterior osteophyte, likely chronic. There is an\nadditional small fracture fragment at the anterior aspect of the inferior\nendplate of C6, also well corticated and likely compatible with old fracture\nof anterior osteophyte. Alignment is normal. There is moderate multilevel\ndegenerative change, including anterior and posterior osteophytosis, disc\nspace narrowing, and endplate sclerosis. There is no evidence of spinal canal\nstenosis. There is moderate neural foraminal narrowing on the left at C3-C4,\non the right at C4-C5, and bilaterally at C5-C6, secondary to uncovertebral\nosteophytes. There is no prevertebral soft tissue swelling.The thyroid is\nunremarkable. There is a well-circumscribed lesion at the left lung apex\nmeasuring 2.1 x 1.6 cm (03:58), which appears to be simple fluid density\nthough unclear if pleural based or vascular in etiology. Partially visualized\nlung apices are otherwise within normal limits.", "output": "1. No definite evidence of acute fracture or traumatic malalignment.\n2. Small, well corticated ossific fragments located anteriorly at the inferior\nendplates of the C5 and C6 vertebral bodies, likely compatible with chronic\nfractures of anterior osteophytes.\n3. Moderate multilevel degenerative change, most notably at C5-C6 and C6-C7,\nas described above.\n4. Well-circumscribed fluid density structure at the medial left lung apex\nmeasuring 2.1 x 1.6 cm which appears to be simple fluid density, though\nunclear if pleural based or vascular in etiology. Dedicated nonurgent chest\nCT would further characterize." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "Normal study." }, { "input": "There is no fracture seen. At the craniocervical junction and C2-3 levels no\nabnormalities are seen. At C3-4 there is mild anterolisthesis of C3 over C4. \nDisc protrusion is seen resulting in moderate spinal stenosis.\n\nAt C4-5 there is a large central disc herniation seen. There is severe spinal\nstenosis seen. There is no foraminal narrowing.\n\nAt C5-6 posterior disc osteophyte is seen. Moderate to severe spinal stenosis\nis seen. There is moderate-to-severe right-sided and mild left-sided\nforaminal narrowing.\n\nAt C6-7 posterior disc osteophyte and small central protrusion resulting in\nmoderate spinal stenosis and right foraminal narrowing.\n\nAt C7-T1 and T1-2 no abnormalities are seen.\n\nMild vascular calcifications are seen.", "output": "Spinal canal narrowings are seen from C4-5 to C6-7 levels. Most pronounced\nchanges are seen at C5-6 level. No fracture is seen." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Multilevel degenerative\ndisc disease noted most notable at C3-4 level. A large nuchal ligament\ncalcification is noted. Small posterior disc osteophyte complexes are noted\nat C3-4, C4-5, C5-6 and C6-7 resulting in mild narrowing of the central spinal\ncanal. There is no critical central spinal canal or neural foraminal\nstenosis. No prevertebral edema. The aerodigestive tract appears patent.\nLung apices are clear. Thyroid gland appears normal. Partially visualized\npacemaker leads in the left upper chest.", "output": "Degenerative changes, no fracture or malalignment." }, { "input": "No definite acute fractures identified. Several air lucencies notably in the\nvertebral bodies of C3 and C5 probably reflect pneumatocysts. Multilevel\ndegenerative changes of the cervical spine with endplate sclerosis,\nosteophytosis, loss of intervertebral disc space most notably at C4-C5, and 2\nmm retrolisthesis of C4 over C5. Posterior osteophytes and retrolisthesis\nresulting in mild narrowing of the central canal at C4-C5. Facet hypertrophy\nresulting in mild to moderate neural foraminal narrowing at multiple levels\nbut no severe narrowing is noted.\n\nIncreased pleural density along the apices may be associated with motion\nartifact.", "output": "Multilevel degenerative changes without definite evidence of acute fracture or\ntraumatic malalignment.\n\nNOTIFICATION: Multilevel degenerative changes without definite evidence of\nacute fracture or traumatic malalignment." }, { "input": "There is no fracture or acute malalignment of the cervical spine. The\nprevertebral soft tissues are unremarkable. The overall cervical lordosis is\npreserved.\n\nMild degenerative changes at C5-6 with uncovertebral joint hypertrophy and\nintervertebral disc height loss is noted.\n\nThere is no lymphadenopathy. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable.", "output": "No fracture or acute malalignment of the cervical spine." }, { "input": "There is no fracture or acute malalignment of the thoracic spine. The\nprevertebral soft tissues are unremarkable.\n\nMild multilevel degenerative endplate changes are present throughout the\nthoracic spine, including multilevel Schmorl nodes.\n\nThe visualized portions of the lungs are grossly clear, with mild dependent\natelectasis. The other visualized paraspinal soft tissues are normal in\nappearance.", "output": "No fracture or acute malalignment of the thoracic spine." }, { "input": "There is no fracture or acute malalignment of the lumbar spine. The\nprevertebral soft tissues are unremarkable.\n\nPostsurgical changes related to prior posterior pedicle screw fixation of the\nL5-S1 vertebral levels is again seen, with multilevel degenerative changes\nincluding disk space narrowing of the L2-3 through L5-S1 levels, with endplate\nsclerosis, anterior osteophytosis, and bilateral facet arthropathy. Vacuum\ndisc phenomenon is noted at the L2-3 and L3-4 levels. Minimal retrolisthesis\nand right lateral subluxation of L3 on L4 and L2 on L3 is noted. The\nvisualized abdominal and pelvic structures are unremarkable.", "output": "No fracture or acute malalignment of the lumbar spine." }, { "input": "C2-T1 posterior fusion hardware and C3 to C6 laminectomy is re-demonstrated,\nsimilar to prior. There is no acute fracture or traumatic malalignment of the\ncervical spine. There is no prevertebral soft tissue swelling. The bones are\nosteopenic. Moderate multilevel degenerative disc disease and multilevel\nfacet arthropathy is seen. However there is no severe neural foramina\nnarrowing or severe vertebral canal narrowing.\nThere is no evidence of infection or neoplasm.\n\n1.6 cm hypodense left thyroid nodule has not significantly changed since\n___.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. C2-T1 posterior fusion hardware and C3-C6 laminectomy without evidence of\nhardware related complications.\n3. Multilevel degenerative disc disease and facet arthropathy." }, { "input": "Patient is status post C4-C5 laminectomy and C3-C7 posterior fusion. Hardware\nappears intact and without obvious complication.\n\nEvaluation of the cervical spine is slightly limited due to streak artifact\nfrom hardware. Within these limitations, alignment is anatomic.No acute\nfractures. Multilevel anterior bridging osteophytes are suggestive of DISH,\nsimilar to prior. Multilevel intervertebral disc space narrowing is most\nprominent at C3-C4 and C5-C6. At C5-C6, there is moderate spinal canal and\nmild bilateral neural foraminal narrowing. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nRedemonstration of a 3 mm left thyroid lobe nodule.", "output": "1. No acute fracture or traumatic malalignment.\n2. C3-C7 fusion hardware appears intact and without obvious complication.\n3. Moderate to severe multilevel degenerative changes." }, { "input": "Status post C4-C5 laminectomy with posterior hardware in C3-C7. Streak\nartifact limits assessment. Alignment is normal. No fractures are identified.\nThere is no evidence of spinal canal stenosis.There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. There is\nsevere degenerative changes throughout the cervical spine, most notably\nosteophytosis, loss of intervertebral disc space height, and Schmorl's node\nformation. There are multilevel anterior bridging osteophytes suggestive of\nDISH. There is calcification of the transverse ligament. There is a 0.4 cm\nhypodense nodule in the left thyroid lobe.", "output": "1. No evidence of acute cervical spine fracture or traumatic malalignment.\n2. Status post C4-C5 laminectomy with posterior hardware in C3-C7. Severe\ndegenerative changes and findings suggestive of DISH as described above." }, { "input": "There are 12 rib-bearing vertebrae. There are laminectomies from C7 through\nT3. Vertebral body heights are preserved. Alignment is normal. Evaluation\nof spinal canal detail on CT is limited compared to MRI. The extra-axial,\nlikely subdural collection seen on the MRI done earlier today from the level\nof T5-T6 through the included upper lumbar spine is not well seen. There is\nno extrinsic spinal canal narrowing.\n\nThe known aortic dissection is again partially visualized and not well\nassessed on noncontrast CT. Visualized aorta is enlarged, as before. There\nare small pleural effusions, left larger than right, with mild dependent\natelectasis in the lower lobes. There may be more extensive interstitial\nand/or airspace opacity in the medial aspect of the posterior basal left lower\nlobe, incompletely evaluated due to respiratory motion artifact. CTA chest\nfrom ___ demonstrated atelectasis or scarring in this area.", "output": "1. The extra-axial, likely subdural collection seen on the MRI done earlier\ntoday from the level of T5-T6 through the included upper lumbar spine is not\nwell seen on noncontrast CT.\n2. The known aortic dissection is not well assessed.\n3. Small pleural effusions, left larger than right, are partially visualized\nwith adjacent dependent atelectasis.\n4. Partially visualized interstitial and/or airspace opacity in the medial\naspect of the posterior basal left lower lobe is not well assessed. It is not\nclear whether there is any acute pathology superimposed upon preexisting\natelectasis or scarring in this area." }, { "input": "There are 5 lumbar-type vertebrae. Vertebral body heights are preserved. \nAlignment is normal. Evaluation of spinal canal detail on noncontrast CTs\nlimited. Hyperdensity within the anterior spinal canal from T12 through mid\nL1 level corresponds to the subdural hematoma seen on the MRI done earlier\ntoday. The thecal sac is displaced posteriorly and narrowed, as seen on the\nMRI. Evaluation of intrathecal detail on CT is limited.\n\nThere are mild disc bulges throughout the lumbar spine. There is mild right\nL2-L3 facet arthropathy and moderate bilateral facet arthropathy at L3-L4 and\nL4-L5, and severe facet arthropathy at L5-S1, as seen on the prior MRI. These\ndegenerative changes did not exert significant mass effect on the thecal sac. \nHowever, the subarticular zones at L3-L4 are narrowed. L2-L3 through L4-L5\nneural foramina are also mildly narrowed.\n\nThe known aortic dissection is not well assessed on noncontrast CT. \nEnlargement of the visualized distal aorta and common iliac arteries is noted.\nMildly hyperdense dependent material within the gallbladder is consistent with\ngallstones plus/minus sludge. 5 mm linear calcification in the interpolar\nright renal hilus on image ___ represent a nonobstructing stone or a\nvascular calcification. There is an approximately 2.5 cm cyst projecting\nanteriorly from the interpolar right kidney.", "output": "1. Hyperdensity within the anterior spinal canal from T12 through mid L1\nlevels corresponds to the subdural hematoma seen on the MRI from earlier\ntoday. The thecal sac is displaced posteriorly and narrowed, as seen on the\nMRI. Evaluation of intrathecal detail on CT is limited.\n2. Mild multilevel lumbar degenerative disease.\n3. The known aortic dissection is not well assessed on noncontrast CT. \nEnlargement of the distal aorta and common iliac arteries is noted.\n4. Cholelithiasis.\n5. 5 mm nonobstructing stone versus vascular calcification in the right renal\nhilus." }, { "input": "Alignment is normal. No acute fractures are identified. Appearance of\nposterior elements C2 is likely congenital..No significant degenerative\nchanges. Congenital narrowing spinal canal. Otherwise central canal is\npatent. No significant foraminal narrowing. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. The thyroid\nbilateral lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Surgical hardware streak artifact limits examination.\n\n Vertebral body alignment is preserved. Vertebral body heights are preserved.\nThe visualized osseous structures are osteopenic. There is no prevertebral\nedema. Within limits of study, no definite evidence of acute cervical spine\nfracture.\n\nMultilevel degenerative changes of the cervical spine are noted, including\nloss of intervertebral disc height, endplate sclerosis, Schmorl's nodes, facet\nhypertrophy, disc osteophytes, with at least mild vertebral canal narrowing at\nC5-6.\n\nRight thyroid lobe inferior margin thoracic inlet probable surgical clips with\nassociated artifact is noted. Otherwise, the visualized portion of the\nthyroid gland is grossly preserved. Limited imaging lungs are grossly clear. \nBilateral temporomandibular joint degenerative changes are noted.\nAtherosclerotic vascular calcifications are noted. Limited imaging of the\nparotid glands demonstrate bilateral subcentimeter nonspecific probable lymph\nnodes.", "output": "1. Limited study as described.\n2. Within limits of study, no definite evidence of acute fracture or\nmalalignment.\n3. Multilevel cervical spondylosis as described with at least mild vertebral\ncanal narrowing C5-6.\n4. Probable surgical clip along inferior margin of right thyroid lobe with\nassociated artifact." }, { "input": "The bones are diffusely heterogeneous and somewhat sclerotic, which may relate\nto renal osteodystrophy, correlate with other systemic process. There is\nstable alignment with mild anterolisthesis of C4 on C5, C4 on C5 and, C5 on\nC6. No definite acute 1displaced fractures are identified.Large bridging\nanterior osteophytes are progressed since ___. Severe uncovertebral and\nfacet joint hypertrophy throughout the cervical spine resulting multiple level\nneural foraminal stenosis being severe at C4-C5 bilaterally, C5-C6 on the\nleft, C6-C7 bilaterally.There is no prevertebral soft tissue swelling\n\nAsymmetrically smaller right parotid gland secondary to resection of a\npreviously seen mass. 5 mm calcification in the right submandibular gland is\nagain seen. The gland itself has lost volume compared to ___ compared to the\nleft. Partially imaged lung apices demonstrate mild paraseptal emphysema.", "output": "1. No definite acute fracture or dislocation. Diffusely heterogeneous and\nsomewhat sclerotic osseous structures diffusely, may relate to renal\nfailure/renal osteodystrophy; correlate with other systemic process.\n2. Severe multilevel degenerative changes including large anterior\nosteophytes." }, { "input": "There are 5 non rib bearing lumbar vertebral bodies. Note is made of partial\nsacralization of the L5 vertebral body. Streak artifact from spinal fusion\nhardware limits assessment of the lower lumbar spine. Given this limitation,\nthere is no acute fracture. Patient is status post laminectomies at L3\nthrough L5 with posterior spinal fusion. Interbody spacers are seen from\nL2-L3 through L4 -L5. Overall fusion hardware appears intact without definite\nevidence of failure or loosening. Note is made of that the left L5 pedicle\nscrew appears to extrude beyond the vertebral body by approximately 11 mm\n(2:70).\n\nSevere degenerative changes are seen throughout the lumbar spine. There is\nmild retrolisthesis of L1 on L2. There is a disc bulge at L1/L2 causing\nsevere spinal canal stenosis as well as moderate bilateral neural foraminal\nnarrowing. Remaining intrathecal detail is limited due to streak artifact\nfrom the hardware.\n\nEvaluation of the soft tissues is remarkable for moderate atherosclerotic\ncalcifications. Bilateral punctate renal stones are noted with mild fullness\nof the right renal collecting system.", "output": "1. Status post laminectomy and posterior fusion of L3 through L5 without\ndefinite evidence of hardware related complications. Note is made of that the\nleft L5 pedicle screw which appears to extrude beyond the vertebral body by\n11mm.\n2. Severe degenerative disc disease at L1/L2 causing severe spinal canal\nstenosis.\n3. Bilateral punctate renal stones with mild fullness of the right renal\ncollecting system." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges of the cervical spine are noted common most significant at the levels\nof C3-4, C4-C5 and C5-C6, which result in significant spinal canal narrowing\nand neural foraminal compromise bilaterally. These are better evaluated on\nthe patient's recent MR cervical spine examination. Grade 1 retrolisthesis of\nC5 on C6 is likely degenerative in nature. There is no evidence of infection\nor neoplasm.", "output": "1. No evidence of acute fracture or dislocation.\n2. Multilevel degenerative changes of the cervical spine, better evaluated on\nthe patient's recent MR cervical spine examination." }, { "input": "The patient is status post C3 through C7 laminectomy for decompression. In\nthe operative bed, there is soft tissue swelling, however the underlying\nspinal cord is not well evaluated in this region.\n\nMultilevel multifactorial degenerative changes are seen throughout the\ncervical spine, including anterior and posterior osteophytosis worst from\nC5/C6 multilevel bilateral neural foraminal narrowing is seen, worst from\nC4/C5 on the left, demonstrating moderate stenosis.\n\nThe thyroid is normal. There is no cervical lymphadenopathy. The visualized\napices of the lungs are clear.", "output": "Status post C3 through C7 decompressive laminectomy withsoft tissue swelling\nin the surgical bed. The underlying spinal cord is not well evaluated on CT;\nand an MRI may be helpful for further evaluation. No new fractures are\nidentified. No large Soft tissue hematoma is seen." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ndegenerative changes or critical canal or neural foraminal narrowing.There is\nno prevertebral edema. There is minimal mucosal thickening in the bilateral\nsphenoid sinuses.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Essentially normal study." }, { "input": "There are 12 rib-bearing vertebrae.\n\nAgain seen is a burst fracture involving the T9 vertebral body resulting in\napproximately 25% loss of vertebral body height. There is minimal posterior\nbowing of the posterior cortex without significant mass effect on the thecal\nsac. There is no splaying of the posterior elements or evidence of posterior\nelement fracture. Within the limits of CT resolution, there is no evidence\nfor an epidural hematoma. There is mild prevertebral edema or hematoma\ncentered at T9.\n\nThere is a fracture through the right anterior superior corner of the T12\nvertebral body without significant loss of height. There is no associated\nretropulsion, and no posterior element involvement.\n\nThere is a nondisplaced fracture of the left twelfth rib. There is a small\nprevertebral hematoma anterior to T9. Within the limits of a non contrast CT\nthere is no epidural hematoma. Note is made of an increased left pleural\neffusion compared to the examination done yesterday.\n\nCompared to the torso CT from less than 24 hr earlier, left pleural effusion\nhas increased in size, and small right pleural effusion is new. Bibasilar\natelectasis is noted in the visualized portion of the lungs.", "output": "1. Burst fracture involving the T9 vertebral body with approximately 25% loss\nof height and minimal retropulsion, without mass effect on the thecal sac.\nThere is no posterior element fracture, no CT evidence for epidural hematoma,\nand no secondary signs of posterior ligamentous complex injury. However, given\nthe mechanism of injury, MRI would be significantly more sensitive for\nligamentous or other soft tissue damage, if clinically warranted.\n2. Compression fracture involving the right anterior superior endplate of the\nT12 vertebral body without significant loss of height.\n3. Left twelfth rib fracture.\n4. Compared to the ___ torso CT done less than 24 hours earlier,\nthe left pleural effusion has increased in size, and the small right pleural\neffusion is new." }, { "input": "There is no acute fracture or traumatic malalignment in the cervical spine.\nThe visualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. There is a 7-8 mm focus of\nnodular scarring in the right lung apex, best seen on series 3 image 62. The\nthyroid gland appears grossly unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n\n2. The thyroid gland appears diffusely enlarged. Recommend clinical\ncorrelation and consideration for a non-emergent thyroid ultrasound for\nadditional evaluation, if this has not already been performed.\n\n3. Nodular scarring within the right lung apex measuring 7-8 mm. Please\ncorrelate for risk factors in determining need for followup imaging." }, { "input": "At C7-T1 there is no spinal canal or neural foraminal stenosis.\nAlignment is normal. No fractures are identified or foraminal narrowing.There\nis no prevertebral edema.\nTrace bilateral pleural effusions. Thyroid gland are unremarkable. The\nvisualized and neck vasculature is unremarkable.", "output": "1. No acute fracture or CT evidence of osteomyelitis.\n2. No CT evidence of a enhancing abscess within the soft tissues. If there is\nclinical concern for abscess within the spinal canal MRI of the spine should\nbe considered.\n3. Trace bilateral pleural effusions with adjacent compressive atelectasis." }, { "input": "The study is limited due to suboptimal timing of imaging acquisition with\nrespect to contrast bolus. The images were acquired after the contrast was in\nthe delayed phase.\nAlignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. No CT evidence of cortical thinning or destruction.\n\n\nThere are trace bilateral pleural effusions with adjacent compressive\natelectasis. The patient is status post aortic valve and mitral valve\nreplacement with expected postsurgical changes. Multiple subcentimeter\nmediastinal lymph nodes do not meet CT criteria for lymphadenopathy. The\nvisualized abdominal organs are unremarkable. The kidneys demonstrate normal\nnephrograms. A\nA 17 mm wedge-shaped hypodensity within the right mid kidney (series 301,\nimage 115) which is not optimally characterized on study.", "output": "1. The study is limited by suboptimal timing of imaging acquisition with\nrespect to contrast bolus.\n2. No acute fracture or enhancing abscess in the soft tissues.\n3. No CT evidence of osteomyelitis. MRI of the thoracic spine is more\nsensitive for detection of osteomyelitis and spinal canal pathology.\n4. Trace bilateral pleural effusions with adjacent compressive atelectasis.\n5. A 17 mm wedge-shaped hypodensity within the right mid kidney, differential\nconsiderations include renal infarct in the setting of endocarditis and less\nlikely indeterminate renal lesion. Left renal peripheral hypodensity could\nalso be secondary to a renal infarct.\n\nRECOMMENDATION(S): CT abdomen and pelvis would be recommended for further\nevaluation of the renal lesions." }, { "input": "The study is limited by suboptimal timing of imaging acquisition with respect\nto contrast bolus. The images were acquired while the contrast was in the\ndelayed phase.\n\nAlignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nA partially visualized indeterminate renal lesion is again demonstrated and\nbetter described on the same day CT T-spine. Normal nephrograms are\ndemonstrated within the bilateral kidneys and contrast is demonstrated within\nthe bladder.", "output": "1. The study is limited by suboptimal timing of imaging acquisition with\nrespect to contrast bolus.\n2. No acute fracture or enhancing abscess in the soft tissues.\n3. No CT evidence of osteomyelitis. MRI of the lumbar spine is more sensitive\nfor detection of osteomyelitis and spinal canal pathology.\n4. Wedge-shaped hypodensities within the kidneys bilaterally, may be secondary\nto renal infarcts from septic emboli.\n\nRecommendations:\n\nCT abdomen and pelvis is recommended for further evaluation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "No evidence of traumatic injury." }, { "input": "Alignment is normal. No fractures are identified. There are mild-to-moderate\nmultilevel degenerative changes of the cervical spine including osteophytosis,\nand intervertebral disc space narrowing which is most pronounced at C5-C6.\n\nMultilevel posterior osteophytosis and disc bulge result in mild spinal canal\non spine most pronounced C4-C5. Multilevel uncovertebral and facet joint\nhypertrophy resulting in mild neural foraminal narrowing most pronounced at\nthe right facet joint at C4-C5. There is no prevertebral soft tissue\nswelling.\n\n Small cervical lymph nodes do not meet CT criteria for lymphadenopathy and\nmay be reactive. The lung apices demonstrates no nodularity or focal\nconsolidation. The visualized thyroid is unremarkable.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Mild-to-moderate multilevel degenerative changes as described above are\nmost pronounced at C5-C6." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified.Multilevel degenerative changes are seen including diffuse\nosteopenia, mild anterior and posterior spondylosis, most significant at \nC5-C6, and notable for mild neural foraminal narrowing and posterior disc\nbulge, causing mild spinal canal narrowing at this level.There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment of the cervical spine. Multilevel\ndegenerative changes, similar to prior." }, { "input": "The examination is slightly degraded by motion artifact. Within these\nconfines:\n\nThere is rotatory levoscoliosis of the lumbar spine with apex at L2. 4 mm\nright lateral listhesis of T11 on T12 and T12 on L1 is identified. 3 mm left\nlateral listhesis of L2 on L3. And 1 cm left lateral listhesis of L3 on L4 is\nidentified. There is mild loss of T12 through L3 vertebral body height, of\nuncertain chronicity without evidence of a vertebral or paraspinal soft tissue\nedema to suggest acuity. However in the degree of osteopenia, an suggestion\nof linear increased sclerosis of the superior endplates, if there no\ncontraindications, MRI would be more sensitive for acute compression\ndeformities.\n\nSevere loss of T12-L1 through L5-S1 disc height with multilevel vacuum disc\nphenomenon is noted.\n\nThere is moderate to severe right T12-L1 through L4-L5 neural foraminal\nnarrowing secondary to facet arthropathy and levoscoliosis. Moderate to severe\nleft L5-S1 and moderate right L5-S1 neural foraminal narrowing is noted. There\nis moderate L3-L4 and L5-S1 spinal canal narrowing.\n\nLarge hiatal hernia is identified. Atherosclerotic calcification of the\nabdominal aorta and iliac vessels are identified within the confines of\nnoncontrast enhanced examination, the visualize abdominal visceral is grossly\nunremarkable. The visualized lung bases are essentially clear allowing for\nprominent respiratory motion.", "output": "1. Loss of T12 through L3 vertebral body height of uncertain chronicity,\nalthough there is no evidence of prevertebral soft tissue swelling or edema to\nsuggest acuity. However, in the context of osteopenia and if clinically\nindicated and there no contraindications, MRI would be more sensitive to acute\nfractures in the setting.\n2. Scoliosis with severe degenerative changes.\n3. Large hiatal hernia." }, { "input": "There is no evidence for a fracture or prevertebral soft tissue swelling. \nMinimal retrolisthesis of C4 on C5 is again seen, without disc space widening\nor distraction of the posterior elements. There is severe C4-C5 and C5-C6,\nand moderate to severe C3-C4 disc space narrowing. Disc protrusions and\nendplate osteophytes cause mild-to-moderate spinal canal narrowing from C3-C4\nthrough C6-C7. There is also multilevel neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nVisualized lung apices are clear. Endotracheal and orogastric tubes are\npartially visualized. The thyroid is grossly unremarkable. Concurrent head\nCT is reported separately.", "output": "1. No evidence for a fracture.\n2. Minimal retrolisthesis of C4 on C5 is almost certainly degenerative, though\nthere are no remote exams to confirm chronicity.\n3. Multilevel degenerative disease with mild to moderate spinal canal\nnarrowing." }, { "input": "There is slight retrolisthesis of C4 on C5 and of C5 on C6 and anterolisthesis\nof C7 on T1. These are due to degenerative disease. There is loss of\nvertebral body height at C3 and C4 vertebral bodies, unchanged since prior\nMRI, as well as multilevel intervertebral disc height narrowing at levels\nC3-C4, C4-C5, C5-C6, C6-C7, slightly progressed since prior imaging. \nMultilevel degenerative changes with mild anterior canal narrowing at\nC3-C4,-C4-C5, C5-C6, without contacting the anterior aspect of the cord,\nsimilar to prior MRI from ___. Mild neural foraminal narrowing at C4-C5 on\nthe left. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nThere is an 18 mm hypodense nodule is seen in the right thyroid lobe. \n___ College of Radiology guidelines recommend elective ultrasound\nevaluation of incidental thyroid nodules of this size.", "output": "1. Mild degenerative subluxation.\n2. No fractures identified\n3. Multilevel degenerative changes, slightly progressed since ___.\n4. Incidentally noted is a 1.5 cm hypodense right thyroid lobe nodule." }, { "input": "Alignment is normal within the thoracic and lumbar spine.No fractures are\nidentified. No large disc herniation, however, assessment the intraspinal\ncanal is limited on current exam.\n\nMild degenerative changes are seen within the thoracic and lumbar spine. A\nsmall posterior osteophyte at T9-10 causes mild canal narrowing. Facet\narthropathy and posterior osteophytosis at T10-11 causes mild to moderate\ncanal narrowing.\n\nA small right posterior-lateral vertebral body osteophyte and facet\narthropathy at T10-T11 causes moderate right T10-11 neural foraminal\nnarrowing. A large left posterior-lateral osteophyte mildly narrows the left\nT12-L1 neuroforamen.\n\nThere are several large anterior thoracic vertebral osteophytes. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\nSuture material is seen along the greater curvature of the stomach, which\nreflects prior sleeve gastrectomy. Imaged lungs appear unremarkable.", "output": "1. No evidence of malalignment or acute fracture within the thoracic and\nlumbar spine. No large disc herniation, however, assessment for disc disease\nis limited this exam; MRI would be more sensitive for assessment of the\nintraspinal canal and neural foramina.\n2. Mild degenerative changes including moderate right T10-11 and mild left\nT12-L1 neural foraminal narrowing secondary to osteophytes and facet\narthropathy. There is mild canal narrowing at T9-10 and moderate canal\nnarrowing at T10-11.\n\nRECOMMENDATION(S): If further evaluation for intraspinal canal contents is\ndesired, recommend MR." }, { "input": "There is loss of cervical lordosis, with a mild anterolisthesis of C4 on C5,\nlikely degenerative.No acute fractures are identified. Multilevel\ndegenerative changes are seen, most extensive at C5-C6 and C6-C7 and notable\nfor osteophytosis, vertebral body height loss, disc space height loss, and\nfacet joint hypertrophy. There is mild neural foraminal narrowing on the left\nside of C5-C6. There is no spinal canal stenosis. There is no prevertebral\nedema.\n\nPartially visualized opacification of the bilateral mastoid air cells is\nbetter characterized on same day CT of the head.\n\nThe thyroid is unremarkable. Very partially imaged lung apices demonstrate\nsome scarring but are incompletely assessed.", "output": "1. No acute fracture of the cervical spine.\n2. Multilevel degenerative changes of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling.Moderate multilevel degenerative changes are most\nprominent at C4 through C7 with posterior osteophytes and disc bulges\nresulting in mild to moderate spinal canal canal narrowing. Uncovertebral\nhypertrophy causes moderate to severe left neural foraminal narrowing at C3-C4\nand C4-C5.", "output": "No fracture or malalignment. Moderate multilevel changes most prominent at C4\nthrough C7 cause mild to moderate spinal canal narrowing and moderate to\nsevere left neural foraminal narrowing at C3-C4 and C4-C5." }, { "input": "There is no evidence of acute fracture or traumatic malalignment. Moderate to\nsevere degenerative change is seen throughout the cervical spine. Minimal\nretrolisthesis of C4 on C5 and grade 2 anterolisthesis of C7 on T1 is likely\ndegenerative in nature. There is spinal canal narrowing at C4-5 and C5-6. \nThere is heavy calcified atherosclerosis of the carotid arteries. No\nsuspicious lesions are identified. There is no prevertebral soft tissue\nswelling.", "output": "1. No evidence of acute fracture or traumatic malalignment. Multilevel\ndegenerative changes with areas of narrowing of the central canal." }, { "input": "Alignment is unchanged, with substantial spondylolisthesis throughout the\ncervical spine at multiple levels. There is mild retrolisthesis of C3 over C4\nand C4 over C5 and C5 over C6. There is anterolisthesis of C7 over T1. \nOverall stable alignment compared to ___. Degenerative changes are\nnotable for intervertebral disc height loss, posterior osteophytes and\nuncovertebral joint hypertrophy. No critical canal narrowing. Foraminal\nnarrowing most severe at C4-5 where it is moderate to severe on the right and\nmoderate on the left. No acute or displaced fractures are identified. \nChronic fracture along the transverse foramen of C4 on the right is again\nnoted (02:34). There is no prevertebral edema.\n\nCalcifications are seen within the right cervical vertebral artery, which are\nstable. Dense atherosclerotic calcifications seen along the common and\ninternal carotid arteries. There is scarring at the right lung apex which\nappears unchanged from a CT torso performed ___. The thyroid is\ndiminutive without evidence of focal lesion.", "output": "1. No acute fracture or traumatic malalignment.\n2. Unchanged spondylolisthesis of the cervical spine, which includes\nanterolisthesis of C7 over T1.\n3. Scarring at the right lung apex overall unchanged from ___." }, { "input": "Alignment is normal. No cervical spine fractures are identified. There are\nmultilevel mild degenerative changes with disc space narrowing and small\nposterior disc osteophyte complexes, worst at C6-C7, without significant\ncentral canal narrowing. Mild bilateral neural foraminal narrowing is seen at\nC6-7 due to mild uncovertebral spurring. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.\n\nA left mid clavicular fracture is seen on scout images.", "output": "1. No cervical spine fracture or traumatic malalignment.\n2. A left mid clavicular fracture is seen on scout images." }, { "input": "Minimal C4 on C5, C6 on C7 and C7 on T1 retrolisthesis is likely degenerative\nin etiology.No acute fracture identified. Moderate multilevel degenerative\nchanges most significant at C4-C5 and C5-C6, with disc height loss, endplate\nosteophytes and subchondral sclerosis and cysts. Multilevel mild to moderate\ncentral canal stenosis is most pronounced at C4-5, C5-6 and C6-7 due to\nposterior osteophytes. There is multilevel moderate to severe neural\nforaminal narrowing most significant at C3-C4, C5-C6, and C6-C7\nbilaterally.There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nThe lung apices are clear. The thyroid is normal.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Moderate cervical spondylosis. Minimal multilevel retrolisthesis is likely\ndegenerative in etiology." }, { "input": "There is mild anterolisthesis of C4 on C5, new since ___. No\nfracture is identified. There is mild anterior subluxation of C4 on C5 and\nposterior subluxation of C5 on C6 due to degenerative disease. There is\nmarked worsening of degenerative changes, particularly at C5-6 and C6-7 with\nsevere loss of disc heights and endplate irregularities and cystic changes. \nLucency at the right C6 vertebral body is likely degenerative given severe\nsurrounding degenerative changes without other sequela to suggest acute\nfracture (series 602, image 32). There are anterior and posterior osteophytes\nthroughout the cervical spine, worst from C5-C7. There is no spinal canal\nstenosis. Uncovertebral and facet osteophytes cause mild right neural\nforaminal narrowing at C4-5 and C5-6 and mild bilateral neural foraminal\nnarrowing at C6-7. There is no prevertebral edema.\n\nThe thyroid appears normal. There are multiple prominent cervical lymph\nnodes, not pathologically enlarged by CT criteria. There is diffuse\ninterlobular septal thickening of the bilateral lung apices, likely\nrepresenting pulmonary edema.", "output": "1. No evidence of fracture. Mild degenerative subluxations. No other\nalignment abnormalities.\n2. Multilevel degenerative changes of the cervical spine, worst at C5-6 and\nC6-7.\n3. Septal thickening of the bilateral lung apices likely representing\npulmonary edema. Scattered prominent cervical lymph nodes are likely\nreactive." }, { "input": "Alignment is normal. No fractures are identified in the cervical spine.There\nis no significant canal or foraminal narrowing.There is no prevertebral\nedema.There is a incompletely evaluated fracture of the partially visualized\nleft clavicle.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Incompletely evaluated fracture of the partially visualized left clavicle." }, { "input": "Right-sided pars interarticularis defect L5. Fragmentation of the inferior\nleft L5 articular process at L5-S1 articulation may be sequela of prior\nfracture. Normal L5-S1 alignment.\n\nThere is minimal anterolisthesis of the L5-S1 vertebral level. No acute\nfractures are identified. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.Focus of\nwell-defined sclerosis at the posterior right innominate bone, most likely\nbenign bone island. Mild degenerative changes bilateral sacroiliac joints. \nMild lower lumbar facet arthritis. No significant central canal or foraminal\nnarrowing in the lumbar spine.", "output": "1. Pars interarticularis defect L5-S1, normal alignment.\n2. No acute fracture." }, { "input": "There is mild anterolisthesis of C7 on T1, unchanged. Alignment is otherwise\nnormal. No fractures are identified. There are multilevel degenerative\nchanges of the cervical spine including intervertebral, uncovertebral and\nfacet osteophytes as well as loss of height of the intervertebral discs from\nC3 through C7 and endplate sclerosis at these levels.\nThere is no canal or foraminal narrowing at C2-3.\nAt C3-4, uncovertebral and facet osteophytes produce moderate left neural\nforaminal narrowing.\nAt C4-5, intervertebral osteophytes mildly narrow the spinal canal. \nUncovertebral and facet osteophytes produce mild right and moderate left\nneural foraminal narrowing.\nAt C5-6, intervertebral osteophytes mildly narrow the spinal canal. \nUncovertebral and facet osteophytes produce severe right and moderate left\nneural foraminal narrowing.\nAt C6-7, intervertebral osteophytes mildly encroach on the spinal canal\nwithout contacting the spinal cord. Uncovertebral and facet osteophytes\nproduce mild right and moderate left neural foraminal narrowing.\nAt C7-T1 there is no spinal canal or neural foraminal narrowing.", "output": "1. No fractures identified.\n2. Unchanged degenerative subluxation of C7 on T1. Otherwise normal alignment\n3. Multilevel cervical degenerative disease" }, { "input": "Minimal anterolisthesis of C7 on T1 is similar to prior. No acute\nmalalignment. No fractures are identified.Multilevel degenerative changes are\nseen in the cervical spine most notable from C3-C4 through C6-C7, similar to\nprior, most notable for moderate C4-C5 and C5-C6 spinal canal narrowing as\nwell as moderate to severe left C4-5 and bilateral C5-C6 neural foraminal\nnarrowing. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.\n\nThere is fatty atrophy of the left parotid gland.", "output": "No evidence of cervical spine fracture or prevertebral edema." }, { "input": "There is mild retrolisthesis of L1 over L2 and mild anterolisthesis of L4 over\nL5. Multilevel degenerative changes are seen including multilevel vacuum\nphenomenon, intervertebral disc space narrowing, and osteophytosis. Disc\nosteophyte mildly narrows the central canal at T12/L1 and L1/L2. Broad-based\ndisc bulge mildly narrows the central canal at L2/L3 and mild to moderately\nnarrows the central canal at L3/L4. There is moderate narrowing of the\ncentral canal at L4/L5 due to listhesis and possibly disc bulge at this level.\nMild narrowing of the central canal is seen at L5/S1 due to posterior disc\nosteophyte. Facet arthropathy is most noted in the mid to lower lumbar spine,\nright greater than left.No acute fracture is seen. 8 mm calculus is seen in\nthe lower pole of the left kidney. There is an indeterminate 1.3 cm left\nadrenal nodule. Hypodensities are seen in the bilateral kidneys which may\nrepresent cysts, but are not fully characterized on this study re-demonstrated\ncyst in the medial lower pole of the right kidney with thin calcified\nseptation is re-demonstrated, stable in size, measuring 2.4 cm on axial image\nseries 3, image 28. Partially imaged colonic diverticulosis, particularly in\nthe sigmoid colon. Atherosclerotic calcifications are seen.", "output": "1. No acute fracture seen. Re-demonstrated retrolisthesis of L1 over L2 and\nanterolisthesis of L4 over L5. Multilevel degenerative changes have\nprogressed since the prior study. Areas of central canal narrowing throughout\nthe lumbar spine, worst at L4/L5, as above, but seen at all levels.\n2. Indeterminate 1.3 cm left adrenal nodule for which further assessment with\nadrenal protocol CT or MRI could be obtained.\n3. 8 mm left renal calculus.\n4. Hypodensities in the bilateral kidneys not fully characterized on this\nstudy, but most likely representing cysts. Re-demonstrated cyst containing\nthin calcified septation in the lower pole of the right kidney, stable in\nsize." }, { "input": "There are five lumbar-type vertebral bodies which are maintained in height and\nalignment. There is no fracture mixed lucency and sclerosis throughout all of\nthe vertebral bodies which is suspicious for metastatic disease and was seen\non prior though now delineated in better detail on this dedicated exam. \nSpecifically, there are areas of lucency involving the posterior third of the\nT12 vertebral body with erosion of the posterior cortex and some soft tissue\nextending into the canal resulting at least mild canal narrowing at the T12\nvertebral body level. This is similar compared to recent prior chest CT.\n\nAt L1, there is mixed lucency and sclerosis with expansion of the right\npedicle. There is also be soft tissue extension if tumor surrounding the\npedicle including extension into the canal with at least moderate canal\nnarrowing at this level. No definite additional areas of extra osseous\nextension of disease in the lumbar spine based on this CT.\n\nSuperimposed degenerative changes are as follows:\n\nAt T12-L1, there is at least moderate canal narrowing. Soft tissue extension\nfrom the right L1 pedicle contributes to severe right foraminal narrowing\nwhich may affect the exiting T12 nerve root. No significant left foraminal\nnarrowing.\n\nAt L1-2, right L1 pedicle expansion contributes to least mild right foraminal\nnarrowing. No significant left foraminal or canal narrowing.\n\nAt L2-L3, there is a disc bulge and endplate osteophytes without significant\ncanal narrowing. There is mild-to-moderate right and moderate left foraminal\nnarrowing.\n\nAt L3-4, there is a disc bulge without significant canal narrowing. Facet\njoint hypertrophic changes and endplate osteophytes contribute to moderate\nbilateral foraminal narrowing.\n\nAt L4-5, there is intervertebral disc height loss, disc bulge and facet joint\nhypertrophic changes. Mild-to-moderate canal narrowing and moderate left\nforaminal and moderate to severe right foraminal narrowing.\n\nAt L5-S1, severe intervertebral disc height loss with posterior disc bulge and\nendplate osteophytes are noted. There is facet joint hypertrophy. Secondary\nmoderate bilateral foraminal narrowing is noted.\n\nAtherosclerotic calcifications noted in a normal caliber abdominal aorta. \nThere is a 1.0 cm para-aortic lymph node, previously 0.9 cm, not significantly\nchanged given differences in technique.", "output": "1. No fracture.\n2. Diffuse abnormality with mixed lucency and sclerosis throughout the osseous\nstructures worrisome for metastatic disease. Specifically, the right L1\npedicle is expanded with surrounding extra osseous soft tissue extension of\ntumor contributing to at least moderate canal narrowing and severe right\nforaminal narrowing at T12-L1.\n3. Extra osseous extension of disease extending posteriorly from the T12\nvertebral body into the canal contributing to at least mild canal narrowing at\nthis level.\n4. MRI would be optimal for more clear delineation of extra osseous extension\nof disease, specifically into the canal if desired.\n5. Superimposed degenerative changes as above resulting in up to moderate to\nsevere right foraminal narrowing at L4-5. Remaining details as above." }, { "input": "No cervical spine fracture or acute malalignment. Vertebral body and disc\nheight are preserved. Multilevel degenerative changes are noted throughout\nthe cervical spine most prominent at C2 through C7. Pre and paravertebral soft\ntissues are normal. Visualized portions of the skullbase show no\nabnormalities.\n\nLimited assessment of the spinal canal is unremarkable.Visualized portions of\nthe aerodigestive tract are patent. Limited assessment of the lung apices are\nclear. A 0.4 cm (02:13) calcification is seen within the left parotid gland.\nThe parotid glands are otherwise symmetric in appearance without edema.", "output": "1. No cervical spine fracture or acute malalignment\n2. Multilevel degenerative changes throughout the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. Mild multilevel\ndegenerative changes, including intervertebral disc height narrowing and\nosteophyte formation, are most prominent within the lower cervical spine,\nbetter assessed on prior MRI. The known left C7-T1 paracentral disc extrusion\nis better assessed on prior MRI. There is no prevertebral soft tissue\nswelling.", "output": "1. Normal cervical spine alignment, although evaluation of atlantoaxial\ninstability would be better assessed with flexion and extension cervical spine\nradiographs.\n2. Mild multilevel degenerative changes, better assessed on prior MRI." }, { "input": "Alignment is normal. No spinal fracture is identified. There is no\nsignificant canal or foraminal narrowing. There is no prevertebral edema.\n\nHigh density fluid, consistent with hemorrhage, is present in the left\nmaxillary sinus. There are comminuted, displaced fractures of the posterior\nlateral, inferior, anterior, and superior left maxillary sinus walls. . The\nleft ethmoid sinus is also opacified. Associated extensive soft tissue\nswelling and numerous foci of subcutaneous emphysema are seen along the left\nface.\n\nA depressed inferior orbital wall fracture is present and does not appear to\ninvolve the inferior rectus. There is air posterior to the orbit.\n\nWhile no right sided fracture is identified, there is soft tissue edema in the\nright face as well.\n\nNo fracture is identified in the mandible. The medial and lateral pterygoid\nplates are intact bilaterally. The bilateral mastoid air-cells and sphenoid\nsinus are clear. No intracranial hemorrhage is identified on limited views.\n\nThe included thyroid and lung apices are unremarkable. Incidentally noted is\na tracheal diverticulum.", "output": "1. No no acute cervical spine fracture or dislocation.\n2. Multiple left maxillary sinus fractures, detailed above, with extensive\nsoft tissue swelling, loculated subcutaneous air, and fluid, likely\nhemorrhage, in the left maxillary and ethmoid sinuses.\n3. Depressed inferior left orbital wall fracture does not involve the inferior\nrectus. Gas in the left orbit is seen.\n4. Evaluation is limited as the full face is not imaged." }, { "input": "Alignment is normal. No fractures are identified. There is subtle\nirregularity in the anterior superior aspect of the C4 and C5 vertebral\nbodies, likely old and representing small osteophytes. There is mild\nintervertebral disc space narrowing at C4-C5, C5-C6, and C6-C7. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Ill-defined linear branching opacities in bilateral lung apices\nlikely represents scarring. There is a 4 mm hypoattenuating nodule in the\nright lobe of the thyroid (03:56).", "output": "1. No acute fracture or malalignment.\n2. There is subtle irregularity in the anterior superior aspect of the C4 and\nC5 vertebral bodies, likely old and representing small osteophytes.\n3. There is a 4 mm hypoattenuating nodule in the right lobe of the thyroid\n(03:56). No imaging follow-up is recommended per ACR White Paper on follow-up\nof incidentally found thyroid nodules." }, { "input": "There is millimetric anterolisthesis of C3 on C4 and C4 on C5, likely\ndegenerative in etiology.No fractures are identified.There are multilevel\ndegenerative changes of the cervical spine worse at the C5-6 and C6-7 levels\nwhere there is endplate sclerosis and loss of disc height. No significant\nspinal canal narrowing. Uncovertebral facet hypertrophy cause\nmild-to-moderate neural foraminal narrowing at several levels, worst at the\nright C3-4 level and left C4-5 levels.There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm. Pleuroparenchymal\nscarring noted at the bilateral lung apices.", "output": "1. No acute fracture. Minimal anterolisthesis of C3 on C4 and C4 on C5 is\nlikely degenerative in etiology, though no priors are available for\ncomparison.\n2. Multilevel degenerative changes of the cervical spine as above." }, { "input": "No acute fractures are identified. There is mild anterolisthesis of C2 on C3\nand mild retrolisthesis of C3 on C4 and C4 on C5, likely degenerative in\netiology. Multilevel mild to moderate degenerative changes are seen, most\nextensive at C6-C7 and notable for posterior disc bulging with mild to\nmoderate stenosis and bilateral neural foraminal narrowing due to\nuncovertebral spurring.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Calcified punctate\ntonsilliths are incidentally noted within the palatine tonsils bilaterally. \nMild atherosclerotic calcifications are seen at the carotid bifurcations\nbilaterally.", "output": "1. No acute fracture identified.\n2. Multilevel mild to moderate degenerate changes most extensive at C6-C7 with\nposterior disc bulging and mild to moderate stenosis and bilateral\nneuroforaminal narrowing.\n3. Mild multilevel subluxation, likely degenerative in etiology.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ in ___ ___ at 9:45 Am, 5 minutes after discovery of the\nfindings." }, { "input": "Alignment is normal. No fractures are identified. Minimal calcification of\nthe anterior disc annulus at C5-6 is noted. There is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.Visualized thyroid gland and lung apices are clear.", "output": "No fracture or malalignment." }, { "input": "There is no fracture or malalignment within the cervical spine. There is no\nabnormal prevertebral soft tissue swelling. Multilevel degenerative changes\nare noted throughout the cervical spine.\nAt C2-3, intervertebral osteophytes and a disc bulge mildly encroach on the\nspinal canal. Uncovertebral and facet joint osteophytes produce severe right\nand moderate left neural foraminal narrowing.\nAt C3-4, intervertebral osteophytes and a midline protrusion of the disc\nproduce moderate narrowing of the spinal canal and appear to at least\nflattening the anterior surface of the spinal cord. Uncovertebral and facet\nosteophytes produce severe bilateral neural foraminal narrowing. The\nintervertebral osteophytes encroach on the transverse foramina bilaterally.\n\nAt C4-5, the intervertebral osteophytes that narrow the spinal canal and may\ncontact the spinal cord. The intervertebral disk is poorly resolved. There may\nbe a midline disc protrusion. The possible left-sided disc protrusion\nencroaching on the lateral portion of the spinal canal. If further evaluation\nof the soft tissue abnormalities is indicated, an MRI examination may be\nhelpful. There is severe bilateral neural foraminal narrowing due to\nuncovertebral and set osteophytes.\nAt C5-6 is comment uncovertebral and facet osteophytes produce severe\nbilateral neural foraminal narrowing. Mild intervertebral osteophytes slightly\nencroach on the spinal canal without evidence of spinal cord compression.\nAt C6-7, there is marked narrowing of the intervertebral space and apparent\nosseous fusion anteriorly and posteriorly. Findings produce severe bilateral\nneural foraminal narrowing. Intervertebral osteophytes and minimally encroach\non the spinal canal.\n\nAxial images below this level, 2 the upper T5, demonstrate no evidence of\ncanal encroachment.\n\nThere are small bullous changes at the pulmonary apices bilaterally. The lung\napices demonstrate ground-glass opacity along the left major fissure which may\nreflect atelectasis or alternatively aspiration.\n\nExtensive after oral sclerotic calcifications are noted within bilateral\ncarotid arteries as well as the visualized portions of the carotid siphon.\nIncidental note is made of a recurrent right subclavian artery.", "output": "Severe multilevel degenerative changes without cervical fracture or\nmalalignment. Extensive atherosclerotic calcifications within the carotid\nartery siphon and bilateral carotic artery bifurcations. Ground glass opacity\nalong the left major fissue thought to reflect atelectasis though aspiration\ncannot be excluded." }, { "input": "Dental amalgam streak artifact and patient body habitus limits study.\n\nThere is minimal anterolisthesis of C2-C3 and C3-C4 level, likely degenerative\nin etiology. Vertebral body heights are preserved. No definite acute\nfractures are identified. There is no prevertebral soft tissue swelling.\n\nAllowing for difference technique, there has been interval progression of\nmultilevel cervical spondylosis, with loss of intervertebral disc height,\nendplate sclerosis, facet joint hypertrophy, and disc osteophytes resulting in\nat least mild vertebral canal narrowing at C5-6 and C6-7.\n\nThe visualized lung apices appear clear.\nThe thyroid gland is unremarkable. Atherosclerotic calcifications are seen\nalong the left carotid artery bifurcation.\nLimiting imaging of the mandible suggests right mandibular molar periapical\nlucency (see 602:28).\n\nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", "output": "1. Dental amalgam streak artifact and patient body habitus limits study.\n2. No acute fracture or traumatic malalignment.\n3. Mild-to-moderate cervical spondylosis, progressed since ___, with\nmultilevel mild-to-moderate vertebral canal narrowing and moderate left C6-C7\nneural foraminal stenosis, as detailed above.\n4. Right mandibular molar probable periodontal disease, as described.\n5. Nonspecific subcentimeter nodes as described, which may be reactive." }, { "input": "Multilevel degenerative changes in the lumbar spine are severe.\n\nAt T11-T12, no spinal canal stenosis or neural foraminal narrowing.\nAt T12-L1, there is a mild disc bulge indenting the anterior thecal sac. No\nbilateral neural foraminal narrowing.\nAt L1-L2, there is narrowing of the spinal canal from bilateral facet\nhypertrophy, mild disc bulge, and ligamentum flavum thickening. There is mild\nright and moderate left neural foraminal narrowing as a result.\nAt L2-L3, there is spinal canal narrowing from bilateral facet hypertrophy,\ndisc bulge, and ligamentum flavum thickening. There is moderate to severe\nright neural foraminal narrowing and moderate left foraminal narrowing.\nAt L3-L4, there spinal canal stenosis for secondary to a disc bulge noting\nvacuum disc phenomenon also within the bulge. Prominent dorsal epidural fat\nis noted. There is at least moderate canal narrowing as well as bilateral\nmoderate to severe right neural foraminal narrowing and mild left neural\nforaminal narrowing.\nAt L4-L5, there is spinal canal stenosis secondary to endplate osteophytes and\ndisc bulge. There is severe left neural foraminal narrowing and moderate\nright neural foraminal narrowing.\nAt L5-S1, there is severe right neural foraminal narrowing and minimal left\nneural foraminal narrowing. No significant spinal canal stenosis.\n\nIntervertebral disc space narrowing is most pronounced at L4-L5.\n\nAlignment is normal. No fractures are identified.There is no prevertebral soft\ntissue swelling.", "output": "1. Multilevel severe degenerative changes with spinal canal narrowing and\nbilateral moderate to severe neural foraminal narrowing as above.\n2. No acute fracture." }, { "input": "No evidence of acute fracture or malalignment.\nMultilevel degenerative changes are again noted in the cervical spine, largely\nunchanged as compared to the prior examination dated ___.\nDegenerative changes are most significant at the levels of C4-C5, C5-C6, and\nC6-C7 with osteophytosis, endplate sclerosis, and broad-based posterior disc\nbulges/extrusion causing mild-moderate spinal canal narrowing and moderate\nbilateral foraminal narrowing at C5-6 level. A small ossific focus noted at\nthe anterior aspect of the C4-5 disc is new since the prior study however\nappears chronic given the sclerotic margins.\nThere is interval progression of the prominent anterior osteophytes at this\nlevel.\nThere is no appreciable prevertebral soft tissue swelling.\n\nThyroid is grossly homogeneous in appearance. Multiple prominent bilateral\ncervical chain lymph nodes are noted, not pathologically enlarged by CT size\ncriteria. Mildly prominent adenoids with fullness in the nasopharynx and the\nfossa of ___ on both sides and mildly prominent palatine tonsils on\nboth sides. Small amount of fluid in the left mastoid tip.\nThe included portions of the bilateral lung apices are grossly clear.", "output": "No acute fracture or malalignment.\nModerate multilevel degenerative changes of the cervical spine are relatively\nunchanged, causing mild-moderate spinal canal narrowing from C4-C7 levels and\nmoderate bilateral foraminal narrowing at C5-6 level.\nCorrelate clinically to decide on the need for further workup.\nMildly prominent adenoids with fullness in the nasopharynx and fossa of\n___, palatine tonsils and a few neck nodes; small amount of fluid in\nthe left mastoid tip - correlate clinically" }, { "input": "Patient is osteopenic limiting evaluation for subtle fracture. That said,\nthere are multiple nondisplaced fractures identified. Specifically there are \nfractures through the pars interarticularis of C2 on the right (4: 74 ).\nFractures seen to extend through the transverse process involving the\ntransverse foramen (4:86). There is also a sagittally oriented fracture\nthrough the left aspect of the body of C2 (4:62, 601b:25).\n\nDegenerative changes noted at C1 with the lateral masses being relatively\ndysmorphic in appearance likely due to chronic degenerative changes. The the\nring of C1 is intact. However, the posterior aspect of the C1 arch is lucency\n(4:70) which appears to be through the base of an osteophyte, age\nindeterminate.\n\nAcute fracture through the spinous process and right lamina of C4 (04:10 5).\nThere is also nondisplaced fracture through the spinous process of C5 (602 b:\n32)\n\nThere is no other fracture identified within limitation of severe osteopenia.\n\nThere is mild anterolisthesis of C3 on C4, C4 on C5, C7 on T1, and T1 on T2,\nand retrolisthesis of C5 on C6. These are potentially degenerative in nature\nalthough acute injury is not entirely excluded given lack of prior.\n\nThere is no prevertebral soft tissue abnormality.\n\nAtherosclerotic calcifications noted at the carotid bulbs bilaterally. Thyroid\nis unremarkable.\n\nThere is a small right-sided pneumothorax.\n\nA displaced fracture seen through the left transverse process of T3 (4:185)", "output": "1. Acute fracture through the right pars interarticularis of C2 and the left\nbody of C2 as above. The right fracture extends to the transverse foramen\nplacing patient at risk for vascular injury. CTA should be considered.\n2. Degenerative changes at C1, which is a complete ring. Lucency through the\nposterior aspect of the C1 arch which may be fracture through the base of an\nosteophyte, age indeterminate.\n3. Acute fractures through the spinous process of C5 and spinous process and\nright lamina of C4 and left transverse process of T3.\n4. Multilevel the abnormalities of alignment as detailed above, age\nindeterminate. Consider MRI for further evaluation given significant trauma\nand associated fractures.\n5. Right pneumothorax." }, { "input": "Alignment is normal. No fractures are identified. There is intervertebral\ndisc space, endplate irregularity, and osteophyte formation at multiple levels\nof the cervical spine, most severe at C5-C6. There is multilevel moderate\nfacet arthropathy. There is mild left-sided neural foraminal narrowing at\nC4-C5 and C5-C6. There is no evidence of significant spinal canal narrowing. \nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. Pleural scarring in the bilateral right greater than\nleft lung apices is noted. Vascular arteriosclerotic calcifications are\npresent the carotid arteries bilaterally.", "output": "1. No evidence of acute cervical spine fracture or malalignment.\n\n2. Multilevel degenerative changes as described above." }, { "input": "Alignment is normal. There is a small bony fragment located along the\nanterior aspect of C3-C4 (3:33) which appears well corticated, likely\nrepresenting an old fragmented osteophyte. No acute fractures are identified. \nThere are multilevel multifactorial degenerative changes including loss of\nintervertebral disc height and uncovertebral hypertrophy. Posterior disc\nosteophyte complexes are also noted, most prominent at C4-C5 and C5-C6,\nresulting in mild central canal narrowing. There is no evidence of infection\nor neoplasm.", "output": "1. No acute fracture or malalignment.\n2. Multilevel degenerative changes throughout the cervical spine including\nintervertebral disc height loss, uncovertebral hypertrophy and posterior disc\nosteophyte complexes. This results in mild central canal narrowing.\n3. Old fragmented osteophyte anterior to C3-C4." }, { "input": "There is a nondisplaced fracture involving the anterior aspect of the right\ntransverse process extending to the transverse foramen of the C4 vertebral\nbody, with prevertebral soft tissue swelling and mild disc bulge at the C4-5\nlevel (02:34, 602b:35, 36). No subluxation is present. Lung apices are\nclear. Thyroid gland appears normal.", "output": "Fracture of the anterior aspect of the right transverse process extending to\nthe transverse foramen of the C4 vertebral body, with prevertebral soft tissue\nswelling and mild disc bulge at C4-5.\n\nRECOMMENDATION(S): CTA neck is recommended to exclude underlying vertebral\nartery injury. MRI of the cervical spine is also recommended evaluate for\nligamentous injury.\n\nNOTIFICATION: The above findings were communicated via telephone by Dr. ___\nto Dr. ___ at 10:05 on ___, immediately after discovery of the\nfindings." }, { "input": "There is no prevertebral soft tissue swelling. There is no evidence of acute\nfracture. There are moderate-to-severe degenerative changes of the cervical\nspine most pronounced at the C5-6 and C6-7 levels. There is mild\nanterolisthesis of C3-4 and C7-T1, of uncertain chronicity, but likely\ndegenerative in nature.\n\nScarring is noted at the bilateral lung apices. There is no cervical\nadenopathy by CT size criteria. Dense vascular atherosclerotic calcifications\nare noted at the carotid bifurcations bilaterally.", "output": "No evidence of cervical spine fracture. Mild anterolisthesis of C3-4 and\nC7-T1, of uncertain chronicity, but most likely degenerative." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Soft tissue swelling and fat stranding overlying the\nposterior elements may represent contusion or infection (04:22). A partially\nimaged peripherally calcified lesion arising from the root of the third right\nmaxillary molar extending into the maxillary sinus measures at least 2.3 x 1.5\nx 2.1 cm (AP by TR by CC; 3:4, 7:57). Scattered subcentimeter nonspecific\nlymph nodes are noted throughout the neck bilaterally, without definite\nenlargement by CT size criteria. Partially imaged mastoid air cells\ndemonstrate left mastoid air cell partial opacification.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Soft tissue swelling and fat stranding overlying the upper cervical spine\nmay represent traumatic injury or infection.\n3. Partially imaged 2.3 cm calcified lesion arising from the right third\nmaxillary molar extending into the right maxillary sinus. Differential\nconsiderations include keratocystic odontogenic tumor, dentigerous cyst, with\nameloblastoma less likely. If clinically indicated, consider dedicated\nmaxillofacial CT for further evaluation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nOf note, there is an equivocal 8 mm hypodense region within the right thyroid\nlobe, which may be artifactual or may represent a small thyroid nodule (series\n601, image 9).", "output": "1. No acute fracture or dislocation of the cervical spine.\n2. Equivocal 8 mm hypodense region within the right thyroid lobe, which may be\nartifactual or may represent a small thyroid nodule (series 601, image 9)." }, { "input": "The bones are diffusely osteopenic. Mild anterolisthesis of C4 on C5, likely\nchronic and degenerative in etiology. Minimal anterolisthesis of C7 on T1,\nalso likely degenerative. A lucency of the C5 vertebral body, abutting the\ninferior endplate, could be a Schmorl's node or subchondral cyst.\nMild-to-moderate facet joint arthropathy at C2-C3 and C3-C4. Moderate to\nsevere multilevel degenerative changes of the cervical spine, including\nanterior and posterior osteophyte formation, endplate sclerosis, and\nintervertebral disc height narrowing, are most prominent at C5-C7. Mild\ncentral canal stenosis at C2-C3, C4-C5, C5-C6, and C6-C7, due to posterior\ndisc bulge at C2-C3 and posterior osteophytes at the other levels. \nMild-to-moderate neural foraminal narrowing at C4-C5. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nBiapical emphysema is better assessed on the dedicated chest CT. Enteric and\nendotracheal tubes are noted within the esophagus and trachea respectively. \nThe thyroid appears somewhat heterogeneous without dominant nodule.", "output": "1. No acute cervical spine fracture. Mild anterolisthesis of C4 on C5 and C7\non T1 are likely chronic and degenerative in etiology.\n2. Moderate, multilevel degenerative changes of the cervical spine, including\nmild central canal stenosis at C2-C3 and C4-C7." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. There is mucosal\nthickening in the visualized maxillary sinuses, sphenoid sinuses and ethmoid\nair cells, and aerosolized secretions in the right maxillary sinus.", "output": "No acute fracture or traumatic malalignment." }, { "input": "No acute fracture is seen. There is no subluxation. There is no evidence for\nprevertebral edema. There is ossification of the anterior longitudinal\nligament throughout the cervical spine and at the cervicothoracic junction,\nmost extensive at C3 through C5. Discontinuities through the ossified\nanterior longitudinal ligament at C2-C3 through C5-C6, and at C7-T1,\ndemonstrates well corticated margins, indicating chronicity. There is also\nmild ossification of the posterior longitudinal ligament from C3 through C7. \nThere is no disc space widening or splaying of the posterior elements.\n\nPosterior longitudinal ligament ossification and disc protrusions indent the\nventral thecal sac at multiple levels. The spinal canal appears moderately\nnarrowed from C4-C5 through C6-C7. There is multilevel neural foraminal\nnarrowing by uncovertebral and facet osteophytes. There is also a levoconvex\ncurvature of the cervical spine.\n\nIncluded lung apices are clear. Partially visualized thyroid gland is grossly\nunremarkable. There is partial opacification of the right mastoid air cells\nand of the partially included left mastoid air cells. There are foci of\nintracranial air.", "output": "1. No evidence for an acute cervical spine fracture. No subluxation.\n2. Ossification of the anterior and posterior longitudinal ligaments,\nsuggesting diffuse idiopathic skeletal hyperostosis (DISH).\n3. Multilevel degenerative disease.\n4. Scoliosis.\n5. Partial bilateral mastoid air cell opacification and foci of intracranial\nair. Please refer to the concurrent temporal bone CT report for further\ndetail." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. Thyroid gland appears normal.", "output": "Normal cervical spine CT exam." }, { "input": "Alignment is normal. No fractures are identified.Mild degenerative changes\nare noted with calcified disc bulges most pronounced at C2-3, C3-4, and C4-5\nresulting in mild central canal stenosis. Calcification of the transverse\nligament is noted. There is no high-grade central canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Vascular stent is\nnoted within the leftcarotid artery.", "output": "No acute fracture or malalignment." }, { "input": "Dental amalgam, left anterior chest wall hardware and spinal fusion hardware\nstreak artifact and patient body habitus limits study.\n\nGrossly stable straightening of cervical lordosis again noted. Fusion of the\nC2 through C6 vertebral bodies is again noted. Laminectomies of C4 through C7\nvertebral bodies is again noted. Posterior spinal fusion hardware with\ntranspedicular screws at C3, C4, C5, C6, and T1 are noted. Approximately mid\ndistal fractures of bilateral T1 transpedicular screws are again noted. The\nright C3 fixation screw tip is noted again to extend through the right C3\npedicle (see 03:50 on current study and 03:32 on ___ prior cervical\nspine CT). C4 fixation screw tip is also noted to extend through the right C4\npedicle (see 03:56 on current study and 03:38 on ___ prior exam). The\nright C5 fixation screw tip minimally extends through the right C5 pedicle\n(see 3:64 on current study and 03:44 on ___ prior exam). No definite\nperihardware lucency is identified.\n\nNo definite acute fractures are identified. There is no evidence of bony\nvertebral canal narrowing.There is no prevertebral soft tissue swelling.\n\nAt C2-3 there is facet joint hypertrophy and uncovertebral hypertrophy with\nvertebral canal and moderate left neural foraminal narrowing.\n\nAt C3-4 there is uncovertebral hypertrophy and facet joint hypertrophy with no\nvertebral canal, moderate right and severe left neural foraminal narrowing.\n\nAt C4-5 there is uncovertebral hypertrophy and facet joint hypertrophy with no\nvertebral canal and moderate bilateral neural foraminal narrowing.\n\nAt C5-6 there is no vertebral canal or neural foraminal narrowing.\n\nAt C6-7 there is uncovertebral hypertrophy and facet joint hypertrophy with no\nvertebral canal and mild bilateral neural foraminal narrowing.\n\nAt C7-T1 there is no vertebral canal or neural foraminal narrowing.\n\nOTHER:\nSoft tissue densities are noted within bilateral external auditory canals\nwhich may represent cerumen. Left-sided central catheter is partially\nvisualized. Limited imaging of sinuses demonstrate bilateral ethmoid air cell\nand maxillary sinus mucosal thickening. Within the limits of this noncontrast\nstudy, there is no definite evidence of paravertebral or paraspinal mass.\nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", "output": "1. Dental amalgam, left anterior chest wall hardware and spinal fusion\nhardware streak artifact and patient body habitus limits study.\n2. Postsurgical changes related to C2 through C6 fusions, C4 through C7\nlaminectomies and C3 through T1 posterior fusion, with right C3 through C5\nfixation screw tips suggested to extend through corresponding right pedicles\nas described.\n3. Redemonstration of known bilateral T1 transpedicular screw fractures as\ndescribed.\n4. No definite evidence of new cervical spine fracture.\n5. Multilevel cervical bony spondylosis as described, with no vertebral canal\nnarrowing, and C2-3 moderate left, C3-4 moderate right and severe left, and\nC4-5 moderate bilateral neural foraminal narrowing\n6. Paranasal sinus disease , as described." }, { "input": "There is straightening of the cervical lordosis. Again seen are postsurgical\nchanges including fusion of the C2 through C6 vertebral bodies and\nlaminectomies from C4-C7. There are bilateral transpedicular screws at C3,\nC4, C5, C6, and T1. Disc spacer devices are seen at C3-C4 and C5-C6. \nPostsurgical changes overall appear grossly unchanged from the prior exam,\nnoting the right C3, C4, and C5 fixation screw extending through the pedicles.\nThere are fractures of the C7 fixation screws bilaterally, also unchanged from\nprior CT.\n\nThere are no acute fractures identified. There is multilevel degenerative\ndisease of the cervical spine noting multilevel facet arthropathy,\nuncovertebral joint hypertrophy, and osteophytosis resulting in mild vertebral\ncanal narrowing, worst from C5-C7 and moderate to severe neural foraminal\nnarrowing worst at C3-C4. There is no prevertebral edema. There is no\nevidence of infection within limitation of this noncontrast scan.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute cervical spine fractures or traumatic malalignment.\n2. Redemonstration of postsurgical changes of the cervical spine as described\nabove.\n3. Cervical spondylosis." }, { "input": "There is no acute fracture or traumatic malalignment.Mild multilevel\ndegenerative changes are seen throughout the cervical spine. There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "No acute fracture or traumatic malalignment is identified. There is mild\nretrolisthesis of L4 on L5. Additionally degenerative changes are visualized\nL5-S1 with acquired fusion of the joint space. There is no evidence of\nsubstantial spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.The imaged portion of the bilateral kidneys\nand bladder is unremarkable.", "output": "1. No acute fracture traumatic malalignment.\n2. Degenerative changes most prominent about L5-S1." }, { "input": "No acute fracture traumatic malalignment is identified.There is mild\ndegenerative changes at T6-T7 with acquired fusion resulting in mild spinal\ncanal stenosis.There is no prevertebral soft tissue swelling.\nThe imaged portion of the lungs, liver, bilateral kidneys, and left adrenal\nglands is unremarkable. Right adrenal adenoma is identified.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes at T6-T7 which results in mild spinal canal stenosis." }, { "input": "Endotracheal tube and enteric tube are present within the trachea and\nesophagus, respectively.\n\nCervical vertebral bodies are maintained in height and alignment.There is an\nacute nondisplaced fracture through the base of the dens (602b:27) which\nappears to be a type II fracture. There are also acute nondisplaced fractures\ninvolving both the right and left posterior arch of C1 (2:24). No other\nfractures are identified. At C1-C3, there is approximately 5 mm prevertebral\nedema and a 3 mm likely epidural hematoma posteriorly. More inferiorly at\nC6-C7 there is a 6 mm soft tissue density protruding posteriorly resulting in\nsevere spinal canal narrowing (602b:27).\n\nThe thyroid and included lung apices are unremarkable.There are several\nbilateral cervical lymph nodes measuring up to 1.3 cm at level IV on the\nright, which are likely reactive.", "output": "1. Acute non-displaced fractures through the base of the dens (type II) and\nC1 posterior arch bilaterally with prevertebral edema and likely epidural\nhematoma posteriorly.\n2. 6 mm soft tissue density protruding into the spinal canal at C6-C7\nresulting in severe spinal canal narrowing. This may represent traumatic disc\nherniation versus hemorrhage and should be further evaluated with MRI when\nclinically appropriate.\n\nRECOMMENDATIONS: C-spine MRI when clinically appropriate.\n\nNOTIFICATION: Findings and updates to initial wet read were telephoned to Dr.\n___ by Dr. ___ on ___ at 4:32PM." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm.", "output": "No fracture or acute malalignment of the cervical spine." }, { "input": "Partially visualized hardware from previous craniotomy. Alignment is normal.\nNo fractures are identified.There are mild-to-moderate moderate degenerative\nchanges of the cervical spine with loss of intervertebral disc height\nthroughout the cervical spine and vacuum disc phenomena at C6-7.There is no\nprevertebral soft tissue swelling.Partially visualized internal jugular venous\naccess.", "output": "1. No evidence of acute fracture or traumatic subluxation.\n2. Mild-to-moderate degenerative changes of the cervical spine, most severe at\nC6-7." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. There is\nevidence of multilevel degenerative change with osteophyte formation, loss of\ndisc height, and facet hypertrophy. There is vacuum disc hypertrophy at\nC6-C7.", "output": "1. No evidence of acute fracture.\n2. Multilevel degenerative changes." }, { "input": "There is no prevertebral soft tissue abnormality. Cervical vertebrae are\nnormal in height and alignment. There is no evidence of an acute fracture.\nMultilevel degenerative changes are most prominent at the C3-4 level where\nposterior disc osteophyte complexes result in moderate spinal canal narrowing.\nThere is also moderate neural foraminal narrowing at C5-6 on the right and\nC6-7 on the left. Diffuse facet and uncovertebral arthropathy is also noted.", "output": "No evidence of acute fracture or traumatic subluxation. Multilevel,\nmultifactorial degenerative changes in the cervical spine, with mild canal\nnarrowing that C3-4, C5-6 and C6-7 levels and moderate to severe foraminal\nnarrowing at C5-6 and C6-7\nCorrelate clinically to decide on the need for further workup.\n\nA 5.6 mm ground-glass attenuation nodule in the right upper lung series 2,\nimage 58.\nConsider dedicated CT chest for better assessment of the lungs." }, { "input": "There is straightening of the normal cervical lordosis. No fractures are\nidentified.Multilevel degenerative changes are seen, most extensive at C5-6\nand C6-7 and notable for loss of intervertebral disc height, osteophytosis,\nand uncovertebral hypertrophy with mild left neural foraminal narrowing at\nC5-6. Posterior osteophytes at C5-6 and C6-7 cause mild spinal canal\nnarrowing. Moderate spinal canal narrowing is noted at C3-4 due to\nuncovertebral and facet hypertrophy.There is no prevertebral edema.\n\nPleuroparenchymal thickening is seen in the left apex. The left thyroid lobe\nis surgically absent. The right thyroid lobe is heterogeneous with multiple\nnodules measuring up to 1.1 cm.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine.\n3. Multinodular right thyroid lobe with nodules measuring up to 1.1 cm.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Dental amalgam streak artifact and patient body habitus limits study.\n\nQuestion mild widening of the C4-C5 intervertebral disc space without definite\nassociated fracture or prevertebral swelling. No fractures are identified.\n\nModerate degenerative changes are noted at C3-C4 and C5-C6. There is no\nevidence of bony spinal canal narrowing. There is no prevertebral soft tissue\nswelling. Ground-glass opacities and mild interlobular septal thickening in\nbilateral lung apices suggest mild volume overload. Right maxillary sinus\nmucosal thickening is present. Scattered subcentimeter nonspecific lymph\nnodes are noted throughout the neck bilaterally, without definite enlargement\nby CT size criteria.", "output": "1. Dental amalgam streak artifact and patient body habitus limits study.\n2. Within limits of study, no definite cervical spine fracture.\n3. Question mild widening of the C4-C5 intervertebral disc space may reflect a\nhyperextension injury, or intervertebral disc space may appear more prominent\ndue to the moderate degenerative changes at the levels above and below. If\nconcern for cervical spine injury, consider MRI for further evaluation.\n4. Biapical pulmonary ground-glass opacities concerning for volume overload,\nwith differential considerations of infectious or inflammatory etiologies or\nartifact.\n5. Paranasal sinus disease as described.\n6. Multilevel degenerative changes as described.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. in person on ___ at 2:00 AM, 1 minutes after discovery\nof the findings." }, { "input": "Again seen is slight anterior subluxation of L3 on L4 and approximately 6 mm\nof anterior subluxation of L4 upon L5. There is a vacuum phenomenon at the\nL4-5 level. There is interbody fusion at L5-S1.\nImaging from T11-12 through L2 demonstrates facet osteophytes but no spinal\ncanal or neural foraminal compromise.\nAt L2-3, facet osteophytes and a bulging disc produce mild spinal canal\nnarrowing. There is no neural foraminal narrowing.\nAt L3-4 again seen is a right-sided disc protrusion with a fragment migrating\nsuperiorly along the posterior margin of the L3 vertebral body. At the level\nof the interspace disc bulging, facet osteophytes, thickening of the\nligamentum flavum and subluxation produce severe spinal canal narrowing,\nsimilar to the study of ___. There is mild bilateral neural foraminal\nnarrowing.\nThere are postoperative changes after right-sided laminectomy at L4-5. A disc\nbulge and facet osteophytes mildly encroach on the spinal canal. The disc\nbulges into the neural foramina bilaterally.\nAt L5-S1 there is an ossified disc fragment encroaching on the thecal sac. \nFacet osteophytes mildly narrow the neural foramina bilaterally.", "output": "1. Severe spinal stenosis at L3-4.\n2. Mild spinal canal narrowing status post right-sided laminectomy at L4-5." }, { "input": "Study limited by artifact.\n\nPatient is status post L3-L5 fusion, microdiscectomy, and L3 laminectomy and\nright L4 hemilaminectomy. Hardware in place, with no definite ___\nlucency or fracture. There is an interbody fusion at L5-S1. There is\napproximately 0.6 cm of L4 on L5 anterolisthesis, and approximately 0.3 cm of\nL3 on L4 anterolisthesis, unchanged.\n\nAllowing for the artifact of metallic hardware, there is no gross high-grade\nstenosis. There are stable degenerative changes of the spine, with mild to\nmoderate neuroforaminal narrowing. There is no high-grade spinal canal\nnarrowing.\n\nRedemonstration of a partially calcified disc bulge at L2.\n\nAir and edema are visible in the left psoas, with air tracking down to the\niliacus muscle. This could be postsurgical, however, clinical correlation is\nrecommended. There is no large hematoma.\n\nModerate vascular calcifications.", "output": "1. Study limited by artifact.\n2. Status post L3-L5 posterior instrumented fusion. L3 laminectomy and right\nL4 hemilaminectomy. Expected postsurgical changes.\n3. No hematoma.\n4. Air and edema in the left psoas, likely postsurgical, however clinical\ncorrelation recommended." }, { "input": "Multilevel degenerative changes are seen to the C-spine, with endplate\nsclerosis, vertebral body height loss, and disc space height loss, most\nprominent at C4-C6. There is 4 mm anterolisthesis of C3 over C4, of\nindeterminate age given the lack of prior exams, but no perivertebral hematoma\nis seen to suggest acute anterolisthesis. No fractures are identified. There\nis no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Anterolisthesis of C3 over C4, of indeterminate age given the lack of prior\nexams, but no prevertebral hematoma is seen to suggest acute anterolisthesis. \nOtherwise no acute fractures or vertebral malalignment. Multilevel\ndegenerative changes in the C-spine.\n\nCOMMENTS ON ATTENDING REVIEW:\n\nThe anterolisthesis of C3 on C4 is unchanged compared to the ___\nCTA of the neck, with unchanged mild spinal canal narrowing. No acute\nsubluxation and no fracture is seen. Disc osteophyte complexes mildly narrow\nthe spinal canal from C4-C5 through C6-C7. There is multilevel neural\nforaminal narrowing by uncovertebral and facet osteophytes." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. There are several\nprominent, but not pathologically enlarged cervical lymph nodes bilaterally,\nwith the largest measuring up to 0.6 cm in the short axis (3:41), not\nsignificantly changed.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nsignificant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThe imaged lung apices are clear. There are no suspicious thyroid nodules.", "output": "No evidence of fracture or or subluxation." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified. There is no evidence of substantial spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nThe visualized aspect of the lung apices are clear, the thyroid gland appears\nunremarkable.", "output": "No evidence of acute cervical spine fracture or malalignment." }, { "input": "No traumatic malalignment. No acute fractures. There is diffuse multilevel\ndegenerative change most predominant at C5-C6. There is a minimal\nanterolisthesis of C4 over C5, grossly unchanged since the prior CT of the\nneck dated ___. No high-grade spinal canal or neural foraminal\nnarrowing.There is no prevertebral edema. Dense vascular atherosclerotic\ncalcifications are seen in the cervical carotid bifurcations.\n\nNone the lung apices are normal. There is moderate atherosclerotic\ncalcification of the bilateral carotid bifurcations. Some punctate\ncalcifications are seen within the thyroid.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n\n2. Unchanged mild anterolisthesis at C4 upon C5 level." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThere is a tiny left apical pneumothorax. Visualized thyroid is unremarkable.\nSmall amount of stranding and hematoma is seen abutting the left\nsternocleidomastoid muscle in the left neck.", "output": "1. No cervical spine fracture or malalignment.\n2. Tiny apical left pneumothorax.\n3. Small amount of hematoma in the left neck likely reflects seatbelt related\nsoft tissue injury." }, { "input": "Alignment is normal. No acute fractures are identified. There are moderate\nmultilevel degenerative changes spanning C3-6 with loss of disc space height,\nendplate sclerosis and osteophyte formation. There is mild neural foraminal\ncanal narrowing on the right at C5-6 due to uncovertebral osteophytes and\nfacet hypertrophy. There is bilateral fusion of the C3 and C4 facets. There\nis no evidence of spinal canal stenosis. There is no prevertebral soft tissue\nswelling. Focus of sclerosis in the C7 vertebral body is likely a bone\nisland.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate multilevel degenerative disease, as described above." }, { "input": "There is 1 mm anterolisthesis of C3 on C4 and 1 mm of retrolisthesis of C4 on\nC5, which is likely degenerative in nature, however there are no priors for\ncomparison. No acute fractures are identified.There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nThere is moderate degenerative disc disease, most prominent at C4-5. There is\nalso mild neural foraminal stenosis at C4-5 on the right and C5-6 on the left\ndue to a combination of uncovertebral and facet hypertrophy. No significant\nspinal canal stenosis.\n\nThere is scarring at the lung apices bilaterally. The thyroid is slightly\nheterogeneous in appearance, however there are no discrete nodules. No\ncervical lymphadenopathy.", "output": "1. Minimal anterolisthesis of C3 on C4 and retrolisthesis of C4 on C5, which\nis likely degenerative in nature, however there are no priors for comparison.\n2. No evidence of acute fracture." }, { "input": "Patient body habitus and dental amalgam streak artifact limits study.\n\nThere is straightening of cervical lordosis. There is at least partial fusion\nof the C5 through T1 vertebral bodies with anterior flowing osteophytes. \nBilateral C3 and C4 facet joints are fused. The visualized osseous structures\nare osteopenic. There is no prevertebral soft tissue swelling. Within limits\nof study, no definite acute cervical spine fracture.\n\nModerate to severe degenerative changes of the cervical spine include\nintervertebral disc space narrowing, osteophytosis and endplate sclerosis most\npronounced C5-C6.\n\nMultilevel posterior osteophytes, disc bulge and ligamentum flavum hypertrophy\nresult in mild to moderate spinal canal narrowing most pronounced at the C4-C5\nlevel, (series 3, image 33).\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified.\n\nVisualized portion lung apices are clear. The thyroid is preserved. \nAtherosclerotic vascular calcifications are noted. Limited imaging the\nparotid glands demonstrate left parotid numerous punctate nonspecific\ncalcifications. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", "output": "1. Patient body habitus, diffuse osteopenia and dental amalgam streak artifact\nlimits study.\n2. Within limits of study, no definite evidence of acute cervical spine\nfracture or traumatic malalignment.\n3. Multilevel anterior osteophytes as described, suggestive of DISH.\n4. Multilevel cervical spondylosis as described.\n5. Limited imaging the parotid glands demonstrate left parotid numerous\npunctate nonspecific calcifications.\n6. Nonspecific scattered subcentimeter cervical lymph nodes as described." }, { "input": "Old fractures are seen involving the transverse process of the C7 vertebral\nbody bilaterally as well as the spinous process of C7. There is no new\nfracture or change in alignment. There is no prevertebral soft tissue\nswelling.\n\nMinimal degenerative changes are seen throughout the cervical spine. A\nhypodense thyroid nodule is seen within the left thyroid lobe, which measures\n1.1 x 1.3 cm, similar to the prior exam. There is no evidence of cervical\nlymphadenopathy. The visualized apices of lungs are clear.", "output": "Old fractures are seen involving the bilateral transverse processes of the C7\nand spinous process of C7, unchanged compared to the CT from ___. No acute\ncervical spine fractures are identified.\n\nNOTIFICATION: Updated findings were d/w Dr. ___ by Dr. ___ by phone\nat 8:30p on the day of the exam." }, { "input": "There is no acute fracture or malalignment in the cervical spine. There is a\nchronic deformity involving the spinous process of C7, unchanged. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. A left thyroid nodule is again seen measuring\napproximately 1.8 x 1.3 cm, not significantly changed in overall appearance\nfrom prior CT exam. Carotid bulb calcification noted bilaterally.", "output": "1. No acute fracture or malalignment.\n2. Left thyroid nodule measuring up to 1.8 cm can be further assessed on a\nnonemergent basis by ultrasound if there has been no prior work-up." }, { "input": "Alignment is normal. No acute fractures are identified. A deformity of the C7\nspinous process is unchanged. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nThe lung apices are clear. A 1.7 cm left hypodense thyroid nodule has\nincreased compared to ___ but is unchanged compared to the most recent prior\nstudy.", "output": "1. No evidence of cervical spine fracture.\n2. 1.7 cm left thyroid nodule, unchanged from prior, but increased from ___,\nthis can be evaluated with a nonemergent thyroid ultrasound." }, { "input": "Alignment is normal. No fractures are identified.A deformity of the C7 spinous\nprocess is unchanged. There is no severe spinal canal or neuroforaminal\nnarrowing. There is no prevertebral soft tissue swelling.\n\nLung apices are clear. A 1.5 cm hypodense nodule in the left thyroid lobe\nwarrants further evaluation with nonemergent thyroid ultrasound.", "output": "1. No cervical spinal fracture or traumatic malalignment.\n\n2. The previously described 1.5 cm hypodense nodule left thyroid lobe\nwarrants further evaluation with nonemergent thyroid ultrasound." }, { "input": "Alignment is normal. No acute fractures are identified.Chronic fracture of the\nC7 spinous process is noted. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.\n\n1.5 cm hypodense nodule in the left thyroid lobe is unchanged since ___.", "output": "1. No evidence of acute fracture traumatic malalignment.\n2. Chronic C7 spinous process fracture.\n3. 1.5 cm hypodense left thyroid nodule, unchanged since ___. Recommend\nworkup with thyroid ultrasound if not previously worked up.\n\nRECOMMENDATION(S): Thyroid ultrasound if not previously worked up." }, { "input": "Chronic fracture of the C7 spinous process is again noted. There is no acute\nfracture. No subluxation is present and alignment is similar to the previous\nexamination. Degenerative changes with mild intervertebral disc height loss\nand minimal osteophytic spurring is noted at C3-4, C4-5 and C5-6.. There is no\nevidence of high-grade spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nHypoattenuating nodule in the left lobe of thyroid measuring up to 1.5 cm\n(02:58) is unchanged dating back to CT cervical spine ___. 4 mm\nnodule in the left upper lobe (2:69) is unchanged from ___. \nCentrilobular emphysema is seen within the upper lobes. Subtle ill-defined\nground-glass change of the bilateral upper lobes are unchanged from ___ and compatible with scarring.", "output": "1. No acute fracture or malalignment.\n2. Chronic C7 spinous process fracture.\n3. Hypoattenuating nodule measuring up to 1.5 cm in the left lobe of the\nthyroid is unchanged dating back to CT cervical spine ___. This\ncan be further assessed with dedicated thyroid ultrasound if not done\npreviously.\n4. 4 mm nodule in the left upper lobe is unchanged dating back to ___. No additional imaging follow-up is recommended.\n\nRECOMMENDATION(S): Thyroid ultrasound, if not done previously." }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture. \nIntervertebral disc space heights are maintained. There is mild anterior\nsubluxation of C3 upon C4 and posterior subluxation of C4 upon C5. There is no\nprevertebral soft tissue abnormality.\n\nMultilevel degenerative changes are most pronounced at the C3-C7 levels with\nintervertebral disc space narrowing, endplate sclerosis and subchondral cyst\nformation. Posterior osteophytes narrow the spinal canal at the C4-5, C5-6,\nand C6-7 levels.\n\nNote is made of a predominantly lucent and expansile lesion of the clivus with\nareas of possible cortical thinning or breakthrough, which is partially imaged\non this exam and better appreciated on the concurrent CT of the head.\n\nThe thyroid is grossly unremarkable in appearance. No lymphadenopathy is\npresent by CT size criteria. Bilateral carotid atherosclerotic disease is\nnoted. The visualized lung apices demonstrate biapical scarring with nodules\nmeasuring up to 6 mm bilaterally (3:62, 66), which is associated with\ncalcification in the right lung apex (3:64).", "output": "1. No evidence of fracture or malalignment.\n2. Multilevel degenerative changes of the cervical spine.\n3. Partially imaged clival lesion better appreciated on concurrent CT of the\nhead.\n4. Biapical scarring with 6 mm nodules. According to ___\nrecommendations, in the case of nodule size >4 - 6 mm: For low risk patients,\nfollow-up CT at 12 months and if no change, no further imaging needed. For\nhigh risk patients, initial follow-up CT at ___ months and then at ___\nmonths if no change." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nedema. Multilevel, multifactorial degenerative changes are seen throughout\nthe cervical spine, including disc height loss, anterior osteophytosis, and\nfacet joint hypertrophy.\n\nThe thyroid and included lung apices are unremarkable, allowing for\nlimitations of respiratory motion.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Mild to moderate degenerative\nchanges are seen involving predominantly the mid and distal cervical spine\nwith intervertebral disc space narrowing, endplate irregularity, and anterior\nand posterior osteophyte formation. Mild central canal narrowing at C5-6 due\nto a small disc bulge is present. Additionally, moderate to severe neural\nforaminal narrowing is most pronounced on the right at C3-4 due to\nuncovertebral spurring and facet arthropathy.There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Visualized\nthyroid gland is unremarkable. Imaged lung apices are clear.", "output": "1. No acute fracture or subluxation.\n2. Mild to moderate cervical spondylosis." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. Thyroid gland appears normal.", "output": "Normal cervical spine CT exam." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nbony spinal canal or neural foraminal stenosis.\n\nWithin the limits of this noncontrast exam, there is no evidence of infection\nor neoplasm. The patient is intubated, limiting evaluation for prevertebral\nsoft tissue swelling. The visualized portion the lungs demonstrate plate-like\natelectasis and septal thickening.", "output": "1. No acute fracture or malalignment.\n2. Visualized portion of lungs demonstrate plate like atelectasis and septal\nthickening. Recommend clinical correlation and correlation with dedicated\nchest imaging.\n\nRECOMMENDATION(S): Visualized portion of lungs demonstrate plate like\natelectasis and septal thickening. Recommend clinical correlation and\ncorrelation with dedicated chest imaging." }, { "input": "Alignment is normal. No fractures are identified.There is diffuse osteopenia,\nmultilevel degenerative changes are characterized by loss of disc height and\nmild osteophytosis. Minimal spinal canal narrowing is noted at C3-4 and C6-7.\nCongenital nonfusion of the posterior arch of C1 is again noted. \nAdditionally, the irregular sclerotic focus of the left C2 lamina is stable. \nThe soft tissues of the neck are normal. There is no prevertebral edema. \nThere is opacification of the left mastoid air cells and middle ear, partially\nevaluated in this exam dense vascular arteriosclerotic calcifications are\nvisualized in the carotid arteries, the visualized lung apices are clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Stable sclerotic focus in the left lamina of C2, since ___, possibly an\natypical bone island.\n3. There is opacification of the left mastoid air cells and middle ear,\npartially evaluated in this examination." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm.\n\nMultilevel degenerative changes of the cervical spine are present, with\nmultilevel mild spinal canal narrowing secondary to intervertebral osteophytes\nand disc bulges. Mild-to-moderate neural foraminal narrowing at multiple\nlevels, most pronounced at the C5-C6 level and the C6-C7 level..\n\nThe lung apices are grossly clear. The imaged thyroid gland is unremarkable. \nCervical lymph nodes are not enlarged by CT size criteria. There is calcified\natherosclerotic disease at the carotid bifurcations and in the V4 segments of\nthe vertebral arteries", "output": "1. No evidence of fracture or traumatic subluxation.\n2. Multilevel mild degenerative changes, as described above." }, { "input": "As before, the patient is status post C4 through C7 ACDF with interbody\nspacers. No evidence of hardware failure or other complication at this time.\n\nIs anatomic. No fractures or dislocations are identified. There is no evidence\nof spinal canal or neural foraminal stenosis from C2-C3 through C7-T1. There\nis no prevertebral soft tissue swelling.Better evaluated on prior MRI is\nmoderate left T1-T2 neural foraminal narrowing.\n\nThere is partially visualized calcification of the ligamentum flavum at T2\n(___). The thyroid and visualized lung apices are unremarkable. There is no\ncervical lymphadenopathy by size criteria.", "output": "1. As before, the patient is status post C4 through C7 ACDF with interbody\nspacers. No evidence of hardware fracture or perihardware lucency.\n2. No acute osseous fracture.\n3. Spinal canal and neural foraminal stenosis is better evaluated on recent\nMRI cervical spine of ___." }, { "input": "There are 5 non-rib-bearing lumbar vertebral bodies. Alignment is normal. \nThere is no fracture. There is degenerative disc disease with severe L1-2\nthrough L4-5 and moderate L5-S1 disc space narrowing. There are\nintervertebral and facet osteophytes causing mild bilateral neural foraminal\nnarrowing at L1-2 through L4-5, left slightly greater than right.\n\nThere are gallstones. There is moderate calcification of the abdominal aorta\nand origins of the major mesenteric arteries and renal arteries. There are\nmultiple left renal cysts. There is a 7 mm round, hyperdense lesion within\nthe inferior pole of the left kidney, likely a hemorrhagic cyst. There is a 4\nmm calculus in the lower pole of the right kidney, possibly vasculature in\nnature. There is diverticulosis of the descending and sigmoid colon.", "output": "1. Degenerative disc disease with severe disc space narrowing at L1-2 through\nL4-5 and moderate disc space narrowing at L5-S1.\n2. Vertebral body and facet osteophytes cause mild bilateral neural foraminal\nstenosis at L1-2 through L4-5." }, { "input": "There is a lucency through the right aspect of the bifid C5 spinous process\n(301:146) compatible with fracture. There is also a sagittally oriented\nlucency through the posterior arch of C1 on the left (301:71) which could\nrepresent a nondisplaced fracture. There is no other fracture. Alignment is\nmaintained. Degenerative changes are noted with intervertebral disc height\nloss most extensive spanning C4-5 through C7-T1 and contributing to moderate\ncanal narrowing at these levels. Facet joint hypertrophy is most extensive on\nthe left at C2-3 and C3-4. There is no prevertebral edema.\n\nAtherosclerotic calcifications seen at carotid bulbs. Hyperdense tissue\nsuggestive of thyroid seen on the right, no left-sided thyroid tissue is\nidentified. Lung apices are clear.", "output": "Nondisplaced fracture through the C5 spinous process.\nVery subtle linear lucency through the posterior arch of C1 on the left. \nWhile this could represent a nutrient foramen, is not particularly well\nassessed given the thinness of the bone in this region and nondisplaced\nfracture is not excluded.\n\nNOTIFICATION: Findings discussed with Dr. ___." }, { "input": "The study is moderately limited by motion.\n\nPosterior fusion hardware at C1 and C2 are intact, without evidence of\nloosening. There is no evidence of an acute displaced fracture. No\nprevertebral edema. There is approximately 2 mm anterolisthesis of C3 on C4\nand C4 on C5. Multilevel degenerative changes are noted, with\nanterior/posterior osteophytes, loss of intervertebral disc space height, and\nuncovertebral hypertrophy which are most pronounced between C5 through C7. \nThere is up to moderate/severe neuroforaminal stenosis at C5-C6, left greater\nthan right (04:53).\n\nMinimal biapical pleuroparenchymal scarring. Thyroid gland is not well\nvisualized.", "output": "1. No evidence of a displaced fracture, within the limitations of this motion\ndegraded study.\n2. Minimal anterolisthesis of C3 on C4 and C4 on C5 are most likely\ndegenerative. However, clinical correlation is recommended given the absence\nof priors for comparison. MRI may be obtained for further evaluation if\nwarranted." }, { "input": "No subluxation is seen. No fractures are identified.Multilevel severe\ndegenerative changes with ankylosis, flowing bridging anterior osteophytes,\nposterior osteophyte formation, and ossification of the posterior longitudinal\nligament are present. Multilevel mild central canal stenosis is most\npronounced at C3-4, C4-5, C5-6 and C6-7. Additionally, bilateral moderate\nneural foraminal narrowing, right greater than left, is most pronounced at\nC5-C6 and C6-C7. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Small amount of\nsecretions within the trachea at the level of the aortic arch. Moderate to\nsevere atherosclerotic calcifications of the aortic arch is noted.", "output": "1. No acute fracture or malalignment. No prevertebral edema.\n2. Multilevel severe degenerative changes with ankylosis of the cervical\nvertebral bodies, diffuse idiopathic skeletal hyperostosis and ossification of\nthe posterior longitudinal ligament." }, { "input": "Previously seen dissociation at C4-C5, including the previously seen perched\nfacets and substantial anterolisthesis, has been reduced into anatomic\nalignment. Again seen are fracture fragments of the anterior C5 vertebral\nbody and a minimally displaced fracture of the C4 posterior inferior corner. \nThere is a fracture of the C4 right inferior facet with a displaced fragment,\nimage 4:55, and a nondisplaced fracture of the C4 left inferior facet, image\n7:59. Some degree of prevertebral edema/hematoma remains present. The\npreviously seen ventral epidural hematoma at C4 also remains visible on image\n7:48. The spinal canal is mildly to moderately narrowed at C4, improved\ncompared to ___. There is mild right C4-C5 neural foraminal\nnarrowing.\n\nDisc protrusions and endplate osteophytes mildly indent the ventral thecal sac\nat C5-C6 and C6-C7, as seen previously. Other than C4-C5 level, the neural\nforamina are better assessed on the recent MRI.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma. However, a new area of edema is partially visualized in the left\noccipital lobe, concerning for infarction, particularly given the right\nvertebral artery injury seen on the ___ MRI.\n\nMild mucosal thickening is noted in the visualized posterior inferior portions\nof the maxillary sinuses. Visualized portions of the mastoid air cells are\nwell aerated. Endotracheal and orogastric tubes are present. There is\ndiffuse subcutaneous fat edema. There is mild pleural thickening at the\nincluded lung apices.", "output": "1. Previously seen dissociation at C4-C5 has been reduced into anatomic\nalignment.\n2. Minimally displaced fracture of the C4 posterior inferior corner, C5\nanterior vertebral body displaced fracture fragments, and C4 right inferior\nfacet displaced fracture fragment are again seen. C4 left inferior facet\nfracture is no longer displaced status post reduction of perched facets.\n3. Persistent ventral epidural hematoma at C4.\n4. Decreased, now mild to moderate spinal canal narrowing at C4.\n5. New edema in the partially visualized left occipital lobe, concerning for\ninfarction, particular given the right vertebral artery injury seen on the ___ MRI.\n\nRECOMMENDATION(S): Noncontrast head CT for complete visualization of cerebral\ninfarction.\n\nNOTIFICATION: The findings were discussed with ___, N.P. or P.A.\nby ___, M.D. on the telephone on ___ at 12:54 pm, 5 minutes\nafter discovery of the findings." }, { "input": "Dental amalgam and surgical hardware streak artifact, patient body habitus and\nmotion limits examination.\n\nGrossly stable minimal C4 on C5 anterolisthesis is again seen compared to ___ head and neck CTA. Nonspecific probable bone fragment is noted\nposterior to the right C4 inferior articular facet (see 09:43). Postsurgical\nchanges related to patient's known C4-5 ACDF are again noted. No definite\nacute fractures are identified. There is no definite prevertebral soft tissue\nswelling.\n\nThere is no evidence of bony spinal canal narrowing. There is no definite\nabnormal enhancement on post contrast imaging. Grossly stable multilevel\ncervical spondylosis again noted, including facet joint hypertrophy and loss\nof intervertebral disc height spine throughout the cervical spine.\n\nOTHER:\nTracheostomy is partially visualized, with fluid noted within the trachea\nsuperior to level tracheostomy. Limited imaging of sinuses demonstrate\nbilateral maxillary sinus mucosal thickening. Limited imaging of mastoid air\ncells demonstrate bilateral mastoid air cell partial opacification. \nNonspecific patulous esophagus is noted. Scattered subcentimeter nonspecific\nlymph nodes are noted throughout the visualized portion of the neck\nbilaterally, without definite enlargement by CT size criteria. Minimal left\nproximal internal carotid artery probable atherosclerotic calcifications noted\n(see 03:50). Limited imaging lungs demonstrate biapical scarring.", "output": "1. Dental amalgam and surgical hardware streak artifact, patient body habitus\nand motion limits examination.\n2. Postoperative changes related to patient's known C4-5 ACDF with no definite\nevidence of spinal hardware fracture or ___ lucency.\n3. Nonspecific probable bone fragment posterior to right C4 facet, as\ndescribed.\n4. Multilevel cervical spondylosis as described, without definite evidence of\nobvious bony destruction. Please note MRI of cervical spine is more sensitive\nfor the evaluation of discitis osteomyelitis or epidural abscess.\n5. Partially visualized tracheostomy, with fluid noted within trachea superior\nto level of tracheostomy.\n6. Within limits of study, no definite evidence of acute fracture.\n7. Paranasal sinus disease and nonspecific mastoid fluid, as described.\n8. Within limits of study, no definite evidence of cervical mass or abscess.\n9. Nonspecific subcentimeter cervical lymph nodes as described, without\ndefinite lymphadenopathy by CT size criteria, which may be reactive." }, { "input": "Examination is limited by motion artifact. Within this limitation: No\nfractures are identified.There is no prevertebral soft tissue swelling. There\nis no evidence of infection or neoplasm. There is evidence of multilevel\ndegenerative change changes with osteophyte formation, loss of disc height,\nand facet hypertrophy, most severe at C4-C5. There is evidence of neural\nforaminal narrowing at multiple levels.", "output": "1. No acute fracture.\n2. Multilevel degenerative changes." }, { "input": "No acute fracture is identified. There is no abnormal prevertebral soft tissue\nswelling. Significant degenerative changes are identified throughout the\ncervical spine, most pronounced at the C5-C6 level with disc space narrowing,\nendplate sclerosis, subchondral cystic formation, and prominent posterior and\nanterior osteophytes. There is anterolisthesis of C4 on C5. Additional mild\nanterolisthesis is noted at the C7-T1 level. These are felt likely\ndegenerative in etiology.\n\nThe thyroid gland is unremarkable. Bilateral apical lungs demonstrate septal\nthickening and ground-glass opacities suggesting edema.", "output": "1. No acute fracture or subluxation. Extensive degenerative changes most\npronounced at the C5-C6 level.\n\n2. Biapical septal thickening and ground glass opacities nonspecific though\nraises suspicion for mild pulmonary edema." }, { "input": "No acute fractures are identified.T1 and T2 superior endplate deformities are\nchronic. Minimal anterolisthesis of C6 on C7 is likely chronic, exuberant\nleft-sided facet joint hypertrophic changes are noted at this level. Minimal\nanterolisthesis of C4 on C5 is unchanged since ___. Remaining\nvertebral bodies are maintained in alignment. Degenerative changes include\nintervertebral disc height loss, posterior osteophytes and uncovertebral joint\nhypertrophy most notably at C5-6 and C6-7. Facet joint hypertrophy is also\nnoted, there is fusion of the right C3-4 facet joint. There is no critical\ncanal narrowing. There is no prevertebral edema.\n\nThere is a 1.4 cm left thyroid nodule for which no additional imaging is\nnecessary.. Lung apices are clear. Leads from deep brain stimulator devices\nare noted within the subcutaneous tissues of the neck.", "output": "No cervical spine fracture or acute malalignment." }, { "input": "Alignment is normal. No acute fractures are identified. Multilevel\ndegenerative changes are seen throughout the cervical spine with anterior\nosteophytes, facet hypertrophy, subchondral sclerosis and disc space narrowing\nmost prominent from C5 through C7. There is no evidence of spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling. \nCalcification of the cavernous portions of internal carotid arteries and left\nvertebral artery are noted.", "output": "1. No acute fracture or acute malalignment.\n2. Multiple degenerative changes throughout the cervical spine most prominent\nfrom C5 through C7." }, { "input": "Alignment is preserved.There is no acute fracture or traumatic\nsubluxation.There is mild-to-moderate degenerative change throughout the\ncervical spine with loss of intervertebral disc height, uncovertebral\nhypertrophy, and facet arthropathy, most notable at C5-6 and C6-7.there is no\nprevertebral soft tissue swelling.There is a 4 mm hypodense nodule\nincidentally seen in the right lobe of the thyroid gland for which no\nfollow-up is necessary.", "output": "1. No acute fracture or traumatic subluxation.\n2. Mild-to-moderate degenerative change of the cervical spine, most notable at\nC5-6 and C6-7." }, { "input": "There is no evidence of acute fracture or traumatic malalignment.There is a\nlinear lucency through the anterior arch of C1, with well corticated margins\non either side, likely representing congenital non fusion.There is no\nsignificant spinal canal or neural foraminal narrowing.There is no\nprevertebral soft tissue swelling.The thyroid and imaged lung apices are\nunremarkable.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Linear lucency in the anterior arch of C1 with well corticated margins on\neither side likely represents congenital non fusion." }, { "input": "The alignment is overall anatomic, unchanged from prior exam. Likely\ncongenital nonunion of anterior arch of C1 is again noted. At C3, there are\ntubular lucencies through bilateral lamina (02:25), compatible with nutrient\nforamina. There is no associated soft tissue stranding or swelling. There is\nno evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. Left lobe of the thyroid is not\nvisualized. Small amount of soft tissue in the expected region of the right\nlobe of the thyroid is again noted. The imaged lung apices are unremarkable.", "output": "No acute fracture. No alignment abnormalities. No prevertebral swelling." }, { "input": "There is no evidence for a fracture allowing for loss of bone mineralization. \nThere is no subluxation. There is no evidence for prevertebral soft tissue\nswelling. There is obliteration of the C6-C7 disc with near complete fusion\nof the C6 and C7 vertebral bodies, as well as disc space narrowing at C5-C6. \nEndplate osteophytes to the right of midline cause mild to moderate spinal\ncanal narrowing at C6-C7. Small disc protrusions and endplate osteophytes\nmildly indent the ventral thecal sac at C4-C5 and C5-C6. There is multilevel\nneural foraminal narrowing by uncovertebral and facet osteophytes. There is\napparent ossification of the anterior longitudinal ligament at C7 and C7-T1.\n\nA left pleural effusion is partially visualized at the included left thoracic\napex. Trace right pleural fluid is seen at the included right thoracic apex. \nThere is paraseptal emphysema at the lung apices, right greater than left, and\nmild pleural/parenchymal scarring. Visualized upper thoracic esophagus is\npatulous with an air-fluid level. The thyroid gland is grossly unremarkable. \nRight-sided central venous catheter is partially visualized. Concurrent head\nCT is reported separately.", "output": "1. No evidence for a fracture. No subluxation.\n2. Multilevel cervical degenerative disease with mild to moderate spinal\ncanal narrowing at C6-C7.\n3. Patulous upper thoracic esophagus containing an air-fluid level. This\nplaces the patient at risk for aspiration.\n4. Partially visualized pleural effusions, left greater than right.\n5. Paraseptal emphysema at the lung apices." }, { "input": "No gross malalignment of the cervical spine. No evidence of an\nanterolisthesis or retrolisthesis. Vertebral body heights are grossly\npreserved. Mild narrowing of intervertebral disc height at C5-C6 appears\ndegenerative.\n\nNo acute cervical spine fractures are identified. Well-corticated fragments\nat the T2 spinous process appear chronic; correlate with focal symptoms to\nexclude an acute on chronic injury. No prevertebral soft tissue swelling. No\nevidence of infection or neoplasm. Multilevel degenerative changes are mild,\nwith mild narrowing of intervertebral disc height at C5-C6 and T2-T3. Mild\nhypertrophy of the ligamentum flavum and perhaps slight broad-based disc bulge\nat T2-T3 is noted, but no significant spinal canal narrowing.\n\nVisualized lung apices are grossly unremarkable.", "output": "1. No evidence of acute cervical spine fracture.\n2. Well corticated fragments at T2 spinous process appear chronic; correlate\nwith focal symptoms to exclude an acute on chronic injury.\n3. Mild multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. There are degenerative changes in the cervical spine. \nThere is endplate hypertrophic change, mild disc space narrowing at C5-C6\nlevel. There is central, left paramedian disc protrusion at C6-7 level,\ncontacting ventral cord, causing probable mild flattening of the cord\nventrally and moderate central canal narrowing; this area was not as well seen\non prior exam secondary to artifact at this level. Central canal is otherwise\npatent. There is multilevel foraminal narrowing, most prominent and probably\nmoderate at right C3-C4 foramina, similar. There is no evidence of infection\nor neoplasm.\nThe visualized lung apices appear clear. The thyroid gland appears normal. \nThere is chronic left clavicle fracture. Stable, chronic appearance of the\ntip of T2 spinous process.", "output": "1. No acute fracture or traumatic malalignment.\n2. There is disc protrusion at C6-7 level, causing moderate central canal\nnarrowing." }, { "input": "Alignment is normal. No fractures are identified. There are multilevel\ndegenerate changes with disc space narrowing and small posterior discs,\nwithout significant canal narrowing. Multilevel facet arthropathy results in\nup to moderate neural foraminal narrowing, worst on the right at C4-C5 and\nC5-C6. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No evidence of acute cervical spine fracture or traumatic malalignment." }, { "input": "Alignment is normal. No acute fractures are identified. Fragmented anterior\nosteophytes are stable. Multilevel degenerative changes are seen with disc\nspace narrowing and small posterior discs without significant spinal canal\nnarrowing. There is moderate neural foraminal narrowing, most significant at\nthe right C4-C5 and C5-C6. There is no prevertebral soft tissue swelling. The\nlung apices are clear.", "output": "No acute cervical fracture or traumatic malalignment of the cervical spine." }, { "input": "There is compression fracture of the L2 vertebral body extending to the\nposterior aspect of the vertebral body. There is approximately 30% vertebral\nbody height loss. There is no significant retropulsion of fragments. \nAlignment is normal. There is no evidence of significant spinal canal or\nneural foraminal stenosis.Small perivertebral hematoma is present.\n\nExtensive atherosclerotic calcifications are visualized in the aorta. Limited\nevaluation of the kidneys did not reveal hydronephrosis. Cholecystectomy\nclips.", "output": "Compression fracture of L2 vertebral body with extension into the posterior\naspect of the vertebral body and 30% loss of vertebral body height." }, { "input": "Alignment is anatomic.No fractures are identified. Multilevel degenerative\nchanges of the cervical spine, including intervertebral disc height narrowing\nand osteophyte formation, are most prominent within the lower cervical spine. \nThere is no evidence of significant spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no cervical\nlymphadenopathy by size criteria. The visualized aerodigestive tract is\nunremarkable. Minimal paraseptal emphysematous changes of the right lung\napex. Otherwise, no concerning pulmonary nodules identified within the\nvisualized lung.\n\nDiffuse skin thickening of the posterior neck.", "output": "1. No acute cervical spine fracture. Normal alignment.\n2. Additional findings as described above." }, { "input": "Again noted is stable anterolisthesis of C3 on C4, and to a lesser extent, C4\non C5, unchanged since prior examination. Multilevel degenerative changes are\nseen, also unchanged since the most recent examination, 4 with intervertebral\ndisc space narrowing, endplate irregularity, and osteophyte formation\nresulting in moderate to severe bilateral neural foraminal stenosis, worst at\nC3-C4 and C6-C7. There is at least moderate central canal stenosis extending\nfrom C4 -5 through C6 -7 as result of posterior disc osteophyte complexes. No\nprevertebral soft tissue swelling is noted. No fractures are identified.\n\nThe thyroid is heterogeneous without focal nodule. The included lung apices\nare unremarkable.", "output": "1. No acute fracture.\n2. Moderate to severe degenerative changes of the cervical spine with\nmoderate central canal narrowing from C4-5 through C6-7." }, { "input": "The bones are demineralized. No acute displaced fracture is identified. \nVertebral body heights are unchanged. No evidence for prevertebral soft\ntissue swelling. Unchanged kyphotic angulation centered at C4-C5. Unchanged\nmild anterolisthesis at C3-C4, minimal anterolisthesis at C4-C5, and minimal\nretrolisthesis at C6-C7. Mild to moderate disc space narrowing at C3-C4, and\nmoderate to severe disc space narrowing from C4-C5 through C6-C7, with\nendplate sclerosis, endplate cystic changes, and osteophytes, grossly similar\nto the prior CT. Approximately moderate spinal canal narrowing appears\npresent from C3-C4 through C6-C7, similar to prior. Advanced neural foraminal\nnarrowing by uncovertebral and facet osteophytes is again seen at multiple\nlevels, not significantly changed within the limits of CT. Mildly calcified\npannus is again seen in the dorsal aspect of the atlantoaxial joint,\nsuggesting CPPD arthropathy, without spinal canal narrowing at the\ncraniocervical junction.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma in the posterior fossa; no concerning abnormalities are seen. \nThere is a punctate calcification in the left thyroid lobe, not seen\npreviously. No evidence for a discrete thyroid nodule to warrant ultrasound. \nVisualized upper thoracic esophagus is patulous, similar to prior. Visualized\nlung apices appear unremarkable.", "output": "1. No evidence for a fracture. No acute subluxation.\n2. Advanced multilevel degenerative disease is again demonstrated, grossly\nsimilar to the CT from ___. However, more detailed evaluation\ncould be performed by MRI, if clinically warranted." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are notable for intervertebral disc height loss, posterior osteophytes\nand uncovertebral joint hypertrophy most notably at C5-6 and C6-7. Left-sided\nfacet joint hypertrophy noted C2-3 and C3-4. No critical canal narrowing. \nDisc bulges at C3-4 and C4-5 efface the ventral CSF.There is no prevertebral\nedema.\n\nConsolidation and ground-glass noted at the right lung apex appears grossly\nunchanged since ___. Dense atherosclerotic calcifications noted at the\ncarotid bulbs and proximal ICAs. Thyroid is unremarkable.", "output": "Degenerative changes without fracture or malalignment." }, { "input": "THORACIC: Vertebral bodies are preserved in height and alignment. No acute\nfracture. No significant canal or foraminal narrowing identified. Paraspinal\nsoft tissues are unremarkable.\n\nThere is a small left pleural effusion. Calcified pleural based plaques noted\non the left. Postsurgical changes of prior resection noted in the left lower\nlobe. There is a small left pleural effusion. In the right lung, there is\narea of ground-glass and consolidation posteromedially measuring approximately\n4.2 x 2.4 cm, previously 4.0 x 2.0 cm in ___ with component of traction\nbronchiectasis. Given differences in technique, this not significantly\nchanged. Bibasilar parenchymal opacity could be due to atelectasis though\nunderlying fibrosis would be possible.\n\nHeart is enlarged. Atherosclerotic calcifications noted at the aortic root\nand coronary arteries as well as throughout the aorta.\n\nLUMBAR: Lumbar vertebral bodies are maintained in height and alignment. There\nis no fracture or malalignment.\n\nDense atherosclerotic calcifications noted in a normal caliber abdominal\naorta. Other included retroperitoneal paraspinal soft tissues are\nunremarkable.", "output": "No thoracic or lumbar spine fracture or malalignment." }, { "input": "THORACIC: Vertebral bodies are preserved in height and alignment. No acute\nfracture. No significant canal or foraminal narrowing identified. Paraspinal\nsoft tissues are unremarkable.\n\nThere is a small left pleural effusion. Calcified pleural based plaques noted\non the left. Postsurgical changes of prior resection noted in the left lower\nlobe. There is a small left pleural effusion. In the right lung, there is\narea of ground-glass and consolidation posteromedially measuring approximately\n4.2 x 2.4 cm, previously 4.0 x 2.0 cm in ___ with component of traction\nbronchiectasis. Given differences in technique, this not significantly\nchanged. Bibasilar parenchymal opacity could be due to atelectasis though\nunderlying fibrosis would be possible.\n\nHeart is enlarged. Atherosclerotic calcifications noted at the aortic root\nand coronary arteries as well as throughout the aorta.\n\nLUMBAR: Lumbar vertebral bodies are maintained in height and alignment. There\nis no fracture or malalignment.\n\nDense atherosclerotic calcifications noted in a normal caliber abdominal\naorta. Other included retroperitoneal paraspinal soft tissues are\nunremarkable.", "output": "No thoracic or lumbar spine fracture or malalignment." }, { "input": "Cervical alignment is anatomic.No acute traumatic fractures or malalignment\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling.The adenoids and palatine\ntonsils are prominent. Otherwise, the visualized aerodigestive tract is\ngrossly unremarkable. The thyroid gland is unremarkable. The cervical lymph\nnodes are also diffusely prominent, measuring up to 1.2 cm in long axis in\nlevel 3, demonstrating expected reniform shape. These are likely reactive in\nnature. Correlation is recommended. Visualized lungs are clear, allowing for\nrespiratory motion artifact.", "output": "1. There is no acute traumatic fracture or malalignment.\n2. Adenoids and cervical lymph nodes are prominent, potentially reactive in\nnature. Clinical correlation is recommended." }, { "input": "No fractures are identified. There is minimal anterolisthesis of C3 on C4\nwhich is similar compared to prior plain film. Multifactorial, multilevel\ndegenerative changes are present, including multilevel bilateral facet\narthropathy, with ankylosis of the left C4 and C5 facets. Disc space\nnarrowing with anterior posterior osteophytosis and degenerative endplate\nchanges are most pronounced at C4-5 through C6-7. There is no significant\ncanal narrowing.There is no prevertebral edema.\n\nThe thyroid gland is somewhat atrophic in appearance. Interlobular septal\nthickening is noted at the lung apices, potentially reflecting a component of\ninterstitial edema.", "output": "1. No cervical spine fracture or traumatic malalignment.\n2. Moderate multilevel cervical spondylosis.\n3. Bilateral pulmonary apical interlobular septal thickening, potentially\nreflecting underlying interstitial edema." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "There is no acute fracture or malalignment within the cervical spine. No\nprevertebral edema. Degenerative disc disease is most notable at C5-6 with\nmoderate to severe disc space narrowing as well as endplate sclerosis and\nsmall osteophytes. Small posterior disc osteophyte complexes are noted in the\nlower C-spine. No critical central spinal canal or neural foraminal stenosis.\nThe lung apices notable for biapical pleuroparenchymal scarring. The thyroid\ngland appears normal. Partially visualized hardware along the left mandible.", "output": "No acute fracture or malalignment. Degenerative changes as stated above." }, { "input": "Alignment is normal. No fractures are identified.There are mild to moderate\ndegenerative changes throughout the cervical spine. Anterior osteophytes are\nmost pronounced between C5 through C7. There is facet joint arthropathy that\nis most pronounced between C2-C5 on the left. Uncovertebral hypertrophy is\nalso noted. No critical spinal canal stenosis. There is no prevertebral\nsoft tissue swelling.\n\nThere is a 1.2 x 1.1 cm hypodense thyroid nodule on the left (3:66), which\nappears new or larger compared to ___. Lung apices are clear.", "output": "1. No acute cervical spine fracture or malalignment.\n2. 1.2 x 1.1 cm left thyroid nodule, new or larger compared to ___. A\nnonurgent thyroid ultrasound could be considered for further evaluation.\n\nRECOMMENDATION(S): Thyroid ultrasound." }, { "input": "Osseous structures are demineralized.\n\nAlignment is normal. No fractures are identified.There are moderate multilevel\ndegenerative changes in the form of anterior/posterior osteophytes and facet\njoint arthropathy. There is no prevertebral soft tissue swelling. Within the\nlimitations of this noncontrast study, there is no evidence of infection or\nneoplasm.\n\nThe urinary bladder is largely collapsed around a Foley catheter. Post\ninstrumentation air is noted in the bladder lumen. Extensive atherosclerotic\ncalcifications are noted throughout the abdominal aorta and bilateral iliac\nbranches.", "output": "No acute lumbar spine fracture." }, { "input": "Exaggerated thoracic kyphosis causes oblique position of the cervical spine on\naxial images, limiting evaluation.\n\nThe bones are demineralized. No acute displaced fracture is seen vertebral\nbody heights are within normal limits there is no subluxation. There is\nossification of the anterior longitudinal ligament from C3-C4 through the\nincluded upper thoracic spine. There is no evidence for prevertebral soft\ntissue swelling. Evaluation of the spinal canal is limited by artifacts. \nLarge right posterior endplate osteophytes at C2-C3 moderately narrow the\nright aspect of the spinal canal. There is multilevel neural foraminal\nnarrowing by uncovertebral and facet osteophytes\n\nConcurrent head CT is reported separately. Visualized lung apices are clear. \nThe thyroid gland is grossly unremarkable.", "output": "1. Slightly limited exam due to exaggerated thoracic kyphosis, which causes\noblique position of the cervical spine axial images.\n2. No evidence for an acute displaced fracture. No subluxation.\n3. Ossification of the anterior longitudinal ligament from C3-C4 through the\nincluded upper thoracic spine.\n4. Multilevel degenerative disease. Moderate narrowing of the right aspect of\nthe spinal canal at C2-C3 by large posterior endplate osteophytes." }, { "input": "The alignment is overall anatomic without evidence of traumatic malalignment. \nThere is no evidence of acute fracture. There is no prevertebral swelling. \nExtensive vascular calcifications are again noted. The imaged lung apices are\nclear. Degenerative changes of the cervical spine is mild. Uncovertebral\nhypertrophy and posterior osteophyte at C2-3, and C3-4 result an\nmild-to-moderate spinal canal and bilateral neural foraminal narrowing.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes of the cervical spine resulting in mild-to-moderate\nspinal canal and bilateral neural foraminal narrowing, most notable at C2-3\nand C4-5." }, { "input": "There is bony ankylosis of the anterior and posterior ligaments. There is no\ntraumatic malalignment. No acute fracture is identified. There is chronic\nrib deformities at right fourth, sixth, seventh posterior ribs. Anterior\nwedging deformity at T11 is likely chronic. There is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling. The imaged portion of the lungs are unremarkable, aside from mild\nbibasilar atelectasis. Coronary calcifications are severe. The heart is\nmildly enlarged. There is no evidence of pericardial effusion.", "output": "1. No traumatic malalignment or acute fracture of the thoracic spine in the\nsetting of bony ankylosis.\n2. Chronic deformities of the right fourth, sixth and seventh posterior ribs. \nChronic anterior wedging deformity at T11 dating back to ___." }, { "input": "There is no traumatic malalignment. No acute fracture is identified. Mild\ndegenerative changes of the lumbar spine result in mild spinal canal and\nneural foraminal narrowing. Notable is ossification of the anterior\nlongitudinal ligament extending from the lower thoracic spine through the\nlumbar spine to the S1 level. There is also ossification of the interspinous\nligaments. The facet arthropathy is most severe at L5-S1. Patient is status\npost bilateral total hip arthroplasty. There is narrowing of the bilateral SI\njoints. There is no prevertebral soft tissue swelling. Vascular\ncalcifications of the aorta and its major tributaries are severe. There is\nmild ectasia of the left internal iliac artery measuring 1.2 cm. Chronic\nbladder wall thickening is noted.", "output": "1. No acute fracture or traumatic malalignment in the setting of diffuse bony\nankylosis.\n2. Ossification of the anterior longitudinal ligament and interspinous\nligaments.\n3. Thickening of the urinary bladder wall, correlate clinically." }, { "input": "Compression deformity identified at T6 with approximately 50% vertebral body\nheight loss. No discrete fracture line identified. Is no paraspinal soft\ntissue swelling. Elsewhere, vertebral bodies are preserved in height. They\nare preserved in alignment throughout.\n\nThere is evidence of prior posterior left fifth through eleventh rib fractures\nat or close to the costovertebral junction. There is also a discrete lucency\nthrough the posterior aspect of the left eleventh rib (2:81) which could\nrepresent an acute fracture.\n\nThere is a small left pleural effusion. Heart is mildly enlarged. Dense\natherosclerotic calcifications noted at the aortic root and coronary arteries.\nPartially visualized cystic structure in the anterior mediastinum measures at\nleast 3.6 x 1.9 by 5.8 cm cc.\n\nLow-density lesions arising from the left kidney are likely cysts. \nCalcifications in the spleen may be vascular or due to prior granulomatous\ndisease. Low-density liver lesions may represent cysts.", "output": "1. Compression deformity with 50% vertebral body height loss at T6. No CT\nevidence to suggest acuity but clinical correlation is suggested.\n2. Multiple left-sided rib fractures at the costovertebral junction\nposteriorly most of which appear chronic however a fracture of the eleventh\nrib posteriorly may be acute.\n3. Small left pleural effusion.\n4. Partially visualized cystic structure in the anterior mediastinum. \nCorrelation with prior imaging if performed in the past is suggested. Further\nworkup of this lesion can be performed as clinically warranted." }, { "input": "Comminuted type 3 odontoid fracture is again seen, involving an underlying\ncystic (likely degenerative) lesion along the posterior odontoid. The\ncomponent of the fracture involving the C2 vertebral body extends through the\nbilateral C2 transverse processes and disrupting the right transverse foramen,\nas seen previously.\n\nCompared to ___, there is new 3 mm anterior subluxation of the\nodontoid fragment, without angulation. Previously seen left lateral\ndisplacement of the odontoid fragment has also increased, with increased\nlateral subluxation of the left lateral mass of C1 and increased medial\nsubluxation of the right lateral mass of C1 relative to C2. Small fracture\nfragments are again seen along the articular surfaces of the lateral masses of\nC1.\n\nA small dorsally displaced free cortical fracture fragment of the odontoid is\nin unchanged position, with surrounding synovial/epidural soft tissue\nswelling, without effacement of CSF around the craniocervical junction. A\npreviously seen anterior free cortical fracture fragment of the odontoid is\nnow more anteriorly displaced. Prevertebral edema remains present. \nDisruption of the anterior and posterior longitudinal ligament is likely\npresent.\n\nC3 through through T3 vertebral body heights are unchanged, with mild diffuse\nloss of height involving C6 again noted. Minimal retrolisthesis of C3 on C4,\nand mild anterolisthesis of C7 on T1 and of T3 and T4, appear unchanged. Disc\nprotrusions and endplate osteophytes are again seen from C3-C4 through C6-C7\nwith up to moderate spinal canal stenosis at C4-C5. Multilevel neural\nforaminal narrowing by uncovertebral and facet osteophytes is again\ndemonstrated.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are seen on limited assessment. The\nthyroid is grossly unremarkable allowing for motion related to the\naerodigestive tract. Multifocal atherosclerotic calcifications are noted. \nThere is pleural/parenchymal scarring at the included lung apices and a\ncalcified subpleural granuloma at the left apex (2:53-54).", "output": "1. Comminuted type 3 odontoid fracture involving an underlying cystic, likely\ndegenerative lesion along the posterior odontoid is again seen, extending\nthrough bilateral C2 transverse processes and disrupting the right transverse\nforamen.\n2. Small free cortical fracture fragments posterior and anterior to the\nodontoid fracture are again seen, with unchanged prevertebral and retro\nodontoid soft tissue swelling. No effacement of CSF around the craniocervical\njunction.\n3. Compared to ___, there is new 3 mm anterior subluxation of the\nodontoid fragment without angulation. There is also increased left lateral\ndisplacement of the odontoid fragment with increased lateral subluxation of\nthe left lateral mass of C1 and increased medial subluxation of the right\nlateral mass of C1. Small fracture fragments of bilateral C1 lateral masses\nare also again noted.\n4. Multilevel degenerative disease, including multilevel spinal canal\nnarrowing, up to moderate at C4-C5.\n\nNOTIFICATION: The impression above was entered by Dr. ___ on\n___ at 10:54 into the Department of Radiology critical communications\nsystem for direct communication to the referring provider." }, { "input": "Again a type 2 fracture of the odontoid process identified. The fracture\ncleft is still visible and unchanged from the previous study. However, there\nis no change in the alignment of the fragments seen. There is no spinal canal\nnarrowing seen at this level.\n\nOsteopenia is visualized and multilevel degenerative changes are seen as\nbefore.", "output": "Unchanged appearance of the fracture of the odontoid process. No interval\nchange in the alignment of the fragments. No significant new abnormalities." }, { "input": "There is no acute fracture or malalignment of the cervical spine. No\nprevertebral soft tissue abnormalities seen. Multilevel degenerative changes\nare unchanged compared to ___. Fractures of the left maxillary sinus\nare incompletely imaged, and better evaluated on CT head from the same day.\nThe visualized lung apices are clear.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality of\nthe cervical spine." }, { "input": "Trace retrolisthesis of C3 on C4 is most likely degenerative in etiology. No\nacute fractures are identified.There are moderate multilevel degenerative\nchanges of the cervical spine, with anterior and posterior osteophytes and\nbilateral neural foraminal narrowing at C2-C3 and C5-C6. There is no\nprevertebral edema.\n\nThe imaged thyroid is unremarkable. Biapical lung scarring is noted, right\ngreater than left.", "output": "No acute fracture or traumatic subluxation." }, { "input": "No acute fracture, malalignment, or prevertebral soft tissue abnormality of\nthe cervical spine is seen. Straightening of the cervical spine likely\nreflects positioned in a C-collar. Subtle kyphosis at C4-5 level may reflect\nan old injury. Otherwise, no significant degeneration. Prevertebral soft\ntissues normal. Thyroid gland is unremarkable. Imaged lung apices are clear.", "output": "No acute fracture or malalignment." }, { "input": "Dental amalgam and overlying hardware streak artifact limits study. Body\nhabitus limits examination, especially of C7 inferior vertebral bodies..\n\nVertebral body alignment is preserved. No fractures are identified. There is\nno evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\nRight-chest wall and neck soft tissue gas is likely due to chest tube\ninsertion. A small right apical pneumothorax is partially visualized. \nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria. Please see\nconcurrently obtained torso CT for description of thoracic findings.", "output": "1. Dental amalgam and overlying hardware streak artifact, and patient body\nhabitus limits study as described.\n2. Within limits of study, no fracture or traumatic malalignment in the\ncervical spine\n3. Small right apical pneumothorax partially visualized, better evaluated on\nconcurrently obtained torso CT.\n4. Right-chest wall and neck soft tissue gas, compatible with chest tube\ninsertion postoperative changes." }, { "input": "Alignment is normal. No acute cervical spine fractures are identified. \nMild-to-moderate multilevel degenerative changes, include intervertebral disc\nheight narrowing, endplate sclerosis, and osteophyte formation, most\npronounced within the lower cervical spine. Moderate vertebral canal\nnarrowing at C5-C6. Mild neural foraminal narrowing at C5-C6. There is no\nprevertebral edema. Nonspecific focal lucencies within the T1 vertebral body\n(602:50).\n\nThe thyroid and included lung apices are unremarkable. Mucous retention cysts\nnoted in the inferior left maxillary sinus. An enlarged node adjacent to the\nright parotid gland measures 1 cm (3:22).", "output": "No acute cervical spine fracture or traumatic malalignment.\nNonspecific enlarged right periparotid lymph node." }, { "input": "Alignment is normal.Acute compression deformities are seen involving the\nsuperior endplates of T12 and L1. There is mild resultant loss of anterior\nvertebral body height, though there is no bony retropulsion or change in\nalignment. No significant perivertebral hematoma. No significant\ndegenerative disease is seen within the lumbar spine. Mild anterior bridging\nosteophytes are noted in the lower thoracic spine. Mild facet arthropathy is\nnoted in the lower lumbar spine.\n\nDependent atelectasis is seen within the visualized lungs. The imaged portion\nof the abdomen and pelvis is unremarkable.", "output": "Acute superior endplate compression deformities at T12 and L1 without\nretropulsion, changed alignment, or significant hematoma." }, { "input": "Patient is status post T12 through L2 laminectomies. Small foci of air noted\nin the postoperative bed with some peripheral enhancement though known large\ndrainable collection identified within limitation of CT scan.\n\nPigtail catheter seen within left psoas abscess superiorly (301:55) as well as\nmore inferiorly (301:94). Overall the psoas abscess at its inferior aspect\nhas significantly decreased in size, previously approximately 6.7 x 4.5 cm,\nnow approximately 2.8 x 0.6 cm.\n\nDegenerative changes most notable at L4-5 where there is a disc bulge and\nposterior osteophytes as well as thickening of the ligamentum flavum resulting\nat least moderate canal narrowing, better assessed by prior MRI.\n\nAtherosclerotic calcifications noted in the abdominal aorta and iliac vessels\nwhich are normal in caliber.", "output": "1. Patient is status post T12 through L2 laminectomies for drainage of\npreviously seen epidural abscess. Please note that CT is limited for detailed\nof assessment of the structures within the canal. Expected foci of air in the\npostoperative bed.\n2. Two pigtail catheters within the left psoas abscess which has significantly\ndecreased in size, particularly at its inferior margin." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or malalignment of the cervical spine." }, { "input": "Patient is rotated within the scanner, with mild motion artifact, which limits\nevaluation.\n\nThere is no traumatic malalignment of the cervical spine.No acute fractures\nidentified. Note is made of calcified pannus at the atlanto occipital\njunction, as seen on the prior CT head from ___. This causes mild\nmoderate spinal canal narrowing at this level. Severe degenerative changes of\nthe entire cervical spine are demonstrated, with disc space narrowing,\nosteophytosis, and facet hypertrophy at the centrally all levels. At the\nlevel of C6, there is ossification of the ligamentum flavum (602b:37). There\nis no prevertebral soft tissue swelling.\n\nIncreased interstitial lung markings at the bilateral pulmonary apices, and a\nright pleural effusion are incidentally noted. Imaged thyroid is\nunremarkable.", "output": "1. Study is degraded by patient rotation and motion artifact. However,\nwithin this limitation, no evidence of acute cervical spinal fracture or\ntraumatic malalignment.\n\n2. Severe degenerative changes, as noted above.\n\n3. Incidental note of a small right pleural effusion." }, { "input": "A subtle hyperdensity just anterior to the C4 C5 superior endplate seen best\non series 602, image 33 is likely chronic. No definite signs of associated\nsoft tissue swelling. There is subtle anterolisthesis (~2mm) of C4 relative\nto C5. ___ disc disease is most pronounced at C5-6 level with\nmoderate disc space narrowing and small endplate osteophytes. The visualized\noutline of the thecal sac is unremarkable. No critical neural foraminal or\ncentral spinal canal stenosis. Patient is intubated and an OG tube is in\nplace.", "output": "1. No definite fracture or traumatic alignment abnormality.\n2. Subtle anterolisthesis of C4 on C5 likely chronic though in the absence of\npriors clinical correlation advised.\n3. Subtle punctate hyperdensity anterior to the superior endplate of C5,\nlikely chronic. No definite prevertebral soft tissue swelling. Evaluation\nsomewhat limited given intubated state. Please correlate clinically." }, { "input": "There is no acute fracture or traumatic malalignment in the cervical spine. \nThere is left greater than right facet degeneration with bony hypertrophy. \nDisc spaces are grossly preserved. The outline of the thecal sac appears\nnormal. No prevertebral edema. Thyroid gland appears normal. Partially\nresected right mastoid noted.", "output": "No fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. A suboccipital craniectomy\nis again noted, as is resection of the posterior arch of the C1 vertebral\nbody. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling.Within the limitations of this\nnoncontrast exam, there is no evidence of infection or neoplasm.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "No acute fracture. Alignment is normal. Vertebral body heights and\nintervertebral disc spaces are maintained. Minimal anterior osteophyte\nformation is seen. There is no evidence of spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. Nuchal ligament\nossification is noted at C5 and C6 levels. Visualized thyroid gland and lung\napices are clear. Median sternotomy wires are incidentally noted.", "output": "No acute cervical spine fracture or traumatic malalignment." }, { "input": "No acute fracture is identified. Alignment is normal. Multilevel\ndegenerative changes include disc space narrowing, endplate sclerosis and\nosteophytosis, most severe at C5-C6. There is a Schmorl's node at the\nsuperior endplate of C5 which is likely degenerative. At the anterior\ninferior vertebral body of C5, there is a well corticated fragment/fracture an\nanterior osteophyte which is likely chronic. There is no prevertebral soft\ntissue swelling.", "output": "No acute fracture or traumatic malalignment." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Accounting for this numbering, L1\nexhibits a small 13th rib, the site of prior cervical fusion at the level of\nC6-C7 and the site of prior lumbar fusion is at the level of L5-S1.\n\nAlignment is normal.There is a fracture traversing the superior end plate of\nT12 with a small posteriorly displaced fragment with slight retropulsion\nencroaching on the spinal canal but without deformity of the spinal cord\n(602b:58). The acuity/chronicity of this fracture is indeterminate based on\nthe limitations of CT, however on comparisons from ___ this\nabnormality was not present and interval images lack proper visualization of\nthis level. There is anterior wedging of the T8 vertebral body without\ndefinite fracture.\n\nAnterior cervical surgical hardware C6-C7 is visualized and appears intact\nwith proper fusion of C6-C7.\n\nOtherwise, there is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "1. An age-indeterminate T12 superior endplate fracture with a posteriorly\ndisplaced, slightly retropulsed, fragment encroaching on the spinal canal but\nwithout spinal cord deformity.\n2. T8 anterior wedging without a definite fracture." }, { "input": "For the purposes of numbering, the lowest well formed intervertebral disc\nspace was designated the L5-S1 level. Accounting for this numbering, L1\nexhibits a small 13th rib, the site of prior cervical fusion at the level of\nC6-C7 and the site of prior lumbar fusion is at the level of L5-S1.\n\nVertebral body alignment is preserved. Within the limits of this noncontrast\nstudy there is no paravertebral or paraspinal mass identified and there is no\nevidence of infection or neoplasm. The visualized portion of the sacroiliac\njoints are preserved.\n\nAt T12-L1 there is no vertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is no vertebral canal or neural foraminal narrowing.\n\nAt L2-3 there is a broad-based bulging disc with mild canal stenosis. There is\nno neural foraminal stenosis.\n\nAt L3-4 there is moderate to severe spinal canal narrowing due to the thick\nligamentum flavum and a bulging disc. The bulging disc extends into the right\nlateral neural foramina and compresses the right L2 nerve root.\n\nAt L4-5 there is facet arthropathy, disc bulging and thickened ligamentum\nflavum causing moderate to severe spinal canal narrowing. There is also a\nright neural foraminal stenosis with compression of the right L3 nerve root. \nThe left neural foramina is patent.\n\nAt L5-S1 there is fusion of L5-S1 and intact surgical hardware. The surgical\nsite contains soft tissue density which most likely represents surgical\nscarring however fluid collections and/or infection cannot be excluded. In the\nappropriate clinical setting, MR imaging may provide additional information.", "output": "1. No compression fractures or misalignment of the lumbar spine.\n2. L5-S1 surgical site contains soft tissue density which most likely\nrepresents surgical scarring however fluid collections and/or infection cannot\nbe excluded. In the appropriate clinical setting, MR imaging may provide\nadditional information.\n3. Moderate to severe spinal stenosis most prominent at L3-L4 and L4-L5. \nCompression of right L2 nerve root and right L3 nerve root." }, { "input": "No fractures are identified. There is unchanged mild anterolisthesis of C5-C6\nvertebral level when compared to the scout image from the head CT. Mild\nmultilevel degenerative changes are seen in the cervical spine with\nintervertebral disc space narrowing and osteophytic spurring with minimal\nspinal canal narrowing due to a disc bulge at the C3-C4 vertebral level. Mild\nbilateral neural foraminal narrowing is seen at the C4-C5 vertebral level. \nThere is no prevertebral soft tissue swelling.Ill-defined nodular opacities\nare seen in the lung apices which suggest small airways disease. Right\npleural effusion is incompletely imaged.", "output": "1. No acute fracture. Unchanged anterolisthesis of C5-C6 vertebral level,\nlikely degenerative in etiology.\n2. Mild multilevel degenerative changes are seen cervical spine with minimal\nspinal canal narrowing at the C3-C4 vertebral level.\n3. Findings suggestive of small airways disease within the lung apices and\nright pleural effusion, incompletely imaged." }, { "input": "Alignment is normal.No acute fracture.Degenerative changes of the cervical\nspine are mild-to-moderate. A posterior disc bulge at C5-C6 causes mild\nspinal while narrowing. No severe neuroforaminal narrowing. There is no\nprevertebral soft tissue swelling.\n\nIncidental note is made of several hypodense left thyroid nodules, the largest\nmeasuring is a 1.7 cm (3:65). Multiple calcified bilateral submandibular\nsialoliths are present. Biapical pulmonary edema correlates with findings on\nthe recent chest radiograph. The patient is intubated. A presumed enteric\ntube courses in the esophagus and out of view. Chronic upper left rib\ndeformities are present.", "output": "1. No cervical spinal fracture or traumatic malalignment.\n2. Several hypodense left thyroid nodules, the largest of which measuring 1.7\ncm. This warrants follow-up with nonemergent ultrasound.\n\nRECOMMENDATION(S): Thyroid ultrasound for multiple left-sided nodules.\n\nNOTIFICATION: The above findings and recommendation were communicated via\ntelephone by Dr. ___ to Dr. ___ at 19:20 on ___, 5 min\nafter discovery." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified.Mild multilevel degenerative changes are noted. There is mild\nspinal canal narrowing at C5-6 secondary to posterior osteophytes.There is no\nprevertebral soft tissue swelling.\n\nThe lung apices and the thyroid gland are unremarkable, there is no evidence\nof lymphadenopathy. Focal area of low attenuation at T1 vertebral body on the\nleft suggestive of hemangioma (series 3, image 64). Vascular atherosclerotic\ncalcifications are seen in the right carotid bifurcation.\nOpacification of the left maxillary sinus, and sphenoid sinus, better depicted\nin the dedicated head CT, please refer to this report for details.", "output": "1. No evidence of acute cervical spine fracture or traumatic malalignment." }, { "input": "The thoracic spine alignment is normal.There is diffuse osteopenia, no acute\nthoracic spine fractures are identified. A T1, and T8 vertebral hemangiomas\nare noted. Spondylosis and posterior osteophyte is noted at T4-T5 level\ncausing anterior thecal sac deformity, there is no evidence of spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling.\nThere is a moderate hiatal hernia, otherwise the visualized paravertebral\nstructures are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate hiatal hernia.\n3. Non expansile vertebral hemangiomas identified at T1 and T8 vertebral\nbodies as described above.\n4. Diffuse osteopenia and mild multilevel degenerative changes, more\nsignificant at T4-T5 level." }, { "input": "The lumbar spine alignment is normal. No acute lumbar spine fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nBulky anterior osteophytes are seen at L3-L4, and L4-5 levels. There is no\nprevertebral soft tissue swelling. Small punctate vascular arteriosclerotic\ncalcifications are seen in the abdominal aorta. The visualized paravertebral\nstructures are grossly unremarkable.", "output": "1. No acute lumbar spine fracture or traumatic malalignment." }, { "input": "Thoracic dextroscoliosis is noted. Alignment is normal. No fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. No obvious epidural\ncollection/hematoma within the limits of a CT scan.\n\nEvaluation of the partially visualized lung fields limited by respiratory\nmotion. There is right basilar atelectasis. Moderate atherosclerotic\ncalcification of the aorta is noted. Limited evaluation of the upper abdomen\nis unremarkable.", "output": "1. No fracture or traumatic malalignment.\n2. No obvious epidural collection/hematoma within limitations of a CT scan." }, { "input": "Alignment is normal. No fractures are identified. Lumbar levoscoliosis is\nnoted. Multilevel degenerative changes are noted within the visualized\nthoracolumbar spine most prominent at L3-4 and L4-5. At L3-4 there is mild\ndisc bulge with facet joint hypertrophy and ligamentum flavum hypertrophy\nresulting in mild-to-moderate spinal canal narrowing. At L4-5, there is\nmoderate disc bulge and facet joint hypertrophy resulting in and narrowing of\nthe left subarticular recess. There is no prevertebral soft tissue swelling.\nThere is no evidence of obvious epidural collection/hematoma within the spinal\ncanal.\n\nAssessment of the abdomen limited by motion.\nAn IVC filter is located in the infrarenal position.\nThere is extensive atherosclerotic disease of the abdominal aorta and common\niliac arteries.\nPreviously seen 7 mm left para-aortic lymph node is stable.", "output": "1. No fracture or traumatic alignment.\n2. No obvious epidural collection/hematoma in the spinal canal within the\nlimits of CT scan.\n3. Multilevel degenerative changes most notable at L3-4 and L4-5 as detailed\nabove." }, { "input": "The bones are osteopenic. There is 1 mm retrolisthesis of C3 on C4. There is\nchronic appearing widening of the anterior intervertebral space between C7 and\nT1 vertebral bodies (602:32). There is no prevertebral soft tissue swelling. \nCoarse calcification is seen in the left thyroid gland. Evaluation of lung\nparenchyma is limited by motion.", "output": "No acute fracture of the cervical spine.\n\nMinimal retrolisthesis of C3 on C4 is likely chronic. Anterior widening of\nthe C7/T1 anterior intervertebral disc space is also appears chronic." }, { "input": "No fractures are identified and alignment is normal. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no prevertebral soft\ntissue swelling identified.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Alignment is normal. There is severe multilevel degenerative changes of the\ncervical and visualized thoracic spine. Fusion of the C7-T1 vertebral bodies.\n\nC2-C3: No evidence of significant spinal canal stenosis or neural foraminal\nnarrowing.\nC3-C4: Disc bulge with mild spinal canal narrowing. Uncovertebral and facet\njoint osteophytes cause severe left-sided neural foraminal narrowing.\nC4-C5: Ossification of the posterior longitudinal ligament. Intervertebral\nosteophyte narrowing of the spinal canal. Bilateral moderate neural foraminal\nnarrowing secondary to uncovertebral osteophytes.\nC5-C6: Intervertebral osteophytes cause mild spinal canal stenosis and right\nneural foraminal narrowing.\nC6-C7: Widening of the anterior interspace (series 602, image 37), may\nrepresent an old ligamentous injury, however chronicity is indeterminate. \nPrior studies would be helpful. There is a linear lucency through the left\npedicle of the vertebral body with associated sclerotic margins and without\nany evidence of prevertebral soft tissue swelling (series 602, image 38-39 and\nseries 301 image 49-50), likely represent a chronic fracture.\n\nRe-demonstration of a partially visualized endotracheal tube.\nRe-demonstration of right-sided mastoid air cell opacification with fluid in\nthe middle ear cavity.\nThe visualized lung apices are clear.", "output": "1. Severe multilevel degenerative changes of the cervical spine with fusion of\nthe C7-T1 vertebral bodies. Widening of the anterior C6-C7 inter disc space\nwithout evidence of prevertebral soft tissue swelling, may represent an old\nligamentous injury however, chronicity is indeterminate. Prior studies would\nbe helpful.\n2. Linear lucency through the left pedicle at C6-C7 with associated sclerotic\nmargins and without any evidence of prevertebral soft tissue swelling, may\nrepresent a chronic fracture.\n3. Fusion of the C7-T1 vertebral bodies without evidence of joint fusion.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:15pm, 25 minutes after\ndiscovery of the findings." }, { "input": "There are two linear lucencies (anteriorly and laterally) at the right C4\ntransverse process (4a:139) extending to the transverse foramen, are\ncompatible with fractures. Questionable adjacent sclerosis suggesting that\nthese are not be acute, although it is difficult to accurately assess without\npriors for comparison. No other fractures are identified. Alignment is normal.\nThere are multilevel degenerative changes including intervertebral disc height\nloss and uncovertebral hypertrophy, resulting in moderate central canal\nnarrowing. Ossification of the posterior longitudinal ligament, most notable\nat the level of C5 and C6, also contributes to canal narrowing.\n\nThere is widening of the right acromioclavicular joint, which should be\ncorrelated clinically. The thyroid gland is unremarkable. No pulmonary nodules\nare identified in the visualized portions of the bilateral lung apices.", "output": "1. Right C4 transverse process fractures (4a:139) extending to the transverse\nforamen with questionable adjacent sclerosis suggesting that they are chronic,\nthough difficult to accurately assess without priors for comparison. If felt\nto be acute clinically, CTA should be considered to evaluate for possible\nvertebral artery injury.\n2. Right acromioclavicular joint widening, for which clinical correlation is\nrecommended.\n3. Multilevel degenerative changes including loss of intervertebral disc\nheight and uncovertebral hypertrophy, which results in moderate canal\nnarrowing. Ossification of PLL also contributes to canal narrowing.\n\nNOTIFICATION: Final results, including changes to initial preliminary read,\nwere telephoned to Dr. ___ on ___ at 1:58PM." }, { "input": "Alignment is normal. No acute fractures are identified. Again noted is a\nlucency through the base of an osteophyte abutting the superior articular\nfacet of C5 on the right (602:12). There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nMild degenerative disc disease throughout the cervical spine. Left posterior\nparacentral osteophyte at C5-6 combined with a left-sided uncovertebral\nosteophyte causes mild to moderate spinal canal and moderate left neural\nforaminal stenosis. No high-grade spinal canal or neural foraminal stenosis\nat other levels.\n\nMucous retention cyst within the left maxillary sinus. Partially imaged lung\napices are clear. The thyroid is unremarkable. No cervical lymphadenopathy.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Alignment is maintained.A well corticated lucency through the base of a\nposterior osteophyte abutting the inferior articular facet at the level of C5\nis consistent with an old fracture (602b:24, 4:181). A lucency through the\nbase of an osteophyte abutting the superior articular facet at the level of C5\non the right is of indeterminate age (4:170, 602b:23). Elsewhere, there is no\nfracture.\n\nThere is no prevertebral soft tissue swelling.Included portion of the thyroid\nand lung apices are unremarkable.", "output": "A lucency suggesting fracture through the base of an osteophyte abutting the\nsuperior articular facet at the level of C5 on the right is of indeterminate\nage. No other evidence of acute fracture or malalignment." }, { "input": "There is normal lumbar alignment. The vertebral body heights are preserved. \nThere is diffuse osteopenia with prominent trabeculae and lucency at the\nanterior aspects of the T12 and L1 vertebral bodies, without osseous\ndestruction, fracture, or extraosseous soft tissue. There are bulky anterior\nend-plate osteophytes.\n\nAt T12-L1 there is no spinal canal or neural foraminal stenosis.\n\nAt L1-L2 there is no spinal canal or neural foraminal stenosis.\n\nAt L2-L3 there is mild disc bulge without spinal canal or neural foraminal\nstenosis.\n\nAt L3-L4 there is disc bulge, facet osteophytes, and ligamentum flavum\nthickening causing mild spinal canal narrowing and mild bilateral neural\nforaminal stenosis.\n\nAt L4-L5 there is disc bulge, facet osteophytes, and ligamentum flavum\nthickening causing mild spinal canal narrowing and mild bilateral neural\nforaminal stenosis.\n\nAt L5-S1 there is disc bulge and facet osteophytes causing mild spinal canal\nnarrowing without neural foraminal stenosis.\n\nThere is arthrodesis of the bilateral sacroiliac joints. There is\ncalcification of the abdominal vasculature. There is coronary artery\natherosclerosis. There is mild bilateral perirenal stranding. There is\nchololithiasis.\n\nThere is peribronchial spiculated opacities at the bilateral lung bases in\naddition to scattered small pulmonary nodules measuring up to 1.2 x 0.9 cm on\nthe right (02:11) and 1.6 cm on the left (2:8). This is new in comparison to\nprior study. There is a medial diverticulum at the second duodenal segment\n(03:43).", "output": "1. Multilevel degenerate changes of the lumbar spine, as described, causing up\nto mild spinal canal narrowing and mild bilateral neural foraminal stenosis,\nmost advanced at L4-L5. Please note that MRI or myelography provides greater\nsensitivity in evaluation of spinal canal stenosis.\n2. Diffuse osteopenia with prominent trabecula and lucency at the anterior\naspects of the T12 and L1 vertebral bodies, which are new in comparison to ___. Findings likely represent sequela of advanced osteopenia. There\nis clinical suspicion for neoplasm, consider bone scan for further\ncharacterization.\n3. Spiculated peribronchial opacities at the bilateral lung bases in addition\nto scattered smaller lung nodules which are new in comparison to ___ and may represent an infectious, inflammatory, or neoplastic process. \nRecommend clinical correlation and completion or follow chest CT to further\ncharacterize these findings.\n4. Coronary artery atherosclerosis.\n5. Cholelithiasis.\n\nRECOMMENDATION(S): Recommend completion noncontrast chest CT to further\ncharacterize the aforementioned lung findings. If patient is experiencing\nactive infectious symptoms, then a more delayed follow-up noncontrast CT of\nthe chest can be performed to document resolution.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:51 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. No fractures are identified.There is moderate to severe\ndegenerative change throughout the cervical spine with loss of intervertebral\ndisc height, uncovertebral hypertrophy, and facet arthropathy, most severe at\nC6-7.There is no prevertebral soft tissue swelling.Visualized upper lungs are\nwithout abnormality. Visualized thyroid gland is unremarkable.", "output": "No evidence of fracture or subluxation.\nDegenerative disease with spinal canal and neural foraminal narrowing at\nmultiple levels." }, { "input": "3 mm anterolisthesis of C4 on C5 and 4 mm anterolisthesis of C7 on T1.No\nfractures identified.Mild to moderate multilevel degenerative changes include\nosteophytosis, intervertebral disc height loss, and posterior disc bulges\nand/or protrusions. There is mild multilevel spinal canal narrowing. No\nlevel of severe osseous neural foraminal narrowing.There is no prevertebral\nsoft tissue swelling.Paranasal sinus disease is better assessed on the\nconcurrent noncontrast head CT.", "output": "1. No evidence of acute cervical spine fracture.\n2. Mild anterolisthesis of C4 on C5 and C7 on T1 could be chronic in the\nsetting of overall mild to moderate multilevel cervical spine osteoarthritis." }, { "input": "Alignment is normal. No fractures are identified.Anterior posterior osteophyte\nformation and loss of disc heights are seen at C4-5 and C5-6 without\nsignificant interval changes compared to ___. There is no evidence\nof spinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "1. No fracture or acute traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine most severe at C4-5\nand C5-6." }, { "input": "Alignment is unchanged. No acute fractures are identified.Stable severe\nmultilevel degenerative changes are redemonstrated, including mild\nanterolisthesis of C2 on C3. There is unchanged moderate to severe spinal\ncanal stenosis most notable at at C5-C6 and C6-C7 and unchanged moderate to\nsevere neural foraminal stenosis most notable at C3-C4 and C4-C5. There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment. Extensive degenerative changes." }, { "input": "Minimal anterolisthesis of C2 on C3 as before. No interval change in\nalignment since prior. No fractures are identified degenerative changes are\nnotable for intervertebral disc height loss, posterior osteophytes and\nuncovertebral joint hypertrophy which span C3-4 through C6-7. Moderate canal\nnarrowing is noted at these levels. Most significant foraminal narrowing seen\nat C3-4 on the right and is severe. Moderate severe bilateral foraminal\nnarrowing noted at C4-5 and C5-6 and on the left at C3-4. There is no\nprevertebral edema.\n\nThyroid is not visualized. Lung apices are unremarkable.", "output": "Degenerative changes in the cervical spine without fracture or acute\nmalalignment." }, { "input": "There is minimal anterolisthesis of C2 on C3, unchanged since ___. No acute fractures are identified. There is no prevertebral soft\ntissue swelling. Severe multilevel multifactorial degenerative changes\nconsisting of intervertebral disc space narrowing, endplate sclerosis,\nanterior osteophyte formation, posterior intervertebral osteophyte formation,\ndiffuse arthropathy are most conspicuous from C2 through C7. There is\nmoderate to severe neural foraminal narrowing and spinal canal narrowing at\nmultiple levels in the mid cervical spine. There is mucosal thickening of the\nright maxillary sinus, partially imaged.\n\nThe right lung apices are partially imaged with atelectasis or scarring,\nstable since ___. The thyroid gland is markedly atrophic.", "output": "1. No fracture or traumatic malalignment.\n2. Multilevel multifactorial degenerative changes most conspicuous from C2\nthrough C7." }, { "input": "The bones are diffusely demineralized. Minimal anterolisthesis of C2 on C3,\nlikely degenerative. Otherwise, the alignment is normal. No acute cervical\nspine fractures are identified. Severe, multilevel degenerative changes,\nincluding osteophyte formation, endplate sclerosis, and intervertebral disc\nheight narrowing, are most pronounced at C3-C7. Moderate to severe vertebral\ncanal narrowing is most pronounced at C5-C6 and C6-C7. Moderate to severe\nneural foraminal narrowing is most prominent at C3-C4 and C4-C5. There is no\nprevertebral edema.\n\nMild, biapical pleuroparenchymal scarring. The thyroid gland is atrophic.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Severe, multilevel degenerative changes of the cervical spine, most\npronounced within the mid to lower cervical spine." }, { "input": "There is minimal anterolisthesis of C2 on C3, which is unchanged compared to\nprior. Alignment is otherwise normal.. No fractures are identified.There is\nsevere multilevel degenerative changes including osteophytosis, endplate\nsclerosis, and loss of intervertebral disc space height, which is most\npronounced at C3-C7. There is unchanged moderate to severe spinal canal\nstenosis at C5-C6 and C6-C7. There is moderate to severe neural foraminal\nstenosis, most pronounced at C3-C4 and C4-C5.There is no prevertebral edema.\n\nMild biapical scarring of the partially imaged lung apices is noted. The\nthyroid gland is atrophic.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Stable severe multilevel degenerative change of the cervical spine." }, { "input": "Vertebral alignment is normal.\n\nVertebral body heights are preserved without evidence of acute fracture.\n\nThere are mild multilevel degenerative changes, which are most pronounced at\nC6-7, where there is mild bilateral neural foraminal narrowing.\n\nThere is no prevertebral soft tissue swelling. The thyroid gland is mildly\nenlarged without evidence of a focal lesion.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nedema.There are multilevel degenerative changes.\nAt C2-3, there is a midline disc protrusion that does not contact the spinal\ncord. Uncovertebral and facet osteophytes produce severe right neural\nforaminal narrowing.\nAt C3-4, there is a midline disc protrusion that indents the anterior surface\nof the spinal cord. Uncovertebral and facet osteophytes produce moderate\nbilateral neural foraminal narrowing.\nAt C4-5, there is a broad-based disc protrusion, partially calcified, that\nindents the anterior surface of the spinal cord. Uncovertebral and facet\nosteophytes produce moderate bilateral neural foraminal narrowing.\nAt C5-6, intervertebral osteophytes minimally encroach on the spinal canal\nwithout contacting the spinal cord. Uncovertebral and facet osteophytes\nproduce moderate bilateral neural foraminal narrowing.\nAt C6-7, there is no spinal canal narrowing. Uncovertebral and facet\nosteophytes produce moderate to severe bilateral neural foraminal narrowing.\nAt C7-T1 and the included portions of the upper thoracic spine there is no\nspinal canal or neural foraminal narrowing.\nLimited imaging of the thyroid gland demonstrates in homogeneity without a\nwell-defined nodule.\nThe thyroid and included lung apices are unremarkable.", "output": "1. No evidence of fracture or subluxation.\n2. Multilevel cervical degenerative disc disease." }, { "input": "There is mild (2 mm) anterolisthesis of C4 on C5 and mild (3 mm)\nretrolistheses of C6 on C7.No acute fractures are identified.Moderate\nmultilevel degenerative changes with intervertebral disc space narrowing,\nendplate sclerosis and cysts, and anterior and posterior osteophyte formation\nare most pronounced at C5-6, C6-7, and C7-T1. There is asymmetric widening\nanteriorly of the disc space at C6-7. Vertebral body heights are preserved. \nDisc bulging and posterior osteophytes result in mild central canal stenosis,\nworse C6-7. Uncovertebral and facet osteophytes cause moderate to severe\nnarrowing of multiple bilateral neural foramina, most pronounced at C6-7.Mild\nprevertebral soft tissue edema is seen extending from C2-C3 through C5-C6\nlevels.\n\nThere is no evidence of infection or neoplasm. The thyroid and bilateral lung\napices are unremarkable. Visualized aspect of the proximal esophagus is\npatulous.", "output": "1. Multilevel mild subluxation is of indeterminate chronicity, though given\nthe presence of prevertebral soft tissue edema extending from C2-C3 through\nC5-C6, ligamentous injury may be present. MRI of the cervical spine is\nrecommended to assess for ligamentous injury.\n2. No evidence of acute fracture.\n3. Moderate cervical spondylosis, most severe at C6-7.\n\nRECOMMENDATION(S): MRI cervical spine without contrast." }, { "input": "There is grade 1 retrolisthesis of L2 on L3, L3 on L4 and grade 1\nanterolisthesis of L4 on L5 and L5 on S1.No fractures are identified.There are\nsevere multilevel degenerative changes of the lumbar spine including anterior\nand posterior osteophytes, severe loss of disc heights with vacuum disc\nphenomena, endplate sclerosis and subchondral cysts. There is multilevel\nmild-to-moderate moderate spinal canal stenosis due to retrolisthesis,\nposterior osteophyte formation, and ligamentum flavum hypertrophy, most\npronounced at L4-5 and L5-S1. There is moderate to severe bilateral neural\nforaminal stenosis at L3-4 and L5-S1 due to facet hypertrophy.There is no\nprevertebral soft tissue swelling.\n\nThere is no evidence of infection or neoplasm. The partially imaged abdomen\nand pelvis again demonstrates multiple hypoattenuating lesions throughout the\nkidneys likely representing cysts. There is extensive atherosclerotic\ndisease. There are gallstones in the gallbladder without evidence of\ncholecystitis. The partially imaged pancreas, liver, bowel, and bladder are\nunremarkable.", "output": "1. No acute fracture.\n2. Severe lumbar spondylosis with multilevel subluxation.\n3. Multilevel mild to moderate spinal canal and moderate to severe neural\nforaminal narrowing, most severe at L4-5 and L5-S1.\n4. Cholelithiasis." }, { "input": "Kyphotic curvature of the cervical spine and scoliosis limits evaluation on\naxial images. Loss of bone mineralization further limits evaluation. No\ndisplaced fracture is identified. Status post ACDF at C6-C7 without evidence\nfor hardware related complications. No acute subluxation mild anterolisthesis\nat C4-C5 and C5-C6, as well as mild retrolisthesis at C6-C7, are unchanged\ncompared to the ___ radiographs. No evidence for prevertebral\nedema. Disc protrusions and endplate osteophytes indent the ventral thecal\nsac at multiple levels with up to moderate spinal canal narrowing. Multilevel\nneural foraminal narrowing by uncovertebral and facet osteophytes is\nsuboptimally assessed due to the kyphoscoliosis.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are seen on limited evaluation. There\nis moderate mucosal thickening in the visualized lower right maxillary sinus,\nand mild mucosal thickening in the visualized lower left maxillary sinus and\nin the partially visualized ethmoid air cells.\n\nRight maxillary third molar is undescended. Left maxillary third molar has\nbeen removed with a large lucency of the extraction bad. Multiple periapical\nlucencies and dental caries are noted in the maxilla and mandible. The\ncarotid and vertebral artery calcifications are noted. The thyroid is grossly\nunremarkable.\n\nThere are incompletely visualized airspace consolidations in the included\nbilateral upper lungs. Bilateral pulmonary opacities were also seen on the\nmost recent ___ chest radiographs, with the accompanying history\nstating that the patient had aspiration pneumonia. Visualized upper thoracic\nesophagus is patulous.", "output": "1. No evidence for displaced fracture. No acute subluxation.\n2. Status post ACDF at C6-C7 without evidence for hardware related\ncomplications.\n3. Multilevel degenerative disease with moderate spinal canal stenosis.\n4. Multiple periapical lucencies and dental caries in the maxilla and\nmandible.\n5. Incompletely visualized airspace consolidations within bilateral upper\nlungs, last assessed by chest radiography on ___, compatible with\npneumonia or aspiration." }, { "input": "Alignment is preserved. No acute fractures detected. Degenerative changes\nare notable for intervertebral disc height loss, uncovertebral joint\nhypertrophy most notably at C4-5 through C7-T1. These changes result in up to\nmild canal narrowing at C6-7 and moderate to severe right foraminal narrowing\nat C5-6. There is no prevertebral soft tissue swelling.\n\nThyroid is unremarkable. Right apical pneumothorax is partially visualized. \nThere is left mandibular molar periapical lucency with adjacent sclerosis\nsuggesting chronic inflammation.", "output": "1. No acute fracture or malalignment.\n2. Right apical pneumothorax, as seen on concurrent chest CT." }, { "input": "There is no evidence of acute cervical spine fracture. There is mild\nstraightening of the normal cervical lordosis, multilevel, multifactorial\ndegenerative changes are visualized throughout the cervical spine.\n\nFrom C2-C3 through C4-C5 levels, there is no evidence of neural foraminal\nnarrowing or spinal canal stenosis.\n\nAt C5-C6 level, there is bilateral uncovertebral hypertrophy and spondylosis\ncausing anterior thecal sac deformity and moderate to severe spinal canal\nnarrowing, if clinically warranted, correlation with MRI of the cervical spine\nis recommended.\n\nAt C6-C7 level, there is diffuse disc bulge and mild spondylosis causing\nmoderate spinal canal stenosis.\n\nAt C7-T1 level, both neural foramina are patent.\n\nThe right thyroid lobe appears asymmetrically enlarged and slightly\nheterogeneous, without discrete nodule. The included lung apices are\nunremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n\n2. Degenerative changes identified at C5-C6 level consistent with\nuncovertebral hypertrophy and spondylosis causing anterior thecal sac\ndeformity and moderate to severe spinal canal narrowing, correlation with MRI\nof the cervical spine is recommended.\n\n3. Degenerative changes are also visualized at C6-C7 level consistent with\ndiffuse disc bulge causing moderate spinal canal stenosis.\n\n4. Slightly asymmetrically enlarged heterogeneous right thyroid lobe, without\ndiscrete nodule. ___ be further evaluated with nonemergent ultrasound.\n\nRECOMMENDATION(S): Degenerative changes identified at C5-C6 level consistent\nwith uncovertebral hypertrophy, and spondylosis causing anterior thecal sac\ndeformity and moderate to severe spinal canal narrowing, correlation with MRI\nof the cervical spine is recommended." }, { "input": "The lumbar vertebral bodies are maintained in height and alignment. No\nsuspicious osseous lesion is identified. Intervertebral discs are grossly\npreserved in height besides mild disc height loss at L5-S1 with vacuum disc\nphenomenon. Although intrathecal contents are not as well evaluated based on\nnoncontrast CT as well as MRI the following observations are made:\n\nAt L1-L2, there is a posterior diffuse disk bulge. Posterior osteophyte\nformation is also seen resulting at least mild canal narrowing and mild left\nforaminal narrowing.\n\nAt L2-3, there is a diffuse disc bulge without significant canal or foraminal\nnarrowing.\n\nAt L3-4, there is a diffuse disc bulge and mild left foraminal narrowing\n\nAt L4-5, there is a diffuse disc bulge and thickening of the ligamentum flavum\nand prominent epidural fat resulting in at least mild canal mild to moderate\nright greater than left foraminal narrowing.\n\nAt L5-S1, there is a posterior disk bulge with endplate osteophyte resulting\nat least mild canal narrowing and moderate bilateral foraminal narrowing.\n\nIncluded retroperitoneal structures are notable for a left adrenal 9 x 8 mm\nmyelolipoma. Atherosclerotic calcifications seen in normal caliber abdominal\naorta. There is a 2 cm hypodensity in the left kidney, likely a cyst.", "output": "Multilevel degenerative changes including disk bulge with endplate osteophytes\nat L1-L2 causing at least mild canal narrowing. Moderate canal and bilateral\nneural foraminal narrowing at L4-5 due to disk bulge and prominent epidural\nfat and ligamentum flavum thickening. Moderate foraminal narrowing at L5-S1\ndue to disc bulge and endplate osteophytes." }, { "input": "There may be minimal anterolisthesis of C4 on C5, unchanged. No new alignment\nabnormality.No acute fracture is identified. Mild to moderate degenerative\nchanges are most pronounced at C5-6 and C6-7 with intervertebral disc space\nnarrowing, endplate irregularity, and anterior and posterior osteophyte\nformation. Posterior osteophytes mildly narrow the spinal canal at C5-C6 and\nC6-C7. There is mild bilateral neural foraminal, worst at C5-C6, and more\npronounced on the left.There is no prevertebral soft tissue swelling.\n\nVisualized lung apices are unremarkable. Visualized thyroid gland is\nunremarkable.", "output": "1. No acute fracture identified. No change in alignment.\n2. Mild to moderate cervical spondylosis most pronounced at C5-6 and C6-7." }, { "input": "Anterolisthesis of C4 on C5 is unchanged, likely degenerative. The rest of\nthe cervical spine vertebral demonstrates anatomic alignment.No acute\nfractures are identified. There are multilevel degenerative changes of the\ncervical spine including intervertebral disc space narrowing and osteophytosis\nmost pronounced at C5-C6 without significant canal narrowing. Uncovertebral\njoint osteophytes result in moderate left foraminal narrowing at C5-6. There\nis no prevertebral soft tissue swelling.\n\nThyroid atrophic. Lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes most pronounced at C5-C6." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThere is a small hiatal hernia. Atherosclerotic calcifications seen along the\nthoracic aorta and coronary arteries. Enlarged aortocaval lymph node is\npartially visualized and measures 1.4 cm.", "output": "No thoracic spine fracture or malalignment.\nPartially visualized enlarged intra-abdominal lymph node measuring 1.4 cm. \nConsider nonurgent abdominal CT scan for further characterization." }, { "input": "Exaggeration of cervical lordosis. Alignment is otherwise preserved.No acute\nfractures. No prevertebral edema.\n\nMultilevel degenerative changes, multilevel probably mild central canal\nnarrowing and mild-to-moderate foraminal narrowing.\n\nMultiple nodules within thyroid gland, with the largest hypodense nodule in\nthe right lobe measuring 2.3 cm (03:57). Mild lung pleuroparenchymal\nscarring.", "output": "1. No fracture.\n2. Moderate multilevel degenerative change.\n3. Thyroid nodules, largest 2.3 cm, recommendations below.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Anterior fusion hardware and interbody fusion again seen spanning C3 through\nC5 without evidence of hardware complication. Anterior metallic screws appear\nintact without significant perihilar lucency partially imaged posterior\nsurgical hardware in T1 and T2 including posterior spinal rods in pedicular\nscrews, grossly unremarkable.\n\nOblique linear lucency through the inferior, posterior aspect of the C2\nvertebral body, to the left of midline is new since CT from ___, but\nhas sclerotic margins and is felt not to be acute. Best seen on sagittal\nimages.\n\nOtherwise, no acute fracture is seen. Anatomic alignment is maintained. \nFacet joints and uncovertebral joints are intact. Prominent anterior\nosteophytes are seen and C5 and C6. No prevertebral soft tissue swelling is\nseen. The partially imaged lung apices demonstrate left pleural thickening\nand/or pleural thickening.\n\nThe mastoid air cells and middle ear cavities are clear. The partially imaged\nperinasal sinuses are clear.", "output": "1. Anterior fusion hardware from C3 through C5, in anatomic alignment without\nevidence of hardware complication.\n2. Oblique linear lucency through the inferior, posterior left C2 vertebral\nbody, new since ___, but has suggestion of sclerotic margins\nsuggesting that it is not acute and more likely subacute to old. Compare with\nany more recent prior cross-sectional imaging, if none, correlate clinically\nfor acuity.\n3. Partially imaged left pleural effusion and/or pleural thickening.\n\nNOTIFICATION: Radiology critical findings dashboard on ___ at\n23:30." }, { "input": "The patient is status post remote T1 through T8 posterior fusion with\nbilateral pedicle screws at T1, T2, bilateral laminar hooks at T7 and a left\nlaminar hook at T8. No evidence of hardware fracture on CT examination. No\nperihardware lucency. The position of the posterior fusion rods appear\nsimilar to examination of ___. ACDF of C3 through C5 is partially\nimaged, better evaluated on concurrent CT cervical spine.\n\nChronic healed fracture deformity of T3 and T4 with postfusion ankylosis is\nessentially unchanged in configuration from examination of ___. No acute\nvertebral fractures are identified. Lucencies described on prior examination\nin the bilateral T5 pedicles are healed and no longer seen.\n\nThere is no evidence for acute fracture. Thoracic alignment is unchanged and\ngrossly anatomic. Vacuum disc phenomenon at T6-T7 and T7-T8 is slightly more\nprominent when compared to prior examination. Otherwise, disc heights are\npreserved.\n\nEvaluation of the spinal canal is suboptimal secondary to metallic artifact. \nUnchanged 3 mm retropulsion of T4 vertebral body fracture fragments. There is\nno high-grade spinal canal or neural foraminal narrowing.\n\nThere are scattered small pulmonary nodules:\n1 mm nodules in the left lingula (series 2, image 38, 39)\n1 mm subpleural left lower lobe nodule at the lung base (series 2, image 90)\n2 mm left upper lobe pulmonary nodule (series 2, image 41).\nAllowing for respiratory motion and residual left pleural thickening and\nadjacent mild atelectasis, the remainder lungs are clear.\n\nAtherosclerotic calcification of the abdominal aorta and the major vessels are\nidentified. Otherwise, the visualized prevertebral and paraspinal soft\ntissues are unremarkable.\n\nIVC filter is partially visualized.", "output": "1. No acute traumatic fracture or malalignment.\n2. The patient is status post T1 through T8 posterior fusion without evidence\nof hardware fracture or perihardware lucency on CT. Please note, if there is\nhigh clinical concern for hardware fracture, thoracic spine radiograph would\nbe more sensitive.\n3. Although evaluation is suboptimal secondary to metallic artifact, no\nevidence of high-grade spinal canal or neural foraminal narrowing is noted.\n4. Scattered small left upper and lower lobe pulmonary nodules measuring up to\n2 mm. These cannot be correlated with prior chest imaging secondary to\nprominent atelectasis and pleural effusions on prior examinations. If the\npatient has high risk factors, 12 month chest CT follow-up is recommended by\n___ society guidelines. If there are no risk factors, no further\nfollowup is recommended." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence for\nprevertebral edema. There are mild multilevel degenerative changes without\nsignificant spinal canal narrowing.Uncovertebral osteophytes result in left\nC4-5 and bilateral C5-6 neural foraminal narrowing. The included lung apices\nare clear allowing for mild respiratory motion artifact. A nasopharyngeal\nairway is in place.", "output": "No fracture or subluxation." }, { "input": "Dental amalgam streak artifact limits study. Patient body habitus limits\nevaluation of C7 and inferior vertebral body levels.\n\nGrossly stable reversal of cervical lordosis is again seen. Vertebral body\nheights are preserved. The visualized osseous structures are osteopenic.\nThere is no prevertebral edema. Within limits of study, there is no definite\nevidence of acute cervical spine fracture.\n\nGrossly stable multilevel degenerative changes of the cervical spine are\nnoted, including loss of intervertebral disc height, endplate sclerosis,\nSchmorl's nodes, facet joint hypertrophy, and disc osteophytes with no\ndefinite evidence of bony vertebral canal narrowing.\n\nVisualized portion lung apices are grossly clear. Streak artifact limits\nevaluation of the thyroid gland. Scattered subcentimeter nonspecific lymph\nnodes are noted throughout the neck bilaterally, without definite enlargement\nby CT size criteria. Limited imaging the parotid glands demonstrate right\nparotid subcentimeter nonspecific probable lymph nodes.", "output": "1. Patient body habitus and dental amalgam streak artifact limits study.\n2. Within limits of study, no evidence of acute cervical spine fracture.\n3. Grossly stable multilevel cervical degenerative changes compared to ___\nprior exam as described.\n4. Scattered subcentimeter nonspecific cervical lymph nodes as described." }, { "input": "Alignment is anatomic. No acute fracture or traumatic malalignment. Mild\nmultilevel degenerative changes with joint space narrowing and osteophyte\nformation, most prominent at C4-C5 and C5-C6 result in mild central canal\nnarrowing at C4-C5. Additionally, there is very mild left-sided neural\nforaminal stenosis at C4-C5 and bilaterally at C5-C6.There is no prevertebral\nedema.\n\nThe thyroid gland is slightly heterogeneous without discrete nodule. Included\nlung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is diffuse loss of disc space height, most prominent at L2-3\nand L5-S1. The L5-S1 disc space loss is most prominent posteriorly with mild\nanterior widening at this level. Alignment is otherwise near anatomic. \nAssociated endplate degenerative irregularity is seen particularly involving\nthe anterior aspect of the L3 vertebral body. \n\nFrom T12-L1 to L1-L2, there is no significant narrowing.\n\nAt L2-L3, diffuse disc bulge and moderate facet arthropathy mildly effaces the\nthecal sac. The disc bulge minimally encroaches upon the caudal aspect of the\nneural foramina but there is no definite evidence of nerve root impingement.\n\nAt L3-L4, there are similar but slightly more severe findings with disc bulge\nand moderate bilateral facet arthropathy mildly effacing the thecal sac, both\nanteriorly and posterolaterally. In addition, disc and osteophytes mildly\nnarrow the left neural foramen.\n\nAt L4-L5, disc bulge and moderate facet arthropathy moderately narrow the\nspinal canal with effacement of the anterior and posterolateral aspects of the\nthecal sac. Disc and osteophyte mildly narrow the foramina bilaterally as\nwell.\n\nAt L5-S1, small disc bulge and mild facet arthropathy do not cause significant\nspinal canal narrowing. There is, however, mild left foraminal narrowing.\n\nThe partially visualized retroperitoneal and structures of the abdomen and\npelvis are significant for a densely calcified abdominal aorta and proximal\nbranches.", "output": "Multilevel degenerative disc and facet disease, most prominent at\nL4-L5 where there is moderate spinal canal narrowing." }, { "input": "Alignment is anatomic.No acute fractures are identified. Moderate multilevel\ndegenerative change is noted, including multilevel disc space narrowing, facet\nhypertrophy, endplate sclerosis, and anterior osteophytosis. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.The thyroid is normal. Partially visualized\nlung apices are notable for biapical scarring.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Moderate multilevel degenerative change, as described above." }, { "input": "Redemonstrated is an anterior wedge compression deformity of the T12 vertebral\nbody. No other fractures identified. The alignment is otherwise normal. An\nossific density posterior to the spinous process of the T11 vertebral body is\nwell corticated, unlikely due to an acute injury (602:39). There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "Anterior wedge compression deformity of the T12 vertebral body has a sclerotic\nmargin and is likely chronic in nature. No other fractures identified. No\nevidence of spinal canal narrowing." }, { "input": "Redemonstrated is an anterior wedge compression deformity of the T12 vertebral\nbody. No other fractures identified. An well corticated ossific density is\nagain seen posterior to the spinous process of T11 (602:37), unlikely due to\nan acute process. The alignment of the lumbar spine is normal. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "Redemonstrated anterior wedge compression deformity of the T12 vertebral body,\nof undetermined age. Given the sclerosis at the margin and appears chronic. \nNo fractures identified within the lumbar spine. Normal lumbar spine\nalignment." }, { "input": "Alignment is anatomic.No fractures are identified. Mild degenerative changes\nof the cervical spine. There is no evidence of significant spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling. \nMultiple hypodense thyroid nodules, 1 of the largest measuring 1 cm. These do\nnot require further imaging follow-up. Please see separate chest CT for\nthoracic findings.", "output": "No acute traumatic subluxation or fractures.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges notable for intervertebral disc height loss, posterior osteophytes and\nuncovertebral joint hypertrophy most notably at C4-5 and C5-6 resulting in\nmild canal narrowing moderate left foraminal narrowing at C4-5 and moderate\nright foraminal narrowing at C5-6. There is no evidence of severe spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.\n\n The visualized lung apices and thyroid are unremarkable.", "output": "No cervical spine fracture or subluxation." }, { "input": "Again seen is a mixed lytic and sclerotic expansile lesion involving the T12\nvertebral body and its posterior elements. There is Associated soft tissue\nmass with thecal sac compression better evaluated on previous MRI. . No other\nsuspicious lesion is identified. Visualized portions the lung fields are\nunremarkable. Calcifications of the thoracic and abdominal aorta are mild.\nCoronary artery calcifications are also noted. The remainder of the visualized\nportions of the upper abdomen are unremarkable.", "output": "T12 vertebral body lytic and sclerotic lesion, consistent with metastasis." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Thyroid gland is unremarkable. There is minimal bibasilar\ndependent atelectasis. Otherwise the lung fields are clear. Visualized\nportions of the upper abdomen are unremarkable.", "output": "No fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes in the\ncervical spine are mild. A posterior disc protrusion at C4-C5 causes mild to\nmoderate spinal canal narrowing (3:35, 602b:27). No significant neural\nforaminal stenosis is identified. There is no prevertebral soft tissue\nswelling. Incidental note is again made of low lying cerebellar tonsils,\napproximately 7 to 8 mm below the foramen magnum (602b:30).\n\nImaged thyroid and lung apices are unremarkable.", "output": "1. No cervical spinal fracture or traumatic malalignment.\n\n2. Disc protrusion at C4-C5 causes mild to moderate spinal canal narrowing,\nwithout significant neural foraminal narrowing.\n\n3. Low lying cerebellar tonsils, 7 - 8 mm below the foramen magnum,\ncompatible with provided history of known Chiari malformation." }, { "input": "There is no evidence of cervical spine fracture. There is no prevertebral\nsoft tissue swelling. There are severe multilevel degenerative changes with\nnear complete loss of disc space between the C4 through C6 levels. In\naddition, there is mild anterolisthesis of C7/T1. There is a erosion of the\nposterior dens with mild basilar invagination.\n\nThe thyroid is unremarkable. Views of the lung apices demonstrates\ncentrilobular emphysema. There is no pathologically enlarged cervical\nadenopathy. Pacemaker is in place.", "output": "1. No evidence of cervical spine fracture.\n2. Mild basilar invagination of the dens with posterior erosion, of uncertain\nsignificance although findings can be seen in the setting of rheumatoid\narthritis, osteoarthritis and degenerative changes, correlate clinically." }, { "input": "Patient is status post C4-5 fusion with interbody fusion cage. Streak\nartifacts from the surgical hardware limits diagnostic evaluation. Alignment\nis anatomic.No acute fractures are identified.There are anterior posterior\nbridging osteophyte formation throughout the cervical spine. The vertebral\nbody heights are preserved. Severe spinal canal stenosis is again seen at\nC4-5 as on MR cervical spine performed 4 hours prior. There is mild spinal\ncanal stenosis at C3-4 and C6-7. Uncovertebral and facet osteophytes cause\nmoderate to severe left neural foraminal stenosis at C5-6.There is no\nprevertebral soft tissue swelling.There is no cervical lymphadenopathy by size\ncriteria. The thyroid and bilateral lung apices are unremarkable.", "output": "1. Status post C4-5 fusion with interbody fusion cage. Streak artifact from\nsurgical hardware limits diagnostic evaluation. Given the limitation, no\nacute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine with severe spinal\ncanal stenosis at C4-5 as on MR cervical spine performed 4 hours prior. There\nis moderate to severe left neural foraminal narrowing at C5-C6.\n3. Additional findings described above." }, { "input": "Thoracic spine is kyphotic, centered at T7 through T9. No dislocation is\nseen. There is diffuse osteopenia as well as mild multilevel degenerative\nchanges centered at T7 and T8 with endplate sclerosis and anterior osteophyte\nformation.\n\nThere is a moderate superior endplate compression fracture of T3 vertebral\nbody without retropulsion. Severe anterior wedge compression fracture of T7\nwith increased sclerosis and 4 mm of retropulsion causing mild canal narrowing\nas well as mild bilateral neural foraminal narrowing. No prevertebral\nhematoma. Severe anterior compression fracture of T9 with 2 mm of\nretropulsion without significant canal narrowing and no prevertebral hematoma.\nNo additional fractures.\n\nNo evidence of infection or neoplasm.\n\nLimited assessment of lung apices are notable for bibasilar atelectasis and\nbiapical pleural parenchymal scarring. Moderate atherosclerotic\ncalcifications are present.", "output": "1. Severe anterior compression fracture of T7 with 4 mm of retropulsion\ncausing mild canal narrowing and mild bilateral neural foraminal narrowing is\nlikely subacute to chronic given increased sclerosis. .\n2. Severe anterior compression fracture of T9 with 2 mm retropulsion without\nsignificant canal narrowing is of indeterminate age but unlikely acute.\n3. Mild to moderate loss of height of the T3 vertebral body is felt unlikely\nto be acute.\n4. Kyphotic thoracic spine without frank dislocation.\n5. Bibasilar atelectasis." }, { "input": "Alignment is normal. No fractures are identified.No evidence of severe spinal\ncanal or neural foraminal stenosis.There is no prevertebral edema.\n\nThe thyroid is heterogeneous and difficult to assess for nodularity. The\nincluded lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Heterogeneous thyroid which is difficult to assess for nodularity. \nUltrasound imaging may be considered for further evaluation if warranted." }, { "input": "Alignment is normal. No acute fractures are identified. Partially imaged\nthere is a expansile, lytic and destructive lesion of the right eleventh rib\nwhich was recently seen on PET-CT from ___ which demonstrated FDG\navidity. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection within limitations of this noncontrast study.\n\nThere is a moderate size hiatal hernia. A heterogeneous thyroid is reported\non same date C-spine CT.", "output": "1. No acute fracture or traumatic malalignment.\n2. Partially imaged known right eleventh rib metastatic lesion.\n3. Moderate sized hiatal hernia." }, { "input": "Thoracic spine:\n\nThere is a mixed sclerotic and lytic lesion involving the left side of the T9\nvertebral body, left pedicle and neural arch with left paraspinal mass\ninvolving the adjacent rib. The overall size of the mass is approximately 6 x\n3 cm. There is extension into left T9-T10 neural foramen. Mild left-sided\nepidural soft tissue changes also extend anterior and posterior to the thecal\nsac without high-grade thecal sac compression within the limits of the CT\nresolution. There is mild pathologic compression deformity of the vertebral\nbody seen without retropulsion.\n\nThe remaining thoracic vertebral bodies demonstrate osteopenia but no obvious\nlarge area of of lytic abnormalities seen or sclerotic abnormalities\nidentified. The left lower lobe mass extends to the chest wall. There is\nexpansile lesion within the right twelfth rib. The other ribs are not fully\nevaluated.\n\nLumbar spine:\n\nThere is a lytic and sclerotic lesion involving the L1 vertebra predominantly\non the right side. There is no involvement of the pedicles or neural arch. \nMild paraspinal soft tissue changes are seen. No obvious epidural disease\nseen within the resolution of CT. There is possibly a right iliac bone lesion\nwhich is not fully evaluated are.", "output": "1. T9 metastatic lesion with adjacent paraspinal soft tissue mass and\ninvolvement of the left-side of the body and neural arch and pedicle with mild\nepidural soft tissue changes without high-grade thecal sac compression within\nthe resolution of CT. However, MRI can help for further assessment.\n2. L1 metastatic lesion with mild right paraspinal soft tissue mass without\nepidural extension within the CT limits.\n3. Other bony lesions as described.\n4. Left lower lobe mass extending to the chest wall." }, { "input": "There is extreme cervical lordosis. There is a left C7 facet fracture (400b,\n27). Mild multilevel degenerative changes are seen. No significant narrowing\nof the central canal is seen. The lung apices are clear. There is no\nprevertebral soft tissue swelling. There are secretions in the nasopharynx\npresumed due to intubation.", "output": "Left C7 facet fracture.\n\nNOTIFICATION: Updates to the wet read were discussed by Dr. ___ with Dr.\n___ on the telephone on ___ at 10:34 ___," }, { "input": "Alignment is normal. No acute fracture is identified. Progressive sclerosis\nis noted of the C7 facet fracture noted on prior exam. The prevertebral soft\ntissues are unremarkable. Multilevel degenerative changes are noted, with\nosteophytosis and mild multilevel disc space narrowing.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture." }, { "input": "Alignment is normal.No fractures are identified.Multilevel degenerative\nchanges worse at C3-4 where posterior disc bulge causes mild canal narrowing\nand uncovertebral and facet joint hypertrophy causes moderate bilateral neural\nforaminal narrowing.There is no prevertebral soft tissue swelling\n\nThe thyroid and lung apices are unremarkable.", "output": "1. No acute fracture or traumatic subluxation.\n2. Multilevel degenerative changes as above." }, { "input": "Alignment is normal. No acute fractures are identified.There is no\nprevertebral soft tissue swelling.Multilevel degenerative changes with disc\nosteophyte complexes, endplate hypertrophic changes, posterior element\nhypertrophic changes. Disc osteophyte complex at C3-C4 level and diffuse disc\nbulge cause probably moderate central canal narrowing, stable since prior. \nThere is multilevel moderate to severe foraminal narrowing, most prominent at\nC3-C4 level, stable. There is mild vertebral body height loss at T2, T3,\nstable since MRI ___", "output": "No acute changes.\nDegenerative changes cervical spine, worst at C3-C4 level." }, { "input": "Alignment is normal. No acute fractures are identified.Mild T2 vertebral body\nheight loss is chronic. Degenerative changes are most notable C3-4 where\nthere is a disc bulge, posterior osteophytes, uncovertebral joint and facet\njoint hypertrophic changes. There is secondary at least moderate canal\nnarrowing and severe left and moderate to severe right foraminal narrowing,\nsimilar to prior.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Degenerative changes without least moderate canal, severe left foraminal and\nmoderate to severe right foraminal narrowing at C3-4.\nNo fracture or malalignment." }, { "input": "Alignment is normal. No acute fractures. L1 vertebral body height loss is\nunchanged compared to ___. No focal suspicious osseous lesions. \nDegenerative changes include anterior osteophytes and posterior disc bulges. \nNo critical canal foraminal narrowing. Mild-to-moderate foraminal narrowing\nis noted at L4-5 on the right and L3-4 on the left.\n\nIncluded paraspinal soft tissues are unremarkable. Atherosclerotic\ncalcifications noted in the aorta. No right common iliac artery measures 1.5\ncm, the left common iliac artery measures 2.0 cm.", "output": "1. No acute fracture or malalignment.\n2. Aneurysmal left common iliac artery measuring 2.0 cm in diameter." }, { "input": "There is no acute fracture or malalignment in the cervical spine. Mild\nmultilevel degenerative changes are seen throughout the cervical spine with\nannular disc calcification, osteophyte formation, and intervertebral disc\nspace narrowing. Mild multilevel central canal narrowing due to prominent\ndisc bulges appear most pronounced at C2-3, C3-4 and C4-5. No prevertebral\nedema. The aerodigestive tract appears patent.\n\nVisualized lung apices are clear. Thyroid gland appears normal.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Mild multilevel degenerative changes of the cervical spine with mild\ncentral canal narrowing due to disc bulges, most pronounced at C2-3, C3-4 and\nC4-5." }, { "input": "For the purposes of numbering, the lowest rib was designated T12. This\nimplies that there is a lumbarized first sacral segment Intervertebral disc\nspace was designated the\n\nThere is mild anterolisthesis of L5 on S1. Alignment is otherwise normal\nThere is no evidence of fracture. The prevertebral and paraspinal soft tissues\nare unremarkable. Multilevel degenerative changes are seen throughout the\nthoracolumbar spine with subchondral sclerosis and disc space narrowing most\nprominent at T11-T12.\n\nT10-11: Possible small left left-sided disc protrusion (4:7) with mild left\nneural foraminal narrowing. No spinal canal narrowing.\n\nT11-T12: Mild degenerative disc disease with loss of height of the disc and\nendplate sclerosis. No encroachment on the thecal sac or neural foramina.\n\nT12-L4: Mild degenerative disc disease with loss of height of the disc and\nendplate sclerosis. No encroachment on the thecal sac or neural foramina.\n\n\nL4-L5: Mild thickening of the ligamentum flavum with small disc bulge is seen\ncausing mild canal narrowing. No neural foraminal narrowing.\n\nL5-S1: Disc bulge in combination with spondylolisthesis and thickening of the\nligamentum flavum produces mild spinal canal narrowing. The disc bulges into\nthe neural foramina bilaterally, greater on the left than right. In these\nlocations, it appears to contact and compresses the exiting left L5 nerve root\nand contact the right L5 nerve root without compression. There is severe\nnarrowing of the left lateral recess with compression of the traversing left\nS1 nerve root by a a superior facet osteophyte.\n\nMild degenerative disease of bilateral sacroiliac joints with subchondral\nsclerosis an ex vacuo phenomenon. Limited assessment of the intra-abdominal\nstructures demonstrates a 2 mm nonobstructing stone within the left collecting\nsystem. There are several high intensity lesions in the left kidney,\nincompletely evaluated on this study. If further characterization is\nindicated, an ultrasound may be helpful.", "output": "1. Mild anterolisthesis of L5 on S1.\n2. No evidence of fracture.\n3. Degenerative disc disease at multiple levels with nerve root compression\nat L5-S1.\n4. Partially lumbarized first sacral segment.\n5. Nonobstructing 2 mm stone within left collecting system." }, { "input": "No acute fracture or dislocation is seen. Mild to moderate degenerative\nchanges seen in the mid to lower cervical spine including disc space narrowing\nC5 through C7 where there are also small anterior posterior osteophytes. \nFacet arthropathy is seen at least at C4 and C5 bilaterally. There is no\nevidence of critical central canal stenosis. There is no prevertebral soft\ntissue swelling.On series 3, image 61, there is a 0.9 x 0.7 cm soft tissue\nnodule adjacent to the right posterior aspect of the trachea, which could\nrelate to thyroid or parathyroid tissue, not fully assessed on this study. \nCorrelate with thyroid and parathyroid function tests and ultrasound or\nnuclear medicine scan.", "output": "1. No acute fracture or dislocation of the cervical spine.\n2. 0.9 x 0.7 cm rounded soft tissue nodule adjacent to the right posterior\naspect of the trachea, inferior to the posterior inferior right lobe of the\nthyroid. Findings may relate to parathyroid or thyroid tissue. Correlate\nwith thyroid and parathyroid function tests as well as ultrasound or nuclear\nmedicine scan." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes most\nnotable at C5-6 which for intervertebral disc height loss and uncovertebral\njoint hypertrophy. No critical canal or foraminal narrowing.There is no\nprevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "No evidence of traumatic cervical malalignment or acute fracture.Multilevel\nmild to moderate degenerative changes of the cervical spine including facet\narthropathy, osteophytosis, and disc space narrowing is noted. No critical\nneural foraminal or central spinal canal stenosis seen. There is no\nprevertebral soft tissue swelling.There is mild biapical lung scarring.", "output": "No traumatic cervical malalignment or acute fracture." }, { "input": "Alignment is normal. No fractures are identified.Mild degenerative changes\nare seen, with small posterior disc bulges and posterior longitudinal ligament\ncalcification. There is no significant spinal canal or neural foraminal\nnarrowing. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.\n\nThere is a mildly displaced fracture of the left posterior second rib.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Left second rib fracture." }, { "input": "Alignment is anatomic. No fractures are identified.There is no high-grade\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. Mild intervertebral disc\nspace narrowing and endplate irregularity is most pronounced at C5-6. There\nis no evidence of spinal canal narrowing. There is mild left neural foraminal\nstenosis at the C5-C6 level due to uncovertebral spurring. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. The imaged thyroid gland appears unremarkable. Visualized lung\napices are clear.", "output": "1. No evidence of fracture or malalignment.\n2. Mild left neural foraminal stenosis at C5-C6." }, { "input": "Alignment is normal. No fractures are identified. Small posterior osteophyte\nat C6/C7 is noted, associated with mild disc bulging, partially evaluated in\nthis exam. There is no evidence of spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm. The airway appears patent, the lung apices are\nclear, the thyroid gland is unremarkable.", "output": "No acute fracture or acute malalignment.\n\nMild degenerative changes identified at C6/C7 level.\n\nRECOMMENDATION(S): Degenerative changes noted at C6/C7 level, partially\nevaluated in this exam, correlation with MRI of the cervical spine is\nrecommended if clinically warranted." }, { "input": "Study is mildly degraded by motion.\n\nIs straightening of the cervical lordosis. There is no acute fracture or\nsubluxation. There is no abnormal prevertebral soft tissue swelling or edema.\nExtensive degenerative changes are most pronounced at the C6-C7 level with\ndisc space narrowing and endplate sclerosis. Prominent posterior osteophytes\nare additionally noted at the C5-C6, C6-C7, and C7-T1 levels which efface the\nanterior CSF space. Prominent anterior osteophytes are additionally noted. \nMultilevel uncovertebral arthropathy is significant.\n\nBiapical centrilobular emphysema is moderate to severe, symmetric. The\nthyroid gland is homogeneous. Extensive atherosclerotic calcifications\ninvolve the right carotid bifurcation. Additional note is made of\ncalcifications which involve the imaged portion of the right brachiocephalic\nartery.\nMinimal bilateral maxillary sinus mucosal thickening is noted.", "output": "1. Study is mildly degraded by motion.\n2. No acute cervical fracture or subluxation.\n3. Multilevel degenerative changes as described.\n4. Right carotid artery bifurcation calcifications.\n5. Biapical centrilobular moderate emphysema." }, { "input": "Mild anterolisthesis of C3 on C4 and minimal anterolisthesis of C4 on C5,\nlikely degenerative, is unchanged. No fractures are identified.Severe\nmultilevel degenerative changes are overall similar to the prior examination. \nThere is no high-grade spinal canal stenosis. There is moderate to severe\nbilateral neural foraminal narrowing at C4-5 and C5-6. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Partially imaged lungs are notable for mild biapical scarring with\nfoci of calcification on the right. Degenerative changes at the\ncraniocervical junction with cystic changes within the odontoid process are \nseen.", "output": "1. Stable severe multilevel degenerative changes.\n\n2. No evidence of acute fracture or traumatic subluxation." }, { "input": "Cervical spine:\n\nThe 3 mm anterolisthesis of C3 on C4 and 3 mm anterolisthesis of C4 on C5 are\nunchanged. No new subluxations are identified. There are no fractures. The\nheight of the vertebral bodies are maintained. The severe, multilevel\ndegenerative changes of the cervical spine are unchanged and most advanced at\nC5-C6, where there is severe bilateral neural foraminal stenosis. The\nprevertebral and paraspinal soft tissues are normal.\n\nThe 8 mm round, well-circumscribed hypodense nodule in the left thyroid lobe\nis unchanged. The left sphenoid sinus contains a tiny amount of aerosolized\nsecretions. The biapical scarring and fibrocalcific changes in the right lung\napex are unchanged.\n\nThoracic spine:\n\nThe alignment of the thoracic spine is normal. The mild loss of height of the\nT4 vertebral body is unchanged. No new fractures are identified. The\nmultilevel degenerative changes of the thoracic spine with calcified disc\nbulges and protrusions at multiple levels are unchanged.\n\nThere are small bilateral pleural effusions with adjacent compressive\natelectasis. There is bibasilar ___ bronchiectasis.\n\nThe two right adrenal myelolipoma are unchanged. Both kidneys contain\nmultiple cysts.\n\nThe 1.7 cm, round, hypodense lesion in the pancreatic tail, measuring water\ndensity, is unchanged. An adjacent 8 mm hypodense lesion in the pancreatic\ntail is also unchanged.", "output": "1. Unchanged compression fracture of the T4 vertebral body. No new fractures\nof the thoracic spine.\n2. No fracture of the cervical spine.\n3. Unchanged, multilevel degenerative changes of the cervical and thoracic\nspine." }, { "input": "Mild anterolisthesis of C3 on C4 and of C4 on C5 is unchanged from multiple\nprior studies. No fractures are identified.There is diffuse osteopenia and\nsevere multilevel multifactorial degenerative changes are stable from recent\nprior studies without critical spinal canal stenosis. Moderate to severe\nmultilevel neural foraminal stenosis is unchanged. There is no prevertebral\nsoft tissue swelling. There is an unchanged rounded well-circumscribed\nhypodense nodule in the left thyroid lobe, measuring approximately 7 x 6 mm in\ntransverse dimension. Unchanged pleural scarring is noted at the lung apices,\nmore significant on the right.", "output": "1. No evidence of acute cervical spine fracture.\n2. Unchanged severe multilevel degenerative changes including mild\nanterolisthesis at C3 upon C4 and C4 upon C5 levels." }, { "input": "No fractures are identified. There is no prevertebral edema. There is mild\nretrolisthesis of C3 on C4 likely due to degenerative changes. There is\nmoderate to severe cervical spondylosis, most prominent at C3-C4 with severe\nloss of intervertebral disc height, endplate sclerosis and irregularity, and\nanterior and posterior osteophyte formation. There is mild spinal canal\nnarrowing and bilateral neural foraminal stenosis, most prominent at C3-C4.\n\nAtherosclerotic vascular calcifications are noted of the right subclavian\nartery, bilateral carotid bifurcations and bilateral vertebral arteries, right\ngreater than left.\n\nThe included portions of the thyroid gland demonstrate a diffusely\nheterogeneous parenchyma with multiple nodules compatible multinodular goiter.\n\nThe included lung apices demonstrate mild centrilobular emphysema.", "output": "1. No evidence of acute fracture.\n2. Moderate to severe cervical spondylosis, with mild spinal canal narrowing\nand bilateral neural foraminal stenosis, most prominent C3-C4.\n3. Mild retrolisthesis of C3 on C4, likely degenerative in etiology.\n4. Multinodular goiter.\n5. Mild centrilobular emphysema.\n6. Moderate atherosclerotic disease." }, { "input": "Alignment is normal. No acute cervical spine fractures are identified. There\nis no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Endotracheal tube terminates above the carina, orogastric tube is\nin place and partially evaluated in this exam. Opacities of the paranasal\nsinuses are better depicted and evaluated in the concurrent maxillofacial CT.", "output": "1. No evidence of acute cervical spine fracture or traumatic malalignment." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Mild degenerative\ndisease with disc space narrowing most pronounced at C6-7 with anterior and\nposterior osteophytes also most pronounced at this level. Facets align\nnormally. No prevertebral edema. The aerodigestive tract appears patent.\nLung apices are clear. Thyroid gland appears normal.", "output": "No fracture or alignment abnormality. Degenerate changes, mild, detailed\nabove." }, { "input": "Alignment is normal.No acute fracture is seen.Multilevel degenerative changes\nare seen, including mild disc space narrowing C3 through C7. There are also\nmultilevel small anterior and posterior osteophytes. Bilateral facet\narthropathy is seen, most noted C2 through C6. There is no prevertebral soft\ntissue swelling.Partially imaged right lobe of the thyroid is quite enlarged\nand may contain a large central hypodensity, exact ___ difficult to\naccurately assessed due to artifact coursing through this region, but possibly\nmeasuring on the order of 2 cm.", "output": "1. No acute fracture or dislocation. Multilevel degenerative changes.\n2. Partially imaged quite enlarged right lobe of the thyroid which may contain\na large central hypodense lesion, exact ___ difficult to accurately\nassess due to artifact coursing through this region, but possibly measuring on\nthe order of 2 cm. Recommend non emergent thyroid ultrasound for further\nassessment.\n\nRECOMMENDATION(S): Nonemergent thyroid ultrasound." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Degenerative\nchanges are noted most notably at C5/6 level with anterior and posterior\nosteophyte formation and a mild disk bulge. These cause mild spinal canal\nnarrowing and may indent the anterior surface of the spinal cord.", "output": "1. Mild degenerative disk disease. Otherwise normal study." }, { "input": "Alignment is normal. No fractures are identified.No significant degenerative\nchanges. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. The thyroid and bilateral lung apices are\nunremarkable.", "output": "No acute findings." }, { "input": "There is no evidence of fracture or dislocation. The prevertebral and\nparaspinal soft tissues are unremarkable. Normal cervical lordosis is\nmaintained. The dens is normally positioned between the lateral masses of C1.\nThere are multilevel degenerative changes most severe at C5-C6 level, with\nsignificant joint space loss and moderate to severe bilateral neural foraminal\nnarrowing, left greater than right.\n\nThere is apparent orogastric tube coiled in the oral cavity and oropharynx. \nAnother enteric tube descends in the esophagus. ET tube is also partially\nimaged on the cross-sectional images but appears to be quite low on the scout\nradiograph approximately at the level of the carina. Right internal jugular\ncentral venous catheter is in the low SVC.\n\nThere partially imaged opacities at the right apex which could reflect\npneumonia.", "output": "1. No evidence of fracture or dislocation. Multilevel degenerative changes\nmost severe at C5-C6.\n2. Apparent orogastric tube coiled in the oral cavity and oropharynx. Please\ncorrelate with physical exam. Another enteric tube descends in the esophagus.\n3. ETT appears to be low on the scout radiograph at approximately the level of\nthe carina. A routine radiograph should be obtained to document positioning.\n4. Partially imaged opacities at the right apex could reflect pneumonia.\n\nRECOMMENDATION(S): Please obtain routine chest radiograph.\n\nNOTIFICATION: The findings were communicated via phone call to ___\nby ___ at 22:00, ___, 6 min after discovery." }, { "input": "Patient is status post posterior fusion of T10-S1 and bilateral iliac bones\nwith spinal rods and pedicle screws. There is no evidence of hardware\nloosening, fracture, or malfunction. There is a large soft tissue defect along\nthe spine corresponding to known wound dehiscence. Alignment of the thoracic\nspine is normal. Mild degenerative changes are noted with anterior bridging\nosteophyte formation. Beam hardening artifact obscures much of the spinal\ncanal but there is no a large abnormal fluid collection.\n\nThe included lung parenchyma is clear. Coronary artery calcifications are\nagain noted. Multiple renal cysts are also present. The thyroid gland is\nmultinodular with a hypodense calcified nodules seen in the right lobe\nmeasuring up to 1.1 x 1.4 cm.", "output": "1. Status post posterior fusion without evidence hardware loosening, fracture,\nor malfunction in the lower thoracic spine. Large dehisced wound along the\nposterior spine.\n\n2. Multi-nodular thyroid with a dominant hypodense nodule seen in the right\nlobe for which nonemergent thyroid ultrasound may be obtained if clinically\nindicated." }, { "input": "Patient is status post posterior fusion of T10 through S1 and bilateral ilium\nwith pedicles screws and spinal rods. There is a large soft tissue wound along\nthe posterior spine. There are lucencies around L2 screws. There is\nretrolisthesis of L2 on L3. Severe degenerative changes are seen with disc\nspace narrowing and vertebral body osteophyte formation. Beam hardening\nartifact obscures much of the spinal canal but no definite large fluid\ncollection is identified.\n\nCoronary artery calcifications are noted. There is moderate atherosclerotic\ncalcification of the abdominal aorta extending into the major side branches.\nMultiple large renal cysts are partially visualized. The prostate is enlarged\nmeasuring 5.8 x 4.8cm in axial ___.", "output": "Status post posterior fusion of the thoracic and lumbar spine. Lucency around\nL2 screws. No other, hardware abnormality. The superficial portion of\nhardware is exposed to the soft-tissue defect." }, { "input": "The patient is status post C3 through is C7 laminectomy and C5-C6 ACDF. There\nis no evidence of hardware fracture or perihardware lucency. Osseous fusion\nof the C5 and C6 vertebral bodies is identified. Cervical alignment is\nanatomic. The craniocervical junction and anterior atlantodental interval are\nunremarkable. The remainder the vertebral body heights and disc spaces are\nmaintained. There is no perihardware lucency.\n\nC2-C3 and C3-C4: There is no significant spinal canal or neural foraminal\nnarrowing. The spinal canal is well decompressed secondary to laminectomy.\n\nC4-C5: A central protrusion contacts and effaces the thecal sac (series 3,\nimage 49). The spinal canal is decompressed secondary to laminectomy. \nUncovertebral and facet arthropathy results in mild left-greater-than-right\nneural foraminal narrowing.\n\nC5-C6: There is no spinal canal or neural foraminal narrowing. Uncovertebral\nand facet arthropathy results in moderate left and mild right neural foraminal\nnarrowing.\n\nC6-C7: There is no spinal canal or neural foraminal narrowing. Uncovertebral\nfacet arthropathy results in mild right and no significant left neural\nforaminal narrowing.\n\nC7-T1: There is no significant spinal canal or neural foraminal narrowing.\n\nAllowing for metallic artifact from the C5-C6 ACDF, prevertebral soft tissues\nare unremarkable. There is no cervical lymphadenopathy by size criteria. The\nthyroid gland is unremarkable. Mild aerosolized debris is seen in the\nnasopharynx. Otherwise, the visualized aerodigestive tract is unremarkable. \nSoft tissue debris in the external auditory canals is noted, likely\nrepresenting cerumen.", "output": "1. The patient is status post C3 through C7 laminectomies and C5-C6 ACDF. \nOsseous fusion of C5 and C6 is noted. There is no hardware fracture,\nperihardware lucency.\n2. Multilevel degenerative changes, most prominent at C4-C5 where a central\nprotrusion contacts and effaces the thecal sac. Facet arthropathy results in\nmoderate C5-C6 and mild C6-C7 left neural foraminal narrowing. There is mild\nright C5-C6 and C6-C7 neural foraminal narrowing.\n3. Neural foraminal stenosis and cord signal change would be better evaluated\non MRI cervical spine, if there no contraindications." }, { "input": "Patient is status post laminectomies of C3 through C7 and C5/C6 ACDF. \nAlignment is stable. There is no evidence of hardware complication. No acute\nfracture dislocation is seen. No prevertebral soft tissue swelling is seen. \nThe thyroid gland is grossly homogeneous. The partially imaged lung apices\nare clear.", "output": "1. Status post laminectomies of C3 through C7 and C5/C6 ACDF without evidence\nof hardware complication. Stable appearance of the cervical spine. No\nevidence of acute fracture or dislocation." }, { "input": "Alignment is normal. No fractures are identified. Mild, multilevel\ndegenerative changes, including intervertebral disc height narrowing and\nosteophyte formation, most prominent within the lower cervical spine. No\nsignificant spinal canal or neural foraminal stenosis.There is no prevertebral\nsoft tissue swelling. Approximately 0.8 cm soft tissue density within the\nsoft tissue overlying the right occiput (03:22), possibly a node. Multiple,\nprominent bilateral cervical nodes.", "output": "No evidence of fracture or subluxation." }, { "input": "Alignment is normal. No fractures are identified.There is mild multilevel\nosteophytosis and intervertebral disc height loss. No significant osseous\nspinal canal narrowing.There is no prevertebral soft tissue swelling. There is\nno evidence of infection or neoplasm. Carotid bifurcation calcifications are\nmoderate.", "output": "No evidence of fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified.There is anterior and\nposterior osteophyte formation throughout the cervical spine, most severe at\nC3-4, C4-5 and, C5-6. There is mild loss of disc height most notably at C4-5\nand C5-6. Intervertebral and facet osteophytes cause mild spinal canal\nstenosis at C3-4, C4-5, and C5-6. Uncovertebral and facet osteophytes cause\nmoderate left neural foraminal narrowing at C3-4 and bilateral neural\nforaminal narrowing at C4-5 and C5-6. There is no prevertebral soft tissue\nswelling.\n\nThe visualized thyroid appears heterogeneous with calcifications containing a\n1.0 x 0.9 cm hypoattenuating nodule in the left lobe. There is moderate\nemphysematous changes and scarring in the bilateral lung apices.", "output": "1. No fracture or acute traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine, most severe at C3-4,\nC4-5, and C5-6." }, { "input": "Alignment is normal. No acute fractures are identified.There is mild\nmultilevel facet osteophytosis. No significant osseous spinal canal or neural\nforaminal narrowing.There is no prevertebral soft tissue swelling.Prominent\nbut not pathologically enlarged cervical lymph nodes are seen throughout the\nneck, nonspecific, but could be reactive. A small amount of soft tissue in\nthe external auditory canal probably reflects cerumen.", "output": "No evidence of fracture or traumatic malalignment.\n\nNonspecific bilateral prominent cervical lymph nodes are not pathologically\nenlarged, but numerous in number." }, { "input": "No fracture or malalignment is seen within the cervical spine. There is no\nsignificant degenerative disease. The prevertebral soft tissues are normal. \nThe imaged lung apices are clear. The imaged portion of the thyroid gland is\nnormal. Base of dens is intact.", "output": "No fracture or malalignment." }, { "input": "There are no acute fractures seen. There is no evidence of prevertebral soft\ntissue swelling.\n\nMultilevel degenerative changes are noted in the cervical spine, including\ndiffuse osteopenia, loss of vertebral body height and intervertebral discs,\nendplate sclerosis, and osteophytosis. There is mild anterolisthesis of C3 on\nC4 and C4 on C5, likely degenerative in etiology. There is mild to moderate\nleft neural foramina narrowing at C2-C3 and C3-C4 secondary to facet\nhypertrophy and osteophytosis. There is no evidence of high-grade central\ncanal narrowing.\n\nThere is no evidence of infection or neoplasm.\n\nThere is a prominent 11 mm right paratracheal node noted, nonspecific. The\nthyroid gland is normal. The visualized portion of the right and left lung\napices are normal.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Moderate multilevel degenerative disease of the cervical spine. Mild C3 on\nC4 and C4 on C5 anterolisthesis is likely degenerative in etiology.\n3. Prominent 11 mm right paratracheal node, nonspecific." }, { "input": "Severe multilevel degenerative changes of the cervical spine are noted. There\nis rather uniform slight loss of vertebral body height at C5 and C6, which\nappears degenerative in etiology. There is significant anterior and posterior\nosteophytes. Loss of intervertebral disc height is greatest at C7-T1 and\nT1-T2. No prevertebral soft tissue swelling. No evidence of acute fracture. \nNo evidence of significant spinal canal narrowing. No suspicious lytic or\nsclerotic osseous lesion. No ___ or ___.\n\nC4-C5 and C5-C6: Disc protrusions results in mild spinal canal narrowing,\nminimally effacing the thecal sac. There is no significant neural foraminal\nnarrowing.\n\nC6-C7: Intervertebral osteophytes and small disc protrusion results in mild\nto moderate spinal canal narrowing. Uncovertebral facet arthropathy results\nin moderate bilateral neural foraminal narrowing.\n\nC7-T1: Intervertebral osteophytes and a disc protrusion results in mild to\nmoderate spinal canal narrowing effacing the thecal sac. Uncovertebral facet\narthropathy results in moderate bilateral neural foraminal narrowing.\n\nCystic changes are noted in the left lung apex.", "output": "1. Moderate to severe multi-level degenerative changes of the cervical spine.\n2. No evidence of acute fracture or traumatic malalignment." }, { "input": "Multilevel degenerative changes of the thoracic spine with prominent anterior\nosteophyte formation, vacuum phenomenon, and loss of intervertebral disc\nheight. There is a small lucency of the right T11 facet compatible with a\nnutrient canal (series 2, image 101), unchanged from prior CTA chest of ___. No anterolisthesis or retrolisthesis. No prevertebral soft tissue\nswelling. No significant spinal canal narrowing. No suspicious lytic or\nsclerotic osseous lesion. Atherosclerotic calcifications are mild in the\nthoracic aorta. Subpleural left apical cysts are noted. The lungs are\notherwise clear.", "output": "1. Multilevel degenerative changes of thoracic spine without evidence of\nacute traumatic fracture or malalignment." }, { "input": "There is 1 cm grade 2 degenerative anterolisthesis of L4 on L5 without\nspondylolysis. Vertebral body heights are preserved. There is no evidence\nfor traumatic fracture or malalignment. Lucency through the right superior L5\nfacet is well corticated and likely represents nutrient canal. There is\nsevere loss of L4-L5 disc space with vacuum disc phenomenon.\n\nL4-L5: There is uncovering of the disc secondary to anterolisthesis. A disc\nbulge with severe facet arthropathy and thickening ligamentum flavum results\nin at least moderate spinal canal narrowing, crowding the thecal sac. There\nis moderate to severe left and right neural foraminal narrowing.\n\nL5-S1: A large facet osteophyte encroaches on the spinal canal and in\nconjunction with a disc bulge resulting in likely moderate to severe spinal\ncanal narrowing. There is moderate bilateral neural foraminal narrowing.\n\nExtensive atherosclerotic dictation of the abdominal aorta and common iliac\nvessels are noted. A calcification adjacent to the distal right ureter likely\nrepresents a gonadal vein phlebolith. The patient is status post\ncholecystectomy. Remainder the prevertebral paraspinal soft tissues are\nunremarkable.", "output": "1. There is no definitive acute traumatic fracture or subluxation.\n2. 1 cm grade 2 anterolisthesis of L4 on L5 is most likely degenerative. \nHowever, MRI is more sensitive for ligamentous injury, if there no\ncontraindications.\n3. Degenerative changes as described above." }, { "input": "Alignment is normal. No fractures are identified. There are stable moderate\nmultilevel degenerative changes. There is no prevertebral edema. There is\nmild left apical paraseptal emphysema. Otherwise, the thyroid and included\nlung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Fusion hardware streak artifact limits examination.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level. By this convention, there is transitional anatomy\nwith lumbarization of S1.\n\nTHORACIC SPINE:\n\nThere is mild kyphosis centered at T7-T8. There is minimal dextroscoliosis of\nthe thoracic spine. Vertebral body heights are preserved. The visualized\nosseous structures are osteopenic.\n\nThere is no evidence of acute or chronic vertebral body height loss. There\nare multilevel mild to moderate degenerative changes including anterior\nosteophytosis for example at T7 and T8. There is no significant spinal canal\nnarrowing. Facet osteophytes contribute to multilevel mild to moderate neural\nforaminal narrowing for example at T9-T10 bilaterally. There is no\nprevertebral soft tissue swelling.\n\nLUMBAR SPINE:\n\nLevoscoliosis of lumbar spine is again noted. There is grade 1, 2 mm\nanterolisthesis of L3 on L4. There is a mild kyphotic curvature of the lumbar\nspine at L4 through S1. The patient is status post L3 through L5 posterior\nfusion at L4 and L5 level laminectomies. Mild height loss at the level of S1\nis stable from priors. There is no definite acute fracture. There is no\nprevertebral soft tissue swelling.\n\nMultilevel degenerative changes are noted including multi level anterior\nosteophytosis. There is degenerative disc disease at L2-L3 with vacuum disc\nphenomenon as well as at L4-L5 and L5-S1. Calcified degenerative disc disease\nis noted L3-L4 and L4-L5. Prominent central disc bulge at L2-L3 as well as\nligamentum flavum hypertrophy contribute to severe canal narrowing at this\nlevel. The large central disc protrusion at L1-L2 compressing the conus\nmedullaris better seen on previous day lumbar MR. ___ and mild\nosteophytosis is noted about the facet joints at multiple levels.\n\n OTHER:\n\nLimited in lungs suggests right lower lobe patchy opacity. Within the limits\nof this noncontrast study, there no definite evidence of paravertebral or\nparaspinal mass. Note is made degenerative changes in the right greater than\nleft sacroiliac joints. Atherosclerotic vascular calcifications are noted.", "output": "1. Fusion hardware streak artifact and diffuse osteopenia limits examination.\n2. Transitional anatomy with sacralization of S1 as described.\n3. No evidence of acute or chronic fracture in the thoracic spine.\n4. Multilevel mild moderate degenerative changes are seen as described above. \nNo evidence of spinal canal narrowing.\n5. L3 through L5 posterior fusion and L4 and L5 level laminectomies\npostsurgical changes with no definite evidence of hardware fracture or\nperihardware lucency.\n6. Severe canal narrowing at L2-L3 better visualized on ___ lumbar\nspine MRI.\n7. Grossly stable mild S1 anterior compression deformity.\n8. Limited imaging of the lungs demonstrate right lower lobe patchy opacity. \nIf clinically indicated, consider dedicated chest imaging for further\nevaluation." }, { "input": "Dental amalgam streak artifact limits study. Additionally, the patient body\nhabitus limits evaluation of C7 inferior vertebral body levels. Within these\nconfines:\n\nThere is approximately 2 mm anterolisthesis of C3 over C4 without definite\nprevertebral soft tissue edema. Vertebral body heights are preserved. There\nis partial fusion of the left C3-4 facet joint. No acute fractures are\nidentified. A defect in the mid posterior arch of C1 was present in ___,\nlikely congenital.\n\nMultilevel degenerative changes of the cervical spine are seen, including loss\nof intervertebral disc height, Schmorl's nodes, endplate sclerosis, facet\njoint hypertrophy and disc osteophytes, with at least mild vertebral canal\nnarrowing at C3-4.\n\nThe thyroid and included lung apices are grossly preserved. Enlarged right\nlevel 2A approximately 1.2 cm lymph node is seen (see 03:23). Additional\nscattered subcentimeter nonspecific lymph nodes are noted throughout the\nvisualized portion of the neck bilaterally, without definite enlargement by CT\nsize criteria.", "output": "1. Patient body habitus and dental amalgam streak artifact limits study as\ndescribed.\n2. Within limits of study, no definite evidence of acute cervical spine\nfracture.\n3. Probable degenerative changes as described. Please note MRI of the\ncervical spine is more sensitive for the evaluation of ligamentous injury.\n4. Enlarged right level IIa lymph node, with additional scattered\nsubcentimeter nonspecific cervical lymph nodes as described." }, { "input": "Alignment is normal. There is reversal of the normal cervical lordosis,\nlikely positional. No fractures are identified.There is no significant canal\nor foraminal narrowing.There is no prevertebral edema.\n\nThe visualize thyroid is unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is no acute fracture or traumatic malalignment. The prevertebral soft\ntissues are stable in appearance. There is significant kyphosis. Multilevel\ndegenerative changes are present, with partial fusion of the C4-5 vertebral\nbodies, and chronic anterolisthesis of C6 on C7. The lung apices are clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Severe multilevel degenerative changes." }, { "input": "The right lateral mass of C1 is fused to the occipital condyle. Vertebral\nbodies are well aligned. There is reversal of the normal cervical lordosis. \nExtensive degenerative changes are seen along the cervical spine with loss of\nintervertebral disc spaces, subchondral sclerosis and irregularity, and\nmultiple bridging osteophytes. Posterior osteophytes and disc bulges is\nunaltered in up to mild to moderate canal narrowing most notably at C3-4 and\nC4-5. Uncovertebral joint osteophytes result in multilevel mild-to-moderate\nforaminal narrowing bilaterally, most notably at C3-C4. No acute fracture\nidentified. There is no prevertebral soft tissue swelling.\n\nMultilevel uncovertebral hypertrophy, facet joint arthropathy, and posterior\nosteophytes result in mild-to-moderate vertebral canal narrowing and mild to\nmoderate neural foraminal stenoses. There is no evidence of infection or\nneoplasm. No focal consolidation is seen in the lung apices. The thyroid is\nunremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Significant cervical spondylosis with multilevel mild-to-moderate vertebral\ncanal and neural foraminal narrowing, as detailed above." }, { "input": "Alignment is normal. No cervical spine fractures are identified. \nDegenerative changes are prominent at C6-7 with loss of disc space and\nprominent anterior osteophytosis. There is mild disc bulging also noted\nposteriorly at this level.\n\nThere is a large hematoma in the hypopharynx abuts the level of the vocal\nfolds. Evaluation for active bleeding is not possible on this noncontrast\nexam. Of note, there is no hematoma seen in the right carotid space. No\nretropharyngeal thickening or hematoma. ET and OG tubes are in place. The\nhyoid bone is intact. There is an abnormal appearance of the thyroid\ncartilage which appears slightly flattened and with a lucency through the\nthyroid cartilage seen on series 3 image 53. This finding is concerning for a\nlaryngeal fracture.", "output": "1. Large hematoma within the hypopharynx above the vocal cords with findings\nconcerning for right thyroid cartilage fracture. Consider neck CTA if there\nis concern for active bleeding.\n\n2. No acute cervical spinal fracture or malalignment. Degenerative changes at\nC6-7 as described.\n\nNOTIFICATION: Findings communicated to Dr. ___ by Dr. ___ at 10:34,\nimmediatley after discovery of findings." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "1. No acute fracture or malalignment." }, { "input": "2 mm anterolisthesis of L3 on L4 is slightly progressed from examination ___.\nOtherwise, lumbar alignment is anatomic. Vertebral body heights are\npreserved. There is no evidence for acute fracture. Vacuum disc phenomenon\nand mild loss of L3-L4 disc height is mildly progressed since ___. There is\nalso moderate loss of L4-L5 and L5-S1 disc height, overall similar to prior\nexam.\n\nT12-L1 through L2-L3: There is no significant spinal canal or neural foraminal\nnarrowing. There is bilateral L2-L3 facet arthropathy.\n\nL3-L4: The disc is uncovered secondary to anterolisthesis. A disc bulge with\nthickening of the ligamentum flavum results in moderate to severe spinal canal\nnarrowing (series 3, image 50). Bilateral facet arthropathy is identified. \nThese degenerative changes results in at least moderate bilateral neural\nforaminal narrowing. This may be overall similar to prior examination.\n\nL4-L5: A disc bulge with thickening of the ligamentum flavum results in\nmoderate spinal canal narrowing. There is bilateral facet arthropathy which\nresults in mild bilateral neural foraminal narrowing.\n\nL5-S1: A left central calcified disc protrusion crowds the left subarticular\nzone likely impinging on the traversing nerve root (series 3, image 67),\nsimilar to prior examination. There is mild spinal canal narrowing and no\nsignificant neural foraminal narrowing.\n\n2 mm lesion of the left adrenal gland, similar in appearance to prior CT,\npreviously described as an adenoma. There is diverticulosis. Left hip\narthroplasty is partially visualized and similar appearance to prior exams. \nOtherwise, visualized abdominal, pelvic and paraspinal soft tissues are\nunremarkable.", "output": "1. Multilevel lumbar spondylosis, most prominent at L3-L4 where there is\nminimal progression of 2 mm anterolisthesis and a disc bulge with vacuum disc\nphenomenon and ligamentum flavum thickening results in moderate to severe\nspinal canal narrowing.\n2. At L5-S1 a left central calcified disc protrusion crowds the left\nsubarticular zone, likely impinging on the traversing left S1 nerve root,\noverall similar to prior examination.\n3. MRI, if there are no contraindications would better evaluate spinal canal\nneural foraminal narrowing.\n4. No evidence of acute traumatic fracture. Additional findings as described\nabove." }, { "input": "No fractures are identified. Multilevel mild to moderate degenerative changes\nare seen in the cervical spine with minimal anterolisthesis of C4 on C5 likely\ndegenerative in etiology. Small posterior disc osteophyte complexes are noted\nat the C2-C3 vertebral level causing mild central canal narrowing. Mild disc\nbulging at the C5-C6 and C6-C7 vertebral levels are seen causing mild central\ncanal narrowing. Uncovertebral hypertrophy is seen at the right C3-C4 and\nright C4-C5 vertebral level causing mild neural foraminal narrowing. There is\nno prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThere is mild scarring at the bilateral lung apices. There are 2 lung nodules\nin the left lung apex, measuring 1 mm and 2 mm (3:67,66.) thyroid gland is\nunremarkable.", "output": "1. No acute fracture. Mild to moderate multilevel degenerative changes in the\ncervical spine.\n2. Incidental note is made of 2 millimetric lung nodules in the left lung\napex." }, { "input": "No fractures are identified.There are severe multilevel degenerative changes\nin the lumbosacral spine with disc space narrowing, vacuum phenomenon,\nsubchondral sclerosis, and large anterior osteophytes. Grade 1\nanterolisthesis of L5-S1 vertebral level is similar to the prior exam.Disc\nbulges with posterior osteophytes and ligamentum flavum hypertrophy result in\nsevere spinal canal stenosis at the L3-L4, L4-L5, and L5-S1 vertebral levels,\nparticularly the L3-L4 level. There is severe neural foraminal stenosis\nbilaterally at L3-4, L4-5 and particularly at the L5-S1 level. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nLimited views of the abdomen are remarkable for a 1.3 cm left renal\nhypodensity with peripheral thin calcification and a 0.8 cm right renal\nhypodensity, likely cysts. Patient is status post cholecystectomy. \nAtherosclerotic calcifications are seen in the abdominal aorta and iliac\narteries. Sigmoid diverticulosis is incidentally noted without evidence of\nacute diverticulitis.", "output": "1. No acute fracture in the lumbosacral spine.\n2. Severe multilevel degenerative changes in the lumbosacral spine, notably at\nthe L5-S1 level.\n3. Severe central canal narrowing, particularly at the L3-L4 level.\n4. Severe neural foraminal stenosis bilaterally at L3 -L4 through L5 -S1\nvertebral levels.\n5. Bilateral renal cysts.\n6. Sigmoid diverticulosis without secondary signs of diverticulitis.\n\nRECOMMENDATION(S): Consider MRI for further assessment of the thecal sac and\nneural foramina." }, { "input": "There is no acute cervical fracture. There is no abnormal prevertebral soft\ntissue edema or thickening. There is mild retrolisthesis of L2 with respect\nto L3. Findings are likely degenerative in etiology. Disc osteophyte complex\nat this level mildly narrows the spinal canal. Additional disc osteophyte\ncomplex at the C5-C6 level effaces the thecal sac without severe spinal canal\nnarrowing. Vertebral body heights are preserved. Multilevel degenerative\nchanges include intervertebral disc space loss and endplate sclerosis worst at\nthe C3-C4 level.\n\nThe lung apices are clear. There is no cervical adenopathy. The thyroid\ngland is homogeneous in attenuation without focal nodularity. Calcifications\nof the nuchal ligament are noted.", "output": "No acute cervical fracture. Mild retrolisthesis of C3 on C4 is felt likely\ndegenerative in etiology in the absence of prevertebral soft tissue swelling\nor edema." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C3-4 and notable for loss of\nintervertebral disc height, anterior osteophytosis, ligamentum flavum\nthickening, and facet and uncovertebral hypertrophy causing mild neural\nforaminal and spinal canal narrowing.There is no prevertebral edema.\n\nA 1.2 cm right thyroid nodule is seen. The included lung apices are\nunremarkable.", "output": "Multilevel degenerative changes of the cervical spine. No acute fracture or\ntraumatic malalignment." }, { "input": "There is no fracture or traumatic malalignment. There is no prevertebral soft\ntissue swelling. Mild multilevel multifactorial, degenerative changes are\nnoted with disc space narrowing and vertebral body osteophyte formation. There\nis also uncovertebral and facet hypertrophy leading to mild bilateral neural\nforaminal narrowing at C5-C6.\n\nThe thyroid gland is unremarkable. The visualized portion of the lung apices\nare clear. Scattered subcentimeter nonspecific lymph nodes are seen\nthroughout the neck bilaterally.", "output": "1. No fracture or traumatic malalignment.\n\n2. Multilevel degenerative changes as described above." }, { "input": "Dental amalgam streak artifact and patient body habitus limits study.\n\nThere is straightening of cervical lordosis, unchanged. No fractures are\nidentified.There are multilevel degenerative changes throughout the cervical\nspine including anterior/posterior osteophytes, loss of intervertebral disc\nspace height and uncovertebral hypertrophy. These findings are most\npronounced between C5 through C7, with there is mild spinal canal narrowing. \nThere is been no significant interval change compared to ___.\nThere is no prevertebral soft tissue swelling.Within the limitations of this\nnoncontrast study, there is no evidence of infection or neoplasm. Thyroid\ngland is unremarkable in appearance. Lung apices are clear.", "output": "1. Dental amalgam streak artifact and patient body habitus limits study.\n2. No acute cervical spine fracture or traumatic malalignment.\n3. Grossly stable multilevel degenerative changes as described above, most\npronounced from C5 through C7." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nA 1.5 cm hypodense nodule is seen in the left thyroid lobe. Included lung\napices are unremarkable.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. A 1.5 cm hypodense nodule is seen in the left thyroid lobe. Recommend\nthyroid ultrasound if previous workup has not been performed." }, { "input": "There is no evidence for a fracture or prevertebral edema. There is no\nsubluxation. There is a minimal dextroconvex curvature of the thoracic spine\nand a partially visualized levoconvex curvature of the thoracic spine.\n\nMultilevel degenerative disease is present. Evaluation of the spinal canal\nand neural foramina by CT is limited compared to MRI. Allowing for this\nlimitation, the following observations are made:\n\nC2-C3: Left facet arthropathy. No spinal canal or neural foraminal\nnarrowing.\n\nC3-C4: Left severe facet arthropathy and uncovertebral osteophytes cause\nsevere left neural foraminal narrowing. No narrowing of the spinal canal or\nright neural foramen.\n\nC4-C5: A small central disc protrusion minimally indents the ventral thecal\nsac without significant spinal canal narrowing. Left facet arthropathy is\npresent, but there is no neural foraminal narrowing.\n\nC5-C6: Broad-based central disc protrusion with overlying endplate\nosteophytes indent the ventral thecal sac and probably remodel the ventral\nspinal cord, though evaluation of the cord by CT compared to MRIs limited. \nMild to moderate spinal canal stenosis appears present. There is moderate to\nsevere right and mild left neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nC6-C7: Evaluation of the spinal canal is limited by streak artifact from the\nshoulder girdles. It is not clear whether there may be a small central disc\nprotrusion mildly indenting the ventral thecal sac. There is moderate to\nsevere right and mild to moderate left neural foraminal narrowing, primarily\nby uncovertebral osteophytes, though left greater than right facet arthropathy\nis present.\n\nC7-T1: Evaluation of the spinal canal is limited by streak artifact from the\nshoulder girdles. It is not clear whether there may be a small disc bulge or\na small central disc protrusion mildly indenting the ventral thecal sac. No\nneural foraminal narrowing is seen.\n\nThere is dependent atelectasis in the included upper lungs.\nThe thyroid gland is grossly unremarkable. No enlarged cervical lymph nodes\nare seen on noncontrast CT.\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities seen on limited assessment.\nThere is a small mucous retention cyst in the posterior medial right sphenoid\nsinus and a small mucous retention cyst with adjacent secretions in the\nanterolateral right sphenoid sinus. Partially visualized ethmoid air cells\nand maxillary sinuses are well-aerated. Middle ear cavities and mastoid air\ncells are well aerated.", "output": "1. No fracture or subluxation in the cervical spine.\n2. Multilevel cervical degenerative disease. Mild to moderate spinal canal\nnarrowing at C5-C6. Multi focal neural foraminal narrowing, including severe\nleft C3-C4 neural foraminal narrowing. Please correlate whether this may be\nrelated to the patient's symptoms.\n\nRECOMMENDATION(S): The spinal cord, spinal canal, and neural foramina could\nbe better assessed by MRI, if clinically warranted.\n\nNOTIFICATION: At 09:49 on ___, Dr. ___ the impression and\nrecommendations above to the ___ QA nurses list, for the ___ QA nurse to follow\nup as appropriate." }, { "input": "Alignment is normal. No fractures are identified.There is minimal anterior\nosteophytosis. Small posterior disc bulge results in mild multilevel spinal\ncanal narrowing, most pronounced at C5-6. No significant osseous neural\nforaminal narrowing. Incidental note is made of a pseudoarticulation between\nthe right C6 and C7 transverse processes.There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm. Heterogeneous\nthyroid gland with no significant discrete nodules. Visualized lung apices\ndemonstrate scarring.", "output": "No evidence of fracture or malalignment." }, { "input": "Thoracic spine: Alignment is normal. No fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nLumbar spine: Alignment is normal. No fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nOther: Incidental 6 mm hemorrhagic right upper pole renal cyst. Punctate\nnonobstructing interpolar right renal stone. Incidental common origin left\ncommon carotid and innominate arteries.", "output": "1. No evidence of fracture or malalignment.\n2. Punctate nonobstructing right nephrolithiasis." }, { "input": "Thoracic spine: Alignment is normal. No fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nLumbar spine: Alignment is normal. No fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nOther: Incidental 6 mm hemorrhagic right upper pole renal cyst. Punctate\nnonobstructing interpolar right renal stone. Incidental common origin left\ncommon carotid and innominate arteries.", "output": "1. No evidence of fracture or malalignment.\n2. Punctate nonobstructing right nephrolithiasis." }, { "input": "There is no acute fracture identified. There is basilar invagination with\nhigh position of the dens. There is osseous fusion of C2-3 as well as of C1\nto the occipital condyles. The atlantodens interval measures 3 mm and is\ntop-normal in size. There is no prevertebral soft tissue swelling. There are\nmultilevel degenerative changes of the cervical spine. The lung apices are\nclear. The thyroid is unremarkable.", "output": "1. No evidence of acute fracture.\n2. Basilar invagination of the dens. Correlate with neurologic symptoms. If\nthis has not been evaluated in the past, consider outpatient MR of the\ncervical spine for further evaluation of the spinal cord particularly if\npatient has neurologic symptoms." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling.\n\nDegenerative changes notable for posterior disc bulge and uncovertebral joint\nhypertrophy most extensive at C4-C5 where there is mild-to-moderate canal\nnarrowing and mild bilateral foraminal narrowing.\n\nIncluded thyroid and lung apices are unremarkable.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "CERVICAL SPINE: Alignment is normal. No fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. No significant\ndegenerative disease is noted within the cervical spine.\n\nNECK: There is no fracture or obvious deformity of the laryngeal cartilage. \nThe hyoid bone is intact. There is effacement of the right piriform sinus\nwithout obvious hematoma or soft tissue gas. Salivary glands appear\nunremarkable. No prevertebral edema.\n\nThere is asymmetry of the laryngeal pharynx just inferior to the laryngeal\ninlet with asymmetric bulging of the right pharyngeal mucosa and effacement of\nthe right piriform recess. The pharyngeal mucosa appears mildly\nhypoattenuating, suggestive of edema.", "output": "1. No fracture or traumatic malalignment.\n2. Effacement of the right piriform sinus may reflect contusion in the setting\nof injury to this area. No fracture or deformity of the laryngeal cartilage. \nRecommend clinical correlation with laryngoscopy." }, { "input": "Re-demonstrated is mild anterolisthesis of C3 on C4 and C4 on C5, similar to\nthat seen on the prior scout imaged from the head CT. No evidence of\ntraumatic cervical malalignment or acute fracture. There is fusion of the\nbilateral C2-C3 facet joints. Multilevel degenerative changes of the cervical\nspine including facet joint arthropathy, osteophytosis, and disc space\nnarrowing is demonstrated. Mild multilevel central canal narrowing is most\npronounced at C4-5 and C5-6 as well as bilateral mild to moderate multilevel\nneural foraminal narrowing, most pronounced at C5-6. There is no prevertebral\nsoft tissue swelling. A 1.3 cm hypodensity in the right thyroid lobe is noted\n(3:63).", "output": "1. No traumatic cervical malalignment or acute fracture.\n2. Moderate cervical spondylosis.\n3. 1.3 cm hypodensity in the right thyroid lobe. No follow-up recommended.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is mild anterolisthesis of C3 over C4. Additionally, there is widening\nof the C3/C4 disc space, particularly anteriorly. No priors are available for\ncomparison to assess for stability and ligamentous injury is not excluded on\nthis study. MRI would further assess. Degenerative changes are seen\nincluding disc space narrowing worst at C5/C6 but also seen and C4/C5 and\nC6/C7. There is subtle loss of height of the T1 vertebral body which can also\nbe further assessed on MRI. Otherwise, no definite acute fracture is seen. \nThe visualized lung apices are clear. No prevertebral soft tissue swelling is\nseen.", "output": "Mild anterolisthesis of C3 over C4 with widening of the C3/C4 disc space,\nparticularly anteriorly, ligamentous injury not excluded. No priors for\ncomparison to assess chronicity. Recommend MRI for further assessment.\n\nEquivocal subtle loss of height of the T1 vertebral body can also be further\nassessed on MRI. No evidence of acute fracture seen elsewhere." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Mild degenerative changes with anterior osteophyte formation\nfrom to C6 vertebral level", "output": "1. No malalignment or fractures a sequela of trauma.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "The bones are diffusely demineralized, which may decrease sensitivity for\nacute nondisplaced fractures. Within this confine: Alignment is anatomic. No\nfractures are identified. The left ring of C1 appears posteriorly subluxed\nrelative to the body of C2, which is likely secondary to rotation. There are\nsevere multilevel degenerative changes of the cervical spine with\nintervertebral disc space narrowing, endplate sclerosis and cystic change,\nvertebral body osteophytosis, and uncovertebral joint hypertrophy, most\nprominent at C3-C4. There is multilevel central canal narrowing, most\nprominent at C3-C4 where it is mild. There is multilevel neural foraminal\nnarrowing, most prominent at C5-C6 on the right where it is moderate to\nsevere.There is no prevertebral edema.\n\nThe visualized lung apices are clear. The thyroid is heterogeneous, and\nslightly enlarged in the right lobe there is a 9 mm hypodense nodule at the\nisthmus. There is no cervical lymphadenopathy by size criteria. Effacement\nof the left vallecula may be secondary to mucous debris. Clinical correlation\nis recommended.", "output": "1. No acute fracture or traumatic subluxation of the cervical spine.\n2. Right thyroid is enlarged and heterogeneous compatible with goiter. A 9 mm\nisthmus hypodense nodule.\n3. There is asymmetric effacement of the left vallecula, likely secondary to\nmucous debris. Clinical correlation is recommended.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no acute fracture or alignment abnormality. There is no prevertebral\nsoft tissue swelling. There are degenerative changes of the spine but no\nsevere spinal canal narrowing. There is a diffusely heterogeneous appearance\nto the bone marrow. There are small bubbles of air in the right jugular vein\nand left subclavian vein, likely iatrogenic from intravenous injection. \nVascular calcifications are noted. Marked left apical pleural thickening is\nnoted, with bilateral pleural effusions, better assessed on the dedicated\nchest CT.", "output": "1. No evidence of acute cervical spine injury.\n2. For full discussion of the bilateral pleural abnormalities, please refer to\nthe report of the subsequently performed chest CT.\n3. Diffuse heterogeneity in the imaged skeleton is concerning for metastatic\nprocess." }, { "input": "Dental amalgam streak artifact, spinal fusion hardware artifact and mild\nmotion limits study. Within these confines:\n\nNumbering of the cervical spine is provided on series 602b, image 23.\n\nThere is stable straightening of the cervical lordosis. Patient is status\npost anterior fusion between C5 through T1, with evidence of bone graft. \nEvaluation of surrounding structures is limited by streak artifact. Hardware\nappears well seated, without evidence of loosening or fracture. No evidence\nof prevertebral soft tissue swelling.\n\nModerate degenerative changes are noted throughout the cervical spine, with\nanterior/posterior osteophytes, loss of intervertebral disc space height,\nuncovertebral hypertrophy, and facet joint arthropathy. No critical spinal\ncanal narrowing.\n\nAt C2-C3, no significant neuroforaminal stenosis.\nAt C3-C4, severe left-sided neural foraminal narrowing (02:37).\nAt C4-C5, severe left-sided neural foraminal stenosis (02:37).\nNo evidence of significant neuroforaminal stenosis in the remainder of the\ncervical spine levels.\n\nNote is made of mild degenerative changes at the right temporomandibular joint\n(601b:23). Thyroid gland is unremarkable in appearance. Imaged lung apices\nare clear. Right maxillary sinus mucous retention cyst versus polyp is noted.\nScattered subcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria.", "output": "1. Dental amalgam streak artifact, spinal fusion hardware artifact and mild\nmotion limits study.\n2. Within limits of study, no acute fracture or traumatic malalignment.\n3. Within limits of study, no definite C5-6 and C6-7 ACDF hardware failure\nnoted.\n4. Multilevel degenerative changes as described, including severe left-sided\nneural foraminal stenosis at C3-C4 and C4-C5.\n5. Paranasal sinus disease as described." }, { "input": "There is anterior fixation hardware spanning C4-T1. There is also posterior\nfixation hardware at C4-C5. There is no evidence of hardware complication or\nmalalignment. There is loss of the normal cervical lordosis. No fractures are\nidentified. There is no evidence of spinal canal stenosis. There is no\nprevertebral soft tissue swelling.\n\nThere is severe foraminal stenosis on the left at C3-4 and C4-5 due to a\ncombination of uncovertebral and facet hypertrophy. There are multiple\nprominent cervical lymph nodes bilaterally, but no pathologically enlarged\nlymph nodes. The partially visualized skull base, thyroid and lung apices are\nwithin normal limits.", "output": "1. No acute fracture or traumatic malalignment.\n2. No evidence of hardward complication.\n3. Severe neural foraminal stenosis C3-4 and C4-5 on the left." }, { "input": "There is straightening of cervical lordosis. Vertebral body heights are\npreserved. There is no prevertebral soft tissue swelling. There is no\ndefinite evidence of acute fracture. Multilevel degenerative changes of the\ncervical spine are noted, including Schmorl's nodes, disc osteophyte\ncomplexes, endplate sclerosis, facet joint hypertrophy, with mild vertebral\ncanal narrowing at C5-6.\n\nOTHER:\nLimited imaging lungs demonstrate minimal biapical pleural scarring. Right\nsubmandibular gland probable calculi are again seen, grossly unchanged (see\n03:34 on ___ prior cervical spine CT and 02:30 on current study). \nScattered subcentimeter nonspecific lymph nodes are noted throughout the\nvisualized portion of the neck bilaterally, without definite enlargement by CT\nsize criteria.", "output": "1. No evidence of traumatic cervical malalignment or fracture.\n2. Multilevel cervical spondylosis as described. Please note MRI of the\ncervical spine is more sensitive for the evaluation of ligamentous injury.\n3. Right submandibular gland calculi, at least partially present on ___ prior\ncervical spine CT." }, { "input": "Alignment of the cervical spine is normal. No acute fracture or prevertebral\nsoft tissue swelling is noted. There is mild degenerative change of the\ncervical spine, most pronounced at C5-C6 and C6-C7 with disc height loss,\nendplate irregularity and posterior and anterior osteophytosis. At C5-6, a\nposterior disc bulge indents the ventral thecal sac, as seen on the previous\nMRI. There is no high-grade spinal canal or neural foraminal narrowing. \nBiapical pleural scarring is noted along with mild centrilobular emphysema. \nThe thyroid gland is unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no fracture or acute malalignment of the cervical spine. The\nprevertebral soft tissues are unremarkable.\n\nModerate multilevel degenerative changes are present throughout the cervical\nspine, most prominent at the C4-5 and C5-6 levels, where there is disc space\nnarrowing, anterior and posterior osteophytosis, and bilateral facet\narthropathy. There is mild straightening of the normal cervical lordosis,\npossibly due to presence of a cervical collar.\n\nThere is no lymphadenopathy. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable.", "output": "No fracture or acute malalignment of the cervical spine." }, { "input": "Study is limited secondary to motion and patient body habitus, limiting\nevaluation of vertebral bodies inferior to C5 level.\n\nThere is minimal anterolisthesis of C5 on C6. No acute fracture is\nidentified.\n\nMultilevel degenerative changes are noted throughout the cervical spine\nincluding significant intervertebral disc space height loss, osteophytosis,\nfacet joint arthropathy and uncovertebral hypertrophy. At the C4-5\nintervertebral disc space is a well corticated body suggestive of anterior\nosteophyte (see 603b:25, 02:41). A similar corticated bodies seen adjacent to\nthe superior endplates of the T1 vertebral body. There is no significant\nprevertebral soft tissue abnormality. The aforementioned degenerative changes\nresult in mild-to-moderate central canal and bilateral neural foraminal\nnarrowing.\n\nThe thyroid and included lung apices are unremarkable. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally without\nenlargement by CT size criteria.", "output": "1. Study is limited secondary to motion and patient body habitus as described.\n2. No definite cervical spine fracture identified.\n3. Multilevel degenerative changes as described.\n4. Please note MRI of the cervical spine is more sensitive for the evaluation\nof ligamentous and spinal cord injury.\n5. Please see concurrently obtained CT of the head and facial bones for\ndescription of non cervical spine structures." }, { "input": "There is minimal anterolisthesis of C6 on C7, and T1 on T2. There is no\nevidence acute fracture. Moderate multilevel degenerative changes of the\ncervical spine include intervertebral disc space narrowing, disc\ncalcification, facet arthropathy, and osteophytosis. This results in moderate\nmultilevel neural foraminal narrowing spanning C3-C4, C4-C5, and C5-C6. No\nevidence of severe spinal canal stenosis. There is no evidence of\nprevertebral soft tissue swelling.\n\nThe thyroid gland is heterogeneous without evidence of discrete nodule. \nVisualized lung apices demonstrate calcified pleural scarring.", "output": "1. No evidence of fracture or traumatic cervical malalignment.\n2. Minimal anterolisthesis of C6 on C7 and T1-T2 is likely degenerative in\nnature.\n3. Multilevel degenerative changes of the cervical spine, as detailed above." }, { "input": "Alignment is normal. No fractures are identified.\n\nThere is no significant spinal canal or neural foraminal compromise from C2\nthrough C5.\n\nAt C5-6, there is a large midline protrusion of the intervertebral disc that\nappears to slightly flatten the anterior surface of the spinal cord. The\nneural foramina appear normal.\n\nThere are tiny intervertebral osteophytes at C6-7 that slightly encroach on\nthe spinal canal. The neural foramina appear normal.\n\nThe C7-T1 and T1-2 levels appear normal.\n\nIncompletely imaged is a defect in the left occipital bone. This has head\nirregular but slightly sclerotic margin. There was a soft tissue element in\nthis location on a brain MR of ___. However, a head CT of ___\ndemonstrated sclerosis but no cortical defect in this location and the area\nappeared normal on a head CT of ___. Thus, this appears to be a\ngradually progressing lesion. Its presence in ___ suggests growth far to\nslow to suspect metastatic disease. Given the patient's history of chronic\nrenal failure, this may represent a brown tumor. Although the sclerotic\nmargin is somewhat reassuring, correlation with clinical history and a head CT\nis recommended and perhaps radionuclide bone scan is recommended.\n\nThere is a sclerotic focus in the left side of the T1 vertebral body. This is\nnew since the neck CT of ___ and may represent a bone island. Again,\ncorrelation with clinical history is recommended and consider a radionuclide\nbone scan.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "1. Degenerative disc disease most marked at C5-6 were a midline disc\nprotrusion appears to flatten the anterior aspect of the spinal cord.\n2. Lytic lesion with sclerotic margins in the left occipital bone,\nincompletely imaged. This may represent a brown tumor, but correlation with\nhistory and perhaps head CT and radionuclide bone scan should be considered.\n3. Sclerotic lesion in the left side of the T1 vertebral body, new since the\nneck CT of ___. This may represent a bone island. Correlation with\nclinical history and perhaps radionuclide bone scan should be considered.\n\nRECOMMENDATION(S): Consider head CT to evaluate the left occipital lesion and\nradio nuclei bone scan to evaluate this as well as the sclerotic focus in the\nleft side of the T1 vertebral body." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. There remains a 2.8 x 0.7 cm (TRV, AP ;\nseries 3, image 33) retropharyngeal fluid/fat stranding, spanning C2-C3\nthrough C3-C4, significantly improved from prior CT neck of is ___. Again seen is a large midline intervertebral disc protrusion at C5-C6\ncausing mild flattening of the anterior thecal sac. There is no significant\nneural foraminal narrowing. A bone island is again seen within the T1\nvertebral body on the left.\n\nThere is septal thickening at the lung apices compatible with mild pulmonary\nedema. The tracheostomy tube is identified. Metallic stent is seen at the\nright supraclavicular region. A 1.1 cm thyroid nodule is seen extending from\nthe left lobe anteriorly (03:50) containing some foci of calcifications. \nLytic focus in the left occipital bone is again identified. There is no\ncervical lymphadenopathy. Fluid opacification of the bilateral mastoid air\ncells middle ear cavities are re-identified.", "output": "1. No acute fracture or traumatic malalignment. Mild degenerative disc\ndisease at C5-C6.\n2. 1.1 cm left thyroid nodule for which a nonemergent thyroid ultrasound is\nrecommended if not previously obtained.\n3. Interval improvement in size of retropharyngeal fluid/fatty stranding\nspanning C2-C3 through C3-C4 since CT neck of ___.\n\nRECOMMENDATION(S): None emergent thyroid ultrasound." }, { "input": "Alignment is normal. No acute fracture is seen. There is multilevel\nintervertebral disc space narrowing, subchondral sclerosis and cystic change,\nand osteophytosis which is most severe at C4-C5, C5-C6, and C6-C7. There is\nmoderate left greater than right facet arthropathy. There is moderate central\ncanal narrowing C4-C5, C5-C6, and C6-C7. There is mild bilateral neural\nforaminal stenosis at C5-C6 and right sided neural foraminal stenosis at\nC6-C7. Reversal of normal cervical lordosis is noted. A focal calcification\nin the right lobe of the thyroid is noted.", "output": "1. No fracture or malalignment.\n\n2. Moderate degenerative changes of the cervical spine at C4-C7 with moderate\ncentral canal narrowing." }, { "input": "This study is somewhat limited due to patient's body habitus. Allowing for\nthis, there is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. Multilevel, multifactorial degenerative\nchanges are present with disc space narrowing, subchondral sclerosis, and\nendplate osteophyte formation. There are posterior disc protrusions at C3-C4\nthrough C6-C7 with mild spinal canal stenosis better evaluated on the prior\nMRI. There is also extensive uncovertebral and facet hypertrophy with neural\nforaminal narrowing most pronounced at C3-C4 through C6-C7 levels.\n\nThe thyroid gland is unremarkable. There is no cervical lymphadenopathy. \nIncluded lung apices are clear. Atherosclerotic calcifications of the carotid\nbifurcation are moderate.", "output": "1. No acute fracture or traumatic malalignment.\n\n2. Multilevel degenerative changes as described above most pronounced at\nC3-C4 through C6-C7 levels with mild spinal canal stenosis and moderate to\nsevere neural foraminal narrowing better characterized on prior MRI." }, { "input": "Alignment appears within normal limits, no priors available for comparison.\nThere is no evidence of acute fracture. Multilevel degenerative changes are\nnoted including facet osteophytes contributing to multilevel mild neural\nforaminal narrowing. Disc bulge at C3/C4 and C4/C5 cause mild narrowing of\nthe central canal. There is no prevertebral edema.\n\nVisualized thyroid gland is homogeneous. Lung apices are significant for mild\npleuroparenchymal scarring and atelectasis; some apparent ground-glass opacity\ncould relate to motion versus component of pulmonary edema.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes. Disc bulges at C3/C4 and C4/C5 cause mild\nnarrowing of the central canal.\n3. Partially imaged lung apices demonstrate apparent ground-glass opacity\nimage may relate to patient motion versus component of pulmonary edema. Chest\nx-ray would further assess." }, { "input": "Alignment is preserved. No acute fractures are identified. Multilevel\ndegenerative changes are again seen throughout the cervical spine. Disc\nbulging at C3-4 and C4-5 appears similar prior and causes mild narrowing of\nthe central canal. There is no prevertebral soft tissue swelling.No\nradiopaque foreign body seen.\n\nBiapical pleuroparenchymal scarring is again seen", "output": "No acute fracture or traumatic malalignment." }, { "input": "No traumatic malalignment is identified.No fractures are identified.Multilevel\ndegenerative changes are most notable for anterior and posterior osteophytes\nat C6-7 causing moderate to severe spinal canal narrowing and severe left\nneural foraminal narrowing. Severe bilateral neural foraminal narrowing is\nnoted at C5-6. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.", "output": "1. No fracture is identified.\n2. Multilevel degenerative changes are most notable for C6-7 moderate to\nsevere spinal canal narrowing and severe neural foraminal narrowing at\nbilateral C5-6 and left C6-7." }, { "input": "Alignment is normal. No acute fracture is seen.There is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.The thyroid gland is grossly homogeneous. Partially imaged lung\napices are clear.", "output": "1. No acute fracture or dislocation of the cervical spine." }, { "input": "There is no evidence of acute cervical spine fracture or traumatic\nmalalignment. There is 2 mm of anterolisthesis of C5 on C6 and C7 on T1. \nThere is no prevertebral soft tissue swelling. There is multilevel loss of\ndisc height with mild associated anterior and posterior osteophytosis worse at\nC4-5. Facet hypertrophy and uncovertebral bony spurring results in minimal\nspinal canal and moderate neural foraminal narrowing, bilaterally worse at\nC4-5 and C5-6.\n\nThere is nodular scarring at the lung apices, bilaterally, more significant on\nthe right. The visualized esophagus, distally is patulous.", "output": "1. No evidence of acute cervical spine fracture or traumatic malalignment." }, { "input": "There is minimal anterolisthesis of C7 on T1. Alignment is otherwise normal\nand no fractures are identified. There is slight rotation of C1 on C2, a\nnormal finding.Posterior osteophytes at C6-7 mildly narrow the spinal canal. \nThere is mild neural foraminal narrowing due to uncovertebral osteophytes\nbilaterally at multiple levels. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.", "output": "1. Mild anterior subluxation of C7 on T1 due to degenerative disease. No\nevidence of fracture.\n2. Alignment is otherwise normal\n3. Degenerative disc disease at multiple levels\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:09 am, 10 minutes\nafter discovery of the findings." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. Multilevel, mild to moderate\nmultifactorial degenerative changes are present with disc space narrowing and\nmild vertebral body osteophyte formation, particularly at C5-C6 and C6-C7\nlevels. There is also uncovertebral and facet hypertrophy causing moderate\nleft neural foraminal narrowing at C5-C6. Two sclerotic foci at the T2\nvertebral body are unchanged since prior study.\n\nThere are partially visualized opacities at the bilateral apices as well as\nmild interlobular septal thickening. There are also mildly enlarged\nmediastinal lymph nodes measuring up to 10 mm in the right paratracheal\nstation. These are increased in size compared to prior study from ___. There is no cervical lymphadenopathy. Atherosclerotic calcifications\nare present in the bilateral carotid arteries. The thyroid gland is\nunremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n\n2. Multilevel degenerative changes as described above.\n\n3. Interval development of bilateral opacities seen at the lung apices\nconcerning for infection with a possible component of mild fluid overload. \nMildly enlarged mediastinal lymph nodes, likely reactive." }, { "input": "Alignment is normal. No fractures are identified. Again seen are multiple\ndegenerative changes throughout the cervical spine most notable at C5 through\nC7 with endplate sclerosis, disc space loss, with small anterior osteophytes. \nA small posterior disc osteophyte complex at C5-C6 is seen causing mild canal\nnarrowing. 2 densely sclerotic lesions within the T2 vertebral body are\nstable since prior examination. No prevertebral soft tissue swelling. There\nis no evidence of infection or neoplasm.\n\nLimited assessment of lung apices demonstrates bilateral heterogeneous\nground-glass opacities, similar in appearance to ___ CT previously\ncharacterized as infectious etiology and possibly cryptogenic organizing\npneumonia.", "output": "1. No acute fracture or dislocation.\n2. Mild degenerative changes most prominent at C5 through C6 with small\nposterior disc osteophyte complex causing mild canal narrowing.\n3. Limited assessment of lung apices again demonstrates bilateral\nheterogeneous ground-glass opacities previously characterized as possibly\ninfectious etiology and possibly cryptogenic organizing pneumonia." }, { "input": "Alignment is normal. No fractures are identified. There mild multilevel\ndegenerative changes worst at C5-C6 and C6-C7 including intervertebral disc\nheight loss and anterior, posterior, and uncovertebral osteophytosis. There\nis mild right osseous neural foraminal narrowing at C4-C5, mild bilateral\nosseous neural foraminal narrowing at C5-C6 and maybe mild osseous neural\nforaminal narrowing at C6-C7. The calcified posterior disc bulge at C4-C5 and\nposterior osteophytes at C5-C6 cause mild canal narrowing. Incidental note is\nagain made of a small bone island in the T2 vertebral body.\n\nScattered biapical ground-glass opacities are better characterized on same day\nchest CT.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Mild degenerative changes as above.\n3. Biapical ground-glass opacities are better characterized on same day chest\nCT." }, { "input": "No traumatic malalignment or fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema. There are\nmultiple subcentimeter hypodensities scattered throughout the cervical spinal\nvertebral bodies (most prominent at C2, C4 and C5), of indeterminate clinical\nsignificance (for example 602/40), which appears to demonstrate trabeculated\npattern on axial sequences (series 2, image 31, 36, felt most likely to\nrepresent hemangiomas.\n\nThe thyroid is unremarkable. There is a large cyst in the right upper lobe. \nVisualized lung apices are otherwise unremarkable. There is no cervical\nlymphadenopathy by size criteria.", "output": "1. No traumatic malalignment or fractures are identified.\n2. Rounded lucencies in the cervical spine at C 2, C4 and C5 which appears to\ndemonstrate trabeculated pattern on axial sequences, felt to most likely\nrepresent hemangiomas. Clinical correlation with patient history is\nrecommended." }, { "input": "Study is moderately degraded by motion and streak artifact. Within these\nconfines:\n\nThere is no acute fracture or malalignment. Mild straightening of the normal\nlordosis is likely degenerative. Please note evaluation for prevertebral soft\ntissue swelling is limited secondary to motion streak artifact. At the C6-7\nlevel there is right disc protrusion, resulting in moderate spinal canal\nnarrowing. There is left neural foraminal narrowing at the C5-6 level.Heavy\ncalcification of the distal vertebral arteries is noted.Within the limitations\nof this noncontrast exam, there is no evidence of neoplasm or infection.", "output": "1. Study is moderately degraded by motion and streak artifact.\n2. Within limits of study, no definite acute fracture or traumatic\nmalalignment.\n3. Multilevel degenerative changes as described." }, { "input": "Vertebral body alignment is preserved. Vertebral body heights are preserved. \nNo prevertebral soft tissue abnormality is seen. Multilevel degenerative\nchanges noted throughout the thoracic spine, including loss of intervertebral\ndisc height, and vacuum disc phenomenon. There is no evidence of bony spinal\nstenosis. Limited imaging of the thorax again demonstrates extensive\natherosclerotic vascular calcifications.\n\nAt the right lung base is a small focus of ___ opacity\n(4:82).", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. ___ / ground-glass opacity at right lung base, concerning for\ninfectious or inflammatory etiology." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nGrade 1 anterolisthesis of the L5 on S1 vertebral bodies is unchanged dating\nback to ___ prior lumbar spine MRI. There is no acute fracture. Chronic\nbilateral L5 pars fractures are again seen, grossly unchanged compared to ___ prior examination. There is transitional anatomy, with partial\nsacralization of L5.\n\nThere is no definite bony spinal canal stenosis. Multilevel degenerative\nchanges are noted, including loss of intervertebral disc height and vacuum\ndisc phenomena. There is heavy atherosclerotic calcification of the\nvisualized vessels, as well as sigmoid diverticulosis.Within the limitations\nof this noncontrast exam, there is no evidence of infection or neoplasm.", "output": "1. No acute fracture, or traumatic malalignment.\n2. Chronic bilateral L5 pars fractures, with grossly stable grade 1 L5 on S1\nanterolisthesis.\n3. Multilevel degenerative changes as described.\n4. Please note MRI of the spine is more sensitive for evaluation of\nligamentous injury and vertebral canal stenosis." }, { "input": "Alignment is normal. No acute cervical spine fractures are identified.\nMultilevel degenerative changes are seen, centered at C4 and C5 with\nuncovertebral hypertrophy, intervertebral disc height loss with secondary mild\nleft foraminal narrowing.There is no prevertebral edema.\n\nExtensive atherosclerotic calcifications are seen in the distal bilateral\nvertebral arteries as well as the bilateral common carotid and internal\ncarotid arteries. There is an abnormal appearance and shape of the first and\nsecond left ribs compatible with old healed fractures. The thyroid and\nincluded lung apices are unremarkable.", "output": "Degenerative changes at C5-C6 without acute fracture or malalignment." }, { "input": "No compression fracture is seen. There is no spinal stenosis identified. No\nlytic or sclerotic lesions are seen. No paraspinal soft tissue abnormalities\nare identified.", "output": "1. No significant abnormalities are seen on CT of the thoracic spine." }, { "input": "Alignment is normal. No fractures are identified. A l stimulator device is\nout of field of view however the lead enters from the posterior subcutaneous\ntissues through the left S4 sacral foramina into the retroperitoneal space\nwith lead tip anterior to the left ileococcygeous muscle within the presacral\nspace.\n\nMinimal degenerative changes throughout the lumbar spine with small anterior\nosteophytes. Small posterior disc bulge at L3-L4 is also seen (05:50). \nAdditional small posterior disc bulge at L4-L5 is noted without significant\nspinal canal or neural foraminal narrowing. There is no additional evidence\nof spinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nThe visualized intra-abdominal structures are notable for large fecal load and\n0.3 cm nonobstructing left renal stone. No hydronephrosis.", "output": "1. Partially visualized device lead tip within the left presacral space.\n2. Minimal degenerative changes throughout the lumbar spine.\n3. 0.3 cm nonobstructing left renal stone." }, { "input": "Alignment is normal. No acute fractures are identified. There is no evidence\nof spinal canal stenosis. Mild degenerative changes seen with disc space\nnarrowing at C5/C6 and to a lesser extent at C6/C7, with are also small\nanterior posterior osteophytes. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm. Thyroid gland is\ngrossly homogeneous. Partially imaged lung apices are clear.", "output": "1. No acute fracture or dislocation.\n\nNOTIFICATION: No acute fracture identified." }, { "input": "There is mild anterolisthesis of C4 on C5 and C5 on C6.No acute fractures are\nidentified. Severe multilevel degenerative changes are present. There is mild\nmultilevel spinal canal narrowing secondary to posterior osteophytes and mild\ndisc bulge. There is no prevertebral soft tissue swelling. There is diffuse\nosteopenia. Scattered small cervical lymph nodes are not pathologically\nenlarged.", "output": "1. Mild anterolisthesis of C4 on C5 and C5 on C6 likely secondary to\ndegenerative changes. However, given lack of priors for comparison, if there\nis high clinical concern for acute ligamentous injury, MRI is more sensitive\nand should be considered.\n2. No acute fractures are identified.\n3. Severe multilevel degenerative changes with mild multilevel spinal canal\nnarrowing noted." }, { "input": "No fractures are identified allowing for loss of bone mineralization. No\nevidence for prevertebral soft tissue swelling. There is minimal\nretrolisthesis at C4-C5, C5-C6, and C6-C7, and minimal anterolisthesis at\nC7-T1. Disc space narrowing is most prominent at C3-C4 and C4-C5. Disc\nprotrusions and endplate osteophytes indent the ventral thecal sac at multiple\nlevels with mild to moderate spinal canal narrowing. There is also multilevel\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nThere is partially imaged right pleural effusion and/or atelectasis, as seen\non recent chest radiographs and abdominal/pelvic CT from ___ and\n___, respectively. Partially visualized thyroid is grossly\nunremarkable.", "output": "1. No evidence of a fracture allowing for loss of bone mineralization.\n2. Minimal spondylolisthesis from C4-C5 through C7-T1 is almost certainly\ndegenerative, though there are no comparison exams to confirm chronicity.\n3. Multilevel degenerative disease with mild to moderate spinal canal\nnarrowing.\n4. Right pleural effusion and/or atelectasis are again partially imaged" }, { "input": "The study is substantially limited due to patient positioning and motion.\n\nWithin limits of this study, there is no definite fracture or prevertebral\nsoft tissue swelling.\n\nMultilevel, multifactorial degenerative changes are present with disc space\nnarrowing, subchondral sclerosis, and marginal osteophyte formation,\nparticularly at C4-C5 level. There is also uncovertebral and facet\nhypertrophy at multiple levels causing with mild bilateral neural foraminal\nnarrowing at C5-C6.\n\nA massively enlarged multinodular goiter is present with the right lobe of the\nthyroid entering the mediastinum causing leftward deviation of the trachea. \nLung apices demonstrate atelectasis. There is dilation of the pulmonary\nartery measuring up to 3.7 cm as well as the ectasia of the ascending aorta\nmeasuring up to 3.9 cm.", "output": "1. Substantially limited evaluation due to patient positioning and motion.\nWithin limits of study, no definite acute fracture or traumatic malalignment.\nRecommend clinical correlation. If clinically indicated, consider repeat\nexamination when patient can tolerate exam.\n2. Multilevel, multifactorial degenerative changes as described above.\n3. Massively enlarged multi nodular goiter the right lobe of the thyroid gland\ncausing leftward deviation of the trachea. A nonemergent thyroid ultrasound\nis recommended for further evaluation if not previously obtained.\n4. Dilation of the pulmonary artery and ectasia of the ascending aorta\nmeasuring 3.7cm and 3.9cm respectively. Recommend clinical correlation.\n\nRECOMMENDATION(S):\n1. Substantially limited evaluation due to patient positioning and motion.\nWithin limits of study, no definite acute fracture or traumatic malalignment.\nRecommend clinical correlation. If clinically indicated, consider repeat\nexamination when patient can tolerate exam.\n2. Massively enlarged multi nodular goiter the right lobe of the thyroid gland\ncausing leftward deviation of the trachea. A nonemergent thyroid ultrasound\nis recommended for further evaluation if not previously obtained.\n3. Dilation of the pulmonary artery and ectasia of the ascending aorta\nmeasuring 3.7cm and 3.9cm respectively. Recommend clinical correlation." }, { "input": "No acute fracture or dislocation is identified. There is no prevertebral soft\ntissue swelling. Multilevel, multifactorial degenerative changes are again\nidentified with disc space narrowing, subchondral sclerosis, and endplate\nosteophyte formation, particularly at C4-C5 level. There is also\nuncovertebral and facet hypertrophy causing mild bilateral neural foraminal\nnarrowing at C5-C6. Posterior endplate osteophytes and disc protrusions are\npresent at C3-C4 through C5-C6 levels effacing the ventral CSF did various\ndegrees. In combination with ligamentum flavum thickening there is likely\nmoderate canal narrowing most notable at C5-C6.\n\nAgain seen is a massively enlarged multi nodular goiter in the right lobe of\nthe thyroid causing leftward shift of the trachea. The visualized lung apices\nare clear. There is no cervical lymphadenopathy.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel, multifactorial degenerative changes as described above.\n3. Massively enlarged multi nodular goiter in the right thyroid lobe for which\na nonemergent thyroid ultrasound is recommended if not previously obtained." }, { "input": "The bones are demineralized. No acute fractures or traumatic malalignment are\nidentified. There is no prevertebral soft tissue swelling.\n\nMultilevel degenerative changes of the cervical spine is again seen, worst at\nC4-5, with vertebral body height loss, disc space narrowing, subchondral\nsclerosis and osteophytosis. Degenerative pannus formation mildly narrows the\nspinal canal at C1-2. There is mild to moderate spinal canal narrowing at\nC3-4, C4-5 and C5-6 due to posterior osteophytes and central disc protrusion.\n\nAgain seen is a large multinodular goiter in the right lobe of the thyroid\nwith mass effect and a leftward shift of the trachea, not significantly\nchanged from prior. Biapical scarring is noted. Heavy calcification of the\nvertebral arteries are seen.", "output": "1. No acute fractures or traumatic malalignment.\n2. Degenerative changes as above.\n3. Unchanged appearance of a large multinodular goiter.\n4. Heavy calcification of the vertebral arteries." }, { "input": "There is no evidence of fracture, dislocation or bone destruction. There is\nno prevertebral soft tissue swelling. Surrounding soft tissue structures are\nunremarkable. Visualized lung apices appear clear.\n\nModerate degenerative changes affect the atlantodens articulation. The right\nC2-C3 facet is moderately narrowed. There is mild spondylolisthesis of C3 on\nC4 which is likely attributable to severe degenerative change of the\nright-sided facet. Associated with that and uncovertebral osteophyte\nformation is moderate bilateral neural foraminal narrowing. At C4-C5,\ninterspace is moderately narrowed. There is severe right-sided and mild\nleft-sided facet arthropathy. Interspace is moderately narrowed. The C5-C6\nand C6-C7 interspaces are severely narrowed and irregular with sclerosis and\nmarginal osteophytes. Associated with this is mild neural foraminal narrowing\nbilaterally. There is slight spondylolisthesis of C7 on T1 associated with\nbilateral facet arthropathy. Bilateral facet arthropathy also probably\nexplains mild spondylolisthesis of T2 on T3. Alignment of the cervical spine\nis mostly similar although spondylolisthesis of C3 on C3 is new but associated\nwith marked worsening of right facet joint degenerative change.\n\nSurrounding soft tissue structures are unremarkable. Visualized lung apices\nappear clear.", "output": "No evidence of fracture or dislocation. Moderate to severe degenerative\nchanges." }, { "input": "No cervical spine fracture or acute malalignment.\nMinimal anterolisthesis of c3 over c4 and c4 over c5.\nMild straightening of the cervical spine. Vertebral body and disc height are\npreserved. Multilevel degenerative changes are noted most notably at C4\nthrough C6 with posterior osteophytes. Pre and paravertebral soft tissues are\nnormal. Visualized portions of the skullbase show no abnormalities.\n\nLimited assessment of the spinal canal demonstrates severe canal narrowing at\nC5 and C6 with moderate-large disc osteophyte complex with posterior\nosteophytes and a component of disc herniation better characterized on MRI\ndated ___. Moderate bilateral uncovertebral hypertrophy is noted\nat the similar level.\nVisualized portions of the aerodigestive tract are patent.\nLimited assessment of the lung apices are clear.\nMild mucosal thickening of the sphenoid sinus is noted.\nAdditional visualized paranasal sinuses are clear.\nA 1.5 x 1.3 cm coarse peripherally calcified nodule is seen within the right\nlobe of the thyroid.", "output": "1. No cervical spine fracture or malalignment minimal anterolisthesis of C3\nover C4 and C4 over C5.\n2. Persistent severe canal narrowing and moderate uncovertebral hypertrophy\nat C5-C6 with moderate-large disc osteophyte complex, better characterized on\nMRI dated ___. No significant change compared to the prior CT\nstudy done 2 days before dated ___.\n3. 1.5 cm partly calcified right thyroid lobe nodule. If not previously\nassessed, and clinically warranted a non urgent thyroid ultrasound can be\nconsidered." }, { "input": "There is been interval ACDF at C4 through C6 with inter disc spacers in place.\nMinimal anterolisthesis of C3 on C4 is unchanged. Alignment at C6 through C6\nis anatomic. No new fractures are visualized. There is no sign of hardware\nloosening or failure. Gas in the prevertebral soft tissues is accounted for by\nrecent postoperative state. A 1.5 cm partly calcified nodule in the right lobe\nof the thyroid gland is again noted. Minimal bilateral maxillary sinus mucosal\nthickening is noted. Periapical lucency and dental caries about several\nmandibular and maxillary teeth is again noted. The visualized portion of the\naerodigestive tract is unremarkable. The visualized portion of the lung apices\nare clear.", "output": "1. Status post C4-6 ACDF without sign of hardware loosening or failure.\nAlignment at these levels is anatomic.\n2. Minimal anterolisthesis of C3 on C4 is unchanged.\n3. Partly calcified nodule in the right lobe of the thyroid. Nonemergent\nultrasound is again recommended for further evaluation.\n4. Multiple periapical lucencies about both maxillary and mandibular teeth.\nCorrelation with dental exam is recommended." }, { "input": "There has been anterior fusion at C4-5 and C5-6. Images of these levels are\nsubstantially obscured by artifacts from the shoulders. Within these\nlimitations, there is no evidence of hardware failure. Alignment appears\nnormal. There is probably bony fusion at C4-5. It is more difficult to\nevaluate the C5-6 level. It appears likely there may be osseous fusion at this\nlevel as well. Within the limitations of the study, there is no evidence of\nosseous encroachment on the spinal canal. Soft tissues of the spinal canal are\nresolved only as inferiorly as upper C4. Below this level, I cannot evaluate\nintraspinal soft tissues.\n\nNo fractures are identified. There is no evidence of infection or neoplasm.\n\nAgain seen is a calcified right thyroid nodule.", "output": "Status post anterior fusion at C4-5 and C5-6. There is likely osseous fusion\nat C4-5. The C5-6 level is difficult to evaluate due to overlying artifacts." }, { "input": "Cervical spine: The exam is moderately degraded below the C4 level due to beam\nhardening artifact related to fusion hardware and patient body habitus.\n\nThere postoperative changes for anterior cervical discectomy and fusion at\nC4-5 and C5-6. There is solid osseous fusion across the C4-5 and C5-6 disc\nspaces. Cervical vertebral body height and alignment appear preserved.\n\nThere is significant artifact in the ventral spinal canal from C4 through C7.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-4, a the disc osteophyte complex, shallow broad-based disc bulge results\nin moderate central canal narrowing, there is mild cord flattening, without\ncomplete effacement of CSF about cord, findings are less severe compared with\nMRI ___. There is probably mild bilateral foraminal narrowing,\nsimilar to prior.\n\nAt C4-5, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C5-6, there is suggestion of right paramedian, ventral osteophyte which\nindents ventral margin of the cord and contributes to probably moderate\nnarrowing of the right side of the canal, and there is mild narrowing left\nmargin of the canal, with well preserved CSF dorsally. This is best seen on\nseries 2, image 45 end is also suggested on MRI exam series 2 image 25\nsagittal T2 weighted images from ___ with correlate on axial T2\nweighted image series 6, image 19. Other areas of artifact in the ventral\ncanal are fairly fuzzy appearing, and this appears well-circumscribed, is\nprobably real abnormality. There is mild-to-moderate\n right and moderate left neural foraminal narrowing.\n\nAt C6-7, analysis poorly seen, there is probably disc osteophyte complex\ncontributing to moderate central canal narrowing, also seen on prior. There\nmay be small component of broad-based shallow disc protrusion, difficult to be\ncertain given artifact.\nFindings may be worse from the ___ MRI. There is mild left neural\nforaminal narrowing. There is no right neural foraminal narrowing.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.\n\nThere is a 15 mm nodule within the right lobe of the thyroid gland with thick\ncalcification. There is a mildly enlarged level 1B lymph node (series 301,\nimage 24). The prevertebral and paraspinal soft tissues are otherwise\nunremarkable. The imaged lung apices are clear.\n\n\nLumbar spine:\nThe exam is mildly degraded due to patient body habitus.\n\nLumbar vertebral body height and alignment are preserved. There are mild\ndegenerative endplate changes at T12-L1, L1-2, and L5-S1 with few endplate\nSchmorl's nodes, endplate hypertrophic changes. Lower lumbar facet arthritis\nis most prominent at L4-5, L5-S1 levels..\n\nThe conus medullaris terminates at the L1-2 level.\n\nAt T11-12, a right paracentral disc protrusion contacting and minimally\neffacing ventral cord, results in mild spinal canal narrowing. There is no\nneural foraminal narrowing.\n\nAt T12-L1, right paracentral disc protrusion results in mild spinal canal\nnarrowing, minimal effacement of the ventral cord, similar to prior. There is\nno neural foraminal narrowing.\n\nAt L1-2, there is minimal spinal canal narrowing, similar to prior. No neural\nforaminal narrowing.\n\nAt L2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt L3-4, there is no spinal canal or neural foraminal narrowing.\n\nAt L4-5, minimal central canal, minimal foraminal narrowing.\n\nAt L5-S1, there is prominent endplate disc osteophyte complex and probable\npartially calcified disc protrusion, which does not indent thecal sac, and is\nbetter seen on the prior MRI. There is mild-to-moderate right and moderate\nleft neural foraminal narrowing.\n\nIncreased attenuation within the posterior paraspinal soft tissues at the L3-4\nlevel may reflect edema. The prevertebral and paraspinal soft tissues are\notherwise unremarkable.", "output": "1. C4-6 ACDF, with solid osseous fusion across the C4-5 and C5-6\nintervertebral disc spaces. There is no evidence for hardware complication.\n2. Images in the cervical spine are compromised at the operated level.\n3. Probably moderate central canal narrowing at C5-C6 level.\n4. Probably moderate spinal canal narrowing at C6-7, likely worse from the ___ MRI.\n5. Lumbar spine degenerative changes.\n6. Mild spinal canal narrowing at T11-12 and T12-L1 due to small disc\nprotrusions.\n7. Bilateral L5-S1 foraminal narrowing.\n8. A 1.5 cm calcified thyroid nodule, recommendations below.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n." }, { "input": "Cervical spine: The exam is moderately degraded below the C4 level due to beam\nhardening artifact related to fusion hardware and patient body habitus.\n\nThere postoperative changes for anterior cervical discectomy and fusion at\nC4-5 and C5-6. There is solid osseous fusion across the C4-5 and C5-6 disc\nspaces. Cervical vertebral body height and alignment appear preserved.\n\nThere is significant artifact in the ventral spinal canal from C4 through C7.\n\nAt C2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt C3-4, a the disc osteophyte complex, shallow broad-based disc bulge results\nin moderate central canal narrowing, there is mild cord flattening, without\ncomplete effacement of CSF about cord, findings are less severe compared with\nMRI ___. There is probably mild bilateral foraminal narrowing,\nsimilar to prior.\n\nAt C4-5, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C5-6, there is suggestion of right paramedian, ventral osteophyte which\nindents ventral margin of the cord and contributes to probably moderate\nnarrowing of the right side of the canal, and there is mild narrowing left\nmargin of the canal, with well preserved CSF dorsally. This is best seen on\nseries 2, image 45 end is also suggested on MRI exam series 2 image 25\nsagittal T2 weighted images from ___ with correlate on axial T2\nweighted image series 6, image 19. Other areas of artifact in the ventral\ncanal are fairly fuzzy appearing, and this appears well-circumscribed, is\nprobably real abnormality. There is mild-to-moderate\n right and moderate left neural foraminal narrowing.\n\nAt C6-7, analysis poorly seen, there is probably disc osteophyte complex\ncontributing to moderate central canal narrowing, also seen on prior. There\nmay be small component of broad-based shallow disc protrusion, difficult to be\ncertain given artifact.\nFindings may be worse from the ___ MRI. There is mild left neural\nforaminal narrowing. There is no right neural foraminal narrowing.\n\nAt C7-T1, there is no spinal canal or neural foraminal narrowing.\n\nThere is a 15 mm nodule within the right lobe of the thyroid gland with thick\ncalcification. There is a mildly enlarged level 1B lymph node (series 301,\nimage 24). The prevertebral and paraspinal soft tissues are otherwise\nunremarkable. The imaged lung apices are clear.\n\n\nLumbar spine:\nThe exam is mildly degraded due to patient body habitus.\n\nLumbar vertebral body height and alignment are preserved. There are mild\ndegenerative endplate changes at T12-L1, L1-2, and L5-S1 with few endplate\nSchmorl's nodes, endplate hypertrophic changes. Lower lumbar facet arthritis\nis most prominent at L4-5, L5-S1 levels..\n\nThe conus medullaris terminates at the L1-2 level.\n\nAt T11-12, a right paracentral disc protrusion contacting and minimally\neffacing ventral cord, results in mild spinal canal narrowing. There is no\nneural foraminal narrowing.\n\nAt T12-L1, right paracentral disc protrusion results in mild spinal canal\nnarrowing, minimal effacement of the ventral cord, similar to prior. There is\nno neural foraminal narrowing.\n\nAt L1-2, there is minimal spinal canal narrowing, similar to prior. No neural\nforaminal narrowing.\n\nAt L2-3, there is no spinal canal or neural foraminal narrowing.\n\nAt L3-4, there is no spinal canal or neural foraminal narrowing.\n\nAt L4-5, minimal central canal, minimal foraminal narrowing.\n\nAt L5-S1, there is prominent endplate disc osteophyte complex and probable\npartially calcified disc protrusion, which does not indent thecal sac, and is\nbetter seen on the prior MRI. There is mild-to-moderate right and moderate\nleft neural foraminal narrowing.\n\nIncreased attenuation within the posterior paraspinal soft tissues at the L3-4\nlevel may reflect edema. The prevertebral and paraspinal soft tissues are\notherwise unremarkable.", "output": "1. C4-6 ACDF, with solid osseous fusion across the C4-5 and C5-6\nintervertebral disc spaces. There is no evidence for hardware complication.\n2. Images in the cervical spine are compromised at the operated level.\n3. Probably moderate central canal narrowing at C5-C6 level.\n4. Probably moderate spinal canal narrowing at C6-7, likely worse from the ___ MRI.\n5. Lumbar spine degenerative changes.\n6. Mild spinal canal narrowing at T11-12 and T12-L1 due to small disc\nprotrusions.\n7. Bilateral L5-S1 foraminal narrowing.\n8. A 1.5 cm calcified thyroid nodule, recommendations below.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n." }, { "input": "Alignment is maintained. No definite fractures are identified. There is no\nprevertebral soft tissue swelling.\n\nMild-to-moderate degenerative changes are seen in the cervical spine, notably\nat the C5-C6 vertebral level with loss of intervertebral disc height,\nosteophyte formation, and subchondral sclerosis. Multilevel vertebral canal\nnarrowing is noted due to posterior osteophytes and disc bulges with resultant\ndeformation of the spinal cord. There is multilevel uncovertebral and facet\njoint hypertrophy, notably at the right C2-C3 and C3-C4 vertebral level.\n\nThere is no evidence of infection or neoplasm. No focal consolidation is\nidentified the lung apices. The thyroid gland is unremarkable.", "output": "1. No definite fracture or subluxation is seen in the cervical spine." }, { "input": "Please note that the numbering scheme of the disc spaces is retained from the\nprior MR study, namely, that there is a \"transitional\" S1 segment. \nTherefore, if a lumbar spinal operation is contemplated in the future, it is\nessential that correct disc space localization be achieved through the use of\nintraoperative x-rays.\n\nAt T11-12 and T12-L1, there is moderate disc space narrowing, a small amount\nof vacuum disc degeneration, and moderate size anterior bridging osteophytes.\n\nAt L1-2, there is a small Schmorl's node arising from the anterior aspect of\nthe L1 inferior endplate. There is a small anterior bridging osteophyte. \nThere is curvilinear dystrophic calcification of the medial aspect of the left\nligamentum flavum. This abnormality causes mild impingement upon the dorsal\nlateral aspect of the thecal sac, again on the left side.\n\nAt L2-3, there is a small anterior bridging osteophyte, and a larger right\nlateral bridging osteophyte.\n\nAt L3-4, there is moderate disc space narrowing, discogenic sclerosis on\neither side of the disc space, and multiple small Schmorl's nodes, also on\nboth sides of the disc space. There is mild bilateral facet joint\ndegeneration and more moderate bilateral thickening of the ligamentum flavum. \nThere is resultant moderately prominent central canal and right L4 lateral\nrecess stenosis. There is mild left and moderate right neural foraminal\nstenosis.\n\nAt L4-5, there is a mildly bulging, moderately narrowed disc. There is mild\nbilateral facet joint degeneration, but with a somewhat more prominent\nosteophyte arising from the medial margin of the left L4 inferior articular\nfacet. There is resultant moderate central canal and prominent left L5\nlateral recess stenosis. There is moderate left neural foraminal stenosis.\n\nAt L5-S1, there is moderate left and milder right-sided facet joint\ndegeneration. There is mild left neural foraminal stenosis.\n\nWithin the right iliac bone marrow, adjacent to the sacroiliac joint is an\novoid, up to 8 mm region of osteolysis, most of which has a well-defined\ncorticated margin. The etiology of this finding is nonspecific. Neither your\nrequisition, nor information provided by the patient on the intake sheet, nor\ninformation from Care Web indicated any known history of a malignancy that\ncould produce an osteolytic metastasis. Please confirm this supposition. A\nbenign process, such as a low fat content hemangioma is an alternative\ndiagnosis, particularly given the generally well corticated lesion margin.\n\nThere is minimal atherosclerotic calcification of the abdominal aorta. There\nare few punctate radiodensities within what appear to be a loop of small\nbowel. Perhaps they are ingested food material or pills.", "output": "Multilevel degenerative changes of the lower thoracic and lumbar spine. \nTransitional S1 segment. Right iliac bone lesion, described above." }, { "input": "There is a transitional lumbar vertebral body segment (lumbarized S1).\n\nStatus post posterior laminectomy and at L3-L4, with partial laminectomy of L3\nand full laminectomy of L4 and L5.. Surgical hardware is intact. The right\npedicular screw at L4 appears to breach the cortex along the lateral aspect of\nthe pedicle and along the lateral aspect of the vertebral body (02:55), as\nwell as the superior endplate. There is appropriate anatomic alignment of the\nlumbar spine. No acute fractures.\n\nPostsurgical changes include soft tissue thickening and minimal subcutaneous\nemphysema at the surgical site. There is likely small volume fluid posterior\nto L5 a surgical drain terminates within the interspinous space of L4/L5. \nBackground degenerative changes are moderate to severe.\n\nThe lucent lesion in the right iliac bone near the sacroiliac joint is\nunchanged in size (series 2, image 94). Background degenerative changes\nthroughout the lumbar spine are stable.", "output": "1. Status post posterior partial laminectomy of L3 and laminectomy of L4 and\nL5 with posterior fusion of L3-L4.\n2. The right pedicular screw at L4 appears to be superiorly and laterally\noriented and breaches the cortex of the lateral aspect of the pedicle and\nvertebral body as well as the superior endplate. Attention on follow-up\nimaging is recommended." }, { "input": "Please note that CT is a port technique for detecting intraspinal soft tissue\nabnormalities. If this is the clinical concern, a follow-up spine MR without\nand with contrast is recommended.\nAgain seen is mild anterior subluxation of C4 on C5. Otherwise, alignment is\nnormal.No fractures are identified.There is no prevertebral soft tissue\nswelling. There is no abnormal enhancement on post contrast imaging. There\nare extensive changes of degenerative disc disease with loss of height of the\nintervertebral discs and disruption of the vertebral endplates at multiple\nlevels. The endplate destruction is most prominent at C7-T1, corresponding to\nthe area of discitis and osteomyelitis. However, there are similar changes\ninvolving the superior endplate of C7 and the inferior endplate of T1.\n\n\nAt C2-3 there is mild canal narrowing due to intervertebral osteophytes. \nThere is severe left neural foraminal narrowing due to uncovertebral\nosteophytes..\n\nAt C3-4 there is mild canal narrowing due to intervertebral osteophytes.\nThere is severe bilateral neural foraminal narrowing due to uncovertebral\nosteophytes\n\nAt C4-5 an intervertebral osteophyte in the midline and slightly to the right\nencroaches on the spinal canal and likely flattens the spinal cord. The\nneural foramina are mildly narrowed by facet and uncovertebral osteophytes..\n\nAt C5-6 there is mild spinal canal narrowing due to intervertebral\nosteophytes. The neural foramina appear normal..\n\nAt C6-7 there is no significant spinal canal or neural foraminal narrowing.\n\nAt C7-T1 there is no spinal canal or neural foraminal narrowing caused by\nosseous structures. CT is not suitable for evaluating intraspinal soft tissue\nabnormalities..", "output": "1. Endplate erosions at C7-T1 be a consequence of infection or degenerative\ndisease.\n2. Irregular endplates of the superior surface of C7 and inferior surface of\nT1 appear more likely due to degenerative disease in the absence of evidence\nof involvement of the adjacent endplates. This would be better evaluated with\nMR imaging.\n3. CT has poor sensitivity for detecting intraspinal soft tissue\nabnormalities.\n\nRECOMMENDATION(S): Repeat MR examination to address the status of intraspinal\nsoft tissue abnormalities associated with the previously demonstrated\nphlegmon." }, { "input": "Alignment is normal. No acute fractures are identified. There is no evidence\nof spinal canal stenosis. There is mild neural foraminal stenosis at the\nright uncovertebral joint of T1. There is multilevel degenerative changes\nincluding intervertebral disc height narrowing, anterior osteophytosis and\nendplate sclerosis most pronounced at T10-T11. No evidence of lytic or\nsclerotic lesions are demonstrated along the vertebral column. There is no\nprevertebral soft tissue swelling.. Mild bibasilar atelectasis is\ndemonstrated.", "output": "1. No acute fractures. No concerning lytic or sclerotic lesions seen along\nthe thoracic spine.\n2. Multilevel degenerative changes demonstrated most pronounced at T10-T11.\n\nRECOMMENDATION(S): If there is continued concern for osseous metastasis a\nnuclear medicine bone scan may be considered." }, { "input": "The previously described nondisplaced fracture of the right C5 lamina and\nright inferior articular facet of C5, extending to the C5-6 facet joint (2:54,\n56, 601b:29, 602b:22, 30) is unchanged compared to prior studies. No new\nfracture is identified.\n\nThe prevertebral soft tissues are unremarkable. Anterior osteophytosis of the\nC5 vertebral body is again noted. Although there is only minimal degenerative\nchange, diffuse canal narrowing is related to congenitally short pedicles.\n\nThere is no lymphadenopathy. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable.", "output": "1. Unchanged nondisplaced right C5 lamina and inferior articular facet\nfractures.\n2. No new cervical spine fracture is identified.\n3. Minimal degenerative changes, but congenitally narrow spinal canal geometry\ndiffusely narrows the spinal canal, as described above." }, { "input": "Alignment is normal. No fractures are identified. Mild multilevel\ndegenerative changes are seen including minimal disc space narrowing at\nmultiple levels and very small anterior and posterior osteophytes. There is\nno prevertebral edema.\n\nA 1.7 x 1.8 cm hypodensity in the left lobe of the thyroid is incompletely\nevaluated on this examination. There is a smaller subcentimeter hypodensity\nin the right lobe of the thyroid. Bilateral tonsilliths are incidentally\nnoted.", "output": "No evidence of acute fracture or traumatic malalignment.\n\n1.8 cm hypodensity in the left lobe of the thyroid is incompletely evaluated. \nRecommend nonurgent thyroid ultrasound for further evaluation when clinically\nappropriate." }, { "input": "Alignment is normal. No fractures are identified. Moderate degenerative\nchanges of the lumbar spine with facet joint arthropathy noted. At L3-4 and\nL4-5 there is mild disc bulge and ligamentum flavum hypertrophy that is\ncausing mild spinal canal narrowing and mild bilateral neural foraminal\nnarrowing. There is no prevertebral soft tissue swelling.\n\nThere is mild to moderate atherosclerotic calcification of the abdominal\naorta. Calcifications noted in the proximal left renal collecting system.", "output": "1. No evidence acute fracture.\n2. Alignment is normal.\n3. Moderate degenerative changes of the lumbar spine. At L3-4 and L4-5 there\nis mild disc bulge and ligamentum flavum hypertrophy that is causing mild\nspinal canal narrowing and mild bilateral neural foraminal narrowing." }, { "input": "There is no evidence of fracture or subluxation.There is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nThe imaged lung apices are clear. The thyroid is unremarkable.", "output": "Normal study." }, { "input": "There is segmentation anomaly of the upper cervical spine, also demonstrated\non the recent CT, with a congenital fusion of C2 and C3 with a tiny residual\nrudimentary disc space between these vertebrae and fusion of the facets. The\npatient is status post anterior fusion of C5, C6 and C7. The recent CT\ndemonstrates adecuate bony fusion of these vertebral bodies. There is mild, 2\nmm, retrolisthesis of C4 on C5 and mild, 1 mm, anterolisthesis of C7 on T1. \nAlignment is otherwise anatomic. The spinal cord maintains normal signal. \nThere is no diffusion abnormality, although susceptibility artifact from the\noutplate and screws somewhat limits the diffusion-weighted images. There is a\nmedial, retropharyngeal course of the internal carotid levels at the C2-3\nlevel. Osseous signal is otherwise unremarkable.\n\nAt C4-C5, retrolisthesis combines with a disc osteophyte complex to mildly\nnarrow the spinal canal with this process, abutting and mildly remodeling the\nventral spinal cord.\n\nFrom C5 through C7, the patient is status post anterior fusion with no\nsignificant spinal canal or foraminal narrowing.\n\nAt C7-T1, mild anterolisthesis with unroofing of the disc and adjacent\nosteophytes mildly narrows the spinal canal with mild remodeling of the\nventral spinal cord.\n\n\nThere is mild paranasal sinus mucosal reaction partially visualized,\nparticularly within the sphenoidal sinus.", "output": "1. Status post anterior fusion of C5 through C7 with mild degenerative disc\ndisease at the C4-5 and C7-T1 levels with mild spinal canal narrowing at these\nlevels as described.\n2. Segmentation anomaly of C2 and C3." }, { "input": "There is no evidence of acute fracture or traumatic malalignment. No\nprevertebral soft tissue swelling is identified. The paraspinal soft tissues\nare unremarkable. Again seen are degenerative changes with anterior fusion of\nC5-C7 and intervertebral spacers which have\nbeen incorporated into the bone. There is also a stable appearance of fusion\nof C2 and C3 vertebral bodies and facets, likely congenital. Again seen is\nstable mild grade I anterolisthesis of C7 on T1 immediately below the level of\nfusion.\n\nThe visualized aerodigestive tract is unremarkable. No lymphadenopathy is\npresent by CT size criteria. Numerous conspicuous level 2B level 5 lymph\nnodes on both sides are not significantly changed compared with the previous\nexam. The lung apices are clear.", "output": "1. No evidence of fracture or malalignment.\n\n2. Moderate degenerative changes and surgical hardware are unchanged from\n___. Conspicuous although not enlarged bilateral lymph nodes are also\nstable." }, { "input": "Minimal anterolisthesis of C7 on T1 is unchanged.Redemonstrated is probably\ncongenital fusion of C2 and C3 vertebral bodies.Anterior fusion of C5 through\nC7 is stable compared to the prior examination.\n\nThere is interval anterior interbody fusion at C3-4 with a space air and\nanterior plate. There is no evidence of hardware failure.\n\nPrevertebral soft tissue swelling along the cervical spine and soft tissue gas\nin the right lateral neck are consistent with postsurgical changes. A\nsurgical drain is also noted.", "output": "Immediate postsurgical changes of C3-C4 anterior fusion.\nNo evidence of hardware failure.\nAnterior subluxation of C7 on T1, unchanged." }, { "input": "Beam hardening artifact from hardware limits diagnostic evaluation.\n\nPatient is status post anterior fusion hardware of C4 to C7. There is no\nevidence of loosening. Alignment is normal. No fractures are identified. \nThere is partial ankylosis of the C2 and C3 vertebral bodies. There is\nmultilevel degenerative changes. There is no evidence of spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm. Chronic rib deformity in the\nleft first rib is noted.", "output": "1. Status post fusion of C4-C7 without evidence of fracture, loosening, or\nmalalignment.\n2. Multilevel right facet arthropathy of the cervical spine." }, { "input": "Congenital fusion of the anterior and posterior elements of C2 and C3 is again\nseen.\n\nThe patient is status post ACDF at C4-C5. The intervertebral graft\ndemonstrates increased incorporation compared to the immediate postsurgical CT\non ___. Evaluation on the intervening ___ CT was limited\nby hardware related artifact. The anterior hardware component appears well\npositioned without evidence for loosening or other complications.\n\nThe patient is also status post more remote ACDF from C5 through C7, with\ncompletely incorporated intervertebral graft at C5-C6 and C6-C7, and with an\nanterior plate and paired screws at C5, C6, and C7. There is no evidence for\nhardware failure or loosening.\n\nAlignment from C3-C4 through C6-C7 is anatomic. Mild anterolisthesis of C7 on\nT1 is unchanged. Levoconvex scoliosis centered at T1 is again noted. No\nacute fracture is seen.\n\nEvaluation of spinal canal detail by CT limited compared to MRI, particularly\nwhere hardware related artifact is present.\n\nAt C4-C5, a central disc protrusion indents the ventral thecal sac, similar to\nprior. The right neural foramen is narrowed by facet and uncovertebral\nosteophytes, also similar to prior.\n\nAt C6-C7, the left neural foramen is mildly narrowed by uncovertebral\nosteophytes, also similar to prior.\n\nAt C7-T1, the mild anterolisthesis mildly indents ventral thecal sac. There\nis moderate right and mild left neural foraminal narrowing by facet and\nendplate osteophytes, similar to prior.\n\nThis exam is not technically optimized for evaluation of the partially\nincluded brain parenchyma, but no concerning abnormalities are seen on limited\nevaluation. There is mild mucosal thickening in the partially visualized\nethmoid air cells. A mucous retention cyst is partially visualized in the\nincluded inferior left maxillary sinus. Middle ear cavities are well aerated.\nNo pneumatized mastoid air cells are seen on either side.\n\nThe right lung apex is not included on the images. Tiny included portion of\nthe left lung apex appears unremarkable.\n\nNo cervical lymphadenopathy is seen on noncontrast CT. The thyroid gland is\ngrossly unremarkable.", "output": "1. Status post ACDF at C4-C5 with increased incorporation of the\nintervertebral graft compared to the immediate postsurgical CT from ___.\n2. Status post more remote ACDF from C5 through C7 with completely\nincorporated intervertebral graft at C5-C6 and C6-C7.\n3. Unchanged hardware position from C4 through C7 without evidence for\ncomplications.\n4. Persistent, at least mild spinal canal narrowing at C4-C5. Evaluation is\nlimited by hardware related artifact.\n5. Unchanged mild anterolisthesis of C7 on T1.\n6. Congenital fusion of C2 and C3 anterior and posterior elements is again\nnoted." }, { "input": "Dental amalgam streak artifact limits study. There is straightening of\ncervical lordosis.No fractures are identified. There is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.Bilateral cervical lymph nodes are slightly prominent, with largest\nmeasuring up to 1.1 cm at right level 2B at approximately level of C2-3\njunction.", "output": "1. Dental amalgam streak artifact limits study.\n2. No acute cervical spine fracture or traumatic malalignment.\n3. Prominent bilateral cervical lymph nodes, including 1.1 cm right level 2b\nlymph node at approximately level C2-3, may be reactive." }, { "input": "The study is severely limited by motion, despite two separate acquisitions, as\nthe patient was uncooperative. Within this limitation, there is no definite\nacute fracture of the cervical spine. There is suggestion of a C7 compression\ndeformity, that is grossly similar to appearance in the ___\nexamination. There is no definite prevertebral soft tissue edema.\n\nThe included thyroid is grossly normal. The lung apices are grossly clear.", "output": "1. Study severely degraded by motion. Within limits of study, no definite\nfracture identified. However presence of fracture cannot be excluded on the\nbasis of this examination. Recommend clinical correlation. If clinically\nindicated, consider repeat examination when patient can tolerate examination.\n2. Grossly similar C7 compression deformity from ___." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. The thyroid\nis normal. Visualized portion of the lung apices reveal no abnormality.", "output": "No fracture or malalignment." }, { "input": "From T12-L1 to L3-4 levels mild degenerative changes seen without spinal\nstenosis or high-grade foraminal narrowing.\n\nAt L4-5 level, severe facet degenerative changes seen with grade 1\nspondylolisthesis of L4 over L5 which is slightly increased from the previous\nMRI study. There is moderate spinal stenosis seen with moderate left and mild\nright foraminal narrowing.\n\nAt L5-S1 level, degenerative disc disease and vacuum is seen within the disc. \nOsteophytes are identified. There is moderate-to-severe right and moderate\nleft foraminal narrowing slightly increased from the previous study.\n\nCalcifications are seen within the abdominal aorta. No other paraspinal soft\ntissue abnormalities are seen.", "output": "1. Degenerative changes predominantly at L4-5 and L5-S1 levels.\n2. Facet degenerative changes and spondylolisthesis with moderate spinal\nstenosis at L4-5 level slightly increased from the previous study with\nforaminal narrowing moderate on the left and mild on the right.\n3. Disc osteophytes with moderate-to-severe right and moderate left foraminal\nnarrowing at L5-S1 level without spinal stenosis." }, { "input": "There is mild reversal of the normal cervical lordosis. There is mild\nposterior subluxation of C6-7. There are no osseous lesions or fractures. \nThere is mild multilevel loss of disc height.\n\nC2-C3: No spinal canal or foraminal narrowing.\n\nC3-C4: Small bilateral facet uncovertebral osteophytes, no spinal canal\nnarrowing, no right and unchanged mild left foraminal narrowing.\n\nC4-C5: Posterior and bilateral facet uncovertebral osteophytes, no spinal\ncanal narrowing, no right and unchanged mild left foraminal narrowing.\n\nC5-C6: Disc osteophyte complex and bilateral facet and uncovertebral\nosteophytes, no spinal canal narrowing, mild bilateral foraminal narrowing.\n\nC6-C7: Bilateral facet uncovertebral osteophytes, no spinal canal narrowing,\nunchanged mild bilateral foraminal narrowing.\n\nC7-T1: Bilateral facet and uncovertebral osteophytes, no spinal canal\nnarrowing, no right and unchanged mild left foraminal narrowing.\n\nThe visualized lung apices are unremarkable. Atherosclerotic changes of the\ncarotid bifurcations are seen.", "output": "1. Unchanged mild cervical spondylosis, as above." }, { "input": "Spinal fusion hardware streak artifact limits examination. Within these\nconfines:\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is grade 1 anterolisthesis of L4 on L5. Postsurgical changes related to\nposterior spinal fusion from L3 through L5, and L4 through L5 laminectomies\nare noted. There is no evidence of acute osseous fracture. There is no\ndefinite evidence of hardware fracture or ___ lucency. There is no\ndefinite evidence of bony vertebral canal stenosis. Within the limits of\nthis noncontrast study there is no paravertebral or paraspinal mass identified\nand there is no evidence of infection or neoplasm. The visualized portion of\nthe sacroiliac joints are preserved.", "output": "1. Spinal fusion hardware streak artifact limits examination.\n2. Status post L3 through L5 posterior spinal fusion with L4 and L5 level\nlaminectomies.\n3. Within limits of study, evidence of lumbar spine or hardware fracture." }, { "input": "Study is mildly degraded by motion.\n\nThere is no acute fracture or traumatic malalignment within the cervical\nspine. No prevertebral soft tissue swelling. The known left first rib\nfracture is partially imaged. Multilevel degenerative changes are noted in\nthe form of anterior/posterior osteophytes, loss of intervertebral disc space\nheight and uncovertebral hypertrophy that results in up to severe spinal canal\nstenosis at C4-C5, C5-C6, and C6-C7.\n\nWithin the limitations of this noncontrast study, there is no evidence of\ninfection or neoplasm. Thyroid gland is unremarkable in appearance. \nEvaluation of the lung apices is limited by motion. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally. Soft\ntissue densities are noted within bilateral external auditory canals which may\nrepresent cerumen.\n\nThere is extensive subcutaneous emphysema.", "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no acute fracture or traumatic malalignment within\nthe cervical spine.\n3. Extensive subcutaneous emphysema.\n4. Partially imaged left first rib fracture.\n5. Multilevel degenerative changes results in severe spinal canal stenosis at\nC4-C5, C5-C6 and C6-C7.\n6. Please note MRI of the cervical spine is more sensitive for the evaluation\nof ligamentous or spinal cord injury.\n7. Please see concurrently obtained CT of the chest abdomen pelvis study for\ndescription of non cervical structures." }, { "input": "At C3-4, there is re-demonstration of an anterior metallic plate and two pairs\nof screws spanning the interspace. Best shown on the sagittal reconstructions\nis a collar of radiolucency surrounding the screws at the C3 level. Such a\nfinding raises the possibility of incomplete incorporation of the screws. The\nplate also appears to tilt posteriorly at the level of the C4 vertebral body,\nanterior to which is bony material. Also, the C4 screws, while largely within\nthe vertebral body, lie just caudal to the disc space, particularly\nanteriorly. Uncovertebral spurring at this level contributes to cause\nprominent bilateral neural foraminal narrowing. A flocculent hyperdense\nappearance overlying the central spinal canal at this interspace appears to\nrepresent artifact arising from the metallic appliances.\n\nAt C4-5, there is prominent disc space narrowing, which along with\nuncovertebral spurring causes severe right and moderately severe left neural\nforaminal stenosis. There is also likely mild central canal stenosis due to a\nshallow posterior spondylitic ridge, as well as mild congenital narrowing of\nthe AP diameter of the bony central spinal canal. There is a small anterior\nbridging osteophyte.\n\nAt C5-6, there is moderate disc space narrowing and a probable shallow\nposterior spondylitic ridge. Again, there is mild congenital narrowing of the\nAP diameter of the bony central spinal canal, which contributes to causing a\nmild degree of central canal stenosis. There is prominent bilateral neural\nforaminal stenosis. There is a small anterior bridging osteophyte.\n\nAt C6-7, there is a mild posterior spondylitic ridge, most evident to the left\nof midline, where likely causes mild impression upon the left ventrolateral\ncord margin. In association with mild disc space narrowing and left-sided\nuncovertebral spurring, there is prominent left-sided neural foraminal\nstenosis. There is a moderate size anterior bridging osteophyte.", "output": "Postsurgical study. Question of lack of bony incorporation of the C3 pedicle\nscrews. Other observations relating to the anterior cervical fixation device,\ndiscussed in detail above, and which should be reviewed, if feasible, by the\nsurgeon who operated on the patient. Multilevel degenreative changes, also\ndiscussed in detail above." }, { "input": "There is no fracture or acute malalignment in the cervical spine.\n\nMild multifactorial multilevel degenerative changes are present throughout\nthe cervical spine, most prominent at the C2-3 through C5-6 levels.\n\nThere is no lymphadenopathy. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable. Significant atherosclerotic calcifications are\npresent at the carotid bifurcations bilaterally.", "output": "No fracture or acute malalignment of the cervical spine." }, { "input": "THORACIC SPINE: There is diffuse osseous demineralization. There is an acute\n2 column burst fracture of the T10 vertebral body, with approximately 50%\nheight loss compared to the T9 level. There is mild retropulsion of a\nfracture fragment, with minimal indentation of the anterior thecal sac. There\nis no CT evidence of epidural hematoma. No other acute fractures are\nidentified. Overall alignment of the thoracic kyphosis is maintained.\n\nDense atherosclerotic calcifications in the descending intrathoracic aorta and\nupper abdominal aorta including at the origin of the celiac axis are\nincidentally noted. Dependent atelectasis is present in the lungs\nbilaterally.\n\nLUMBAR SPINE: There is no acute fracture in the lumbar spine. Multilevel,\nmultifactorial degenerative changes are most prominent at the L3 through S1\nlevels, with rotatory dextro-convex scoliotic curvature in the lower lumbar\nspine, with associated osteophytic degenerative change involving the facet\njoints and associated discs at those levels. A Schmorl node with inferior\nendplate deformity at the L4 level is likely chronic in nature, with no\ndefinite acute fracture identified. Bilateral pars defects are noted at the\nL5 level. This contributes to grade 1 anterolisthesis of L5 on S1. \nHeterogeneous lucencies in the bilateral sacral ala with areas of sclerosis\nmay be related to healed prior insufficiency fractures, with no discrete\nevidence of acute fracture identified on the current exam.\n\nDense atherosclerotic calcifications are noted in the infrarenal abdominal\naorta and bilateral iliac vessels. There is ectasia of the infrarenal aorta\nup to 2 cm in greatest anteroposterior dimension. The urinary bladder is\nmarkedly distended.", "output": "1. Acute 2 column burst fracture of the T10 vertebral body, an unstable\ninjury, with approximately 50% height loss and mild retropulsion of a fracture\nfragment, minimally indenting the anterior thecal sac.\n2. Severe degenerative changes of the lumbosacral spine, with bilateral L5\npars defects and grade 1 anterolisthesis of L5 on S1 as described above.\n3. Sacral demineralization, inferior L4 endplate changes appear chronic.\n4. Ectatic infrarenal abdominal aorta, 2 cm in greatest dimension.\n5. Markedly distended urinary bladder." }, { "input": "THORACIC SPINE: There is diffuse osseous demineralization. There is an acute\n2 column burst fracture of the T10 vertebral body, with approximately 50%\nheight loss compared to the T9 level. There is mild retropulsion of a\nfracture fragment, with minimal indentation of the anterior thecal sac. There\nis no CT evidence of epidural hematoma. No other acute fractures are\nidentified. Overall alignment of the thoracic kyphosis is maintained.\n\nDense atherosclerotic calcifications in the descending intrathoracic aorta and\nupper abdominal aorta including at the origin of the celiac axis are\nincidentally noted. Dependent atelectasis is present in the lungs\nbilaterally.\n\nLUMBAR SPINE: There is no acute fracture in the lumbar spine. Multilevel,\nmultifactorial degenerative changes are most prominent at the L3 through S1\nlevels, with rotatory dextro-convex scoliotic curvature in the lower lumbar\nspine, with associated osteophytic degenerative change involving the facet\njoints and associated discs at those levels. A Schmorl node with inferior\nendplate deformity at the L4 level is likely chronic in nature, with no\ndefinite acute fracture identified. Bilateral pars defects are noted at the\nL5 level. This contributes to grade 1 anterolisthesis of L5 on S1. \nHeterogeneous lucencies in the bilateral sacral ala with areas of sclerosis\nmay be related to healed prior insufficiency fractures, with no discrete\nevidence of acute fracture identified on the current exam.\n\nDense atherosclerotic calcifications are noted in the infrarenal abdominal\naorta and bilateral iliac vessels. There is ectasia of the infrarenal aorta\nup to 2 cm in greatest anteroposterior dimension. The urinary bladder is\nmarkedly distended.", "output": "1. Acute 2 column burst fracture of the T10 vertebral body, an unstable\ninjury, with approximately 50% height loss and mild retropulsion of a fracture\nfragment, minimally indenting the anterior thecal sac.\n2. Severe degenerative changes of the lumbosacral spine, with bilateral L5\npars defects and grade 1 anterolisthesis of L5 on S1 as described above.\n3. Sacral demineralization, inferior L4 endplate changes appear chronic.\n4. Ectatic infrarenal abdominal aorta, 2 cm in greatest dimension.\n5. Markedly distended urinary bladder." }, { "input": "There is straightening of the normal cervical lordosis, which may be\npositional. Otherwise, alignment is normal. No fractures are identified.There\nis no prevertebral soft tissue swelling.\n\nMultilevel degenerative change is noted most prominent at C5-6 and C6-7 with\ndisc space narrowing, endplate sclerosis. There are small intervertebral\nosteophytes causing mild narrowing of the spinal canal at multiple levels. No\nevidence of severe neural foraminal stenosis. Calcification of the nuchal\nligament is visualized.\n\nThe partially visualized skull base, thyroid, and lung apices are within\nnormal limits. No cervical lymphadenopathy. Incidental note is made of\ntonsilliths", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Slightly limited evaluation due to motion artifact along the distal cervical\nspine starting at the level of C5. Mild anterolisthesis of C2 on C3 without\nprevertebral soft tissue swelling. No acute fracture is identified. There\nare multi-level degenerative changes, including disc space narrowing at\nmultiple levels, most noted at C5 through T1. Multilevel facet arthropathy is\nseen bilaterally, left greater than right, most noted C2 through C5. Small\nposterior osteophytes are noted in the mid to lower cervical spine. There is\nno evidence of spinal canal stenosis. No prevertebral soft tissue swelling is\nseen.", "output": "1. Slightly limited evaluation due to motion artifact along distal cervical\nspine starting at level of C5.\n2. No definite acute fracture.\n3. Mild anterolisthesis of C2 on C3 without prevertebral soft tissue swelling\nis most likely degenerative in nature however a subtle ligamentous injury\ncannot be excluded. Correlation for focal tenderness is recommended. MRI is\nmore sensitive in detecting ligamentous injury.\n4. Multi-level degenerative changes." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nThyroid gland is within normal limits. Within the imaged lung apices, a 3 mm\nright upper lobe pulmonary nodule and a 3 mm ground-glass left upper lobe\npulmonary nodule are present (2:71).", "output": "1. No acute fracture or malalignment.\n2. Bilateral upper lobe pulmonary nodules measuring up to 3 mm. In this age\ngroup, this is likely benign. See recommendations below.\n\nRECOMMENDATION(S): For incidentally detected nodules smaller than 6mm in the\nsetting of an incomplete chest CT, no CT follow-up is recommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "There is no evidence of acute fracture, prevertebral soft tissue swelling or\ntraumatic malalignment. Mild anterolisthesis of C3 on C4, is unchanged\ncompared to the prior exam from ___.\n\nOverall, there has been interval progression of the moderate degenerative\nchanges involving the cervical spine, with evidence of severe loss of disc\nspace height at C4-C5 through C6-C7, subchondral cysts and endplate sclerosis.\nMultilevel neural foraminal narrowing is identified, worst on the right at\nC5/C6.\n\nThe thyroid is normal. There is no cervical lymphadenopathy. The visualized\napices of lungs, demonstrate mild scarring, otherwise are unremarkable.", "output": "No acute fracture identified.\nInterval progression of moderate degenerative changes involving the cervical\nspine, compared to the prior exam from ___." }, { "input": "No fracture or change in alignment is present. Mild anterolisthesis of C3 on\nC4 and C7 on T1 appears unchanged. There is multilevel moderate degenerative\nchange with severe disc space narrowing, endplate sclerosis, and anterior and\nposterior osteophytosis worse at C5-6 and C6-7. Posterior osteophytes at at\nC5-6 and C6-7 result in mild to moderate spinal canal narrowing, unchanged. \nAdditionally, multilevel mild bilateral neural foraminal narrowing is present\ndue to uncovertebral hypertrophy and facet arthropathy, worse bilaterally at\nC5-6. No prevertebral soft tissue swelling is present.\n\nThe imaged thyroid gland and lung apices are unremarkable. Median sternotomy\nwire is incidentally noted.", "output": "No fracture or change in alignment." }, { "input": "There is no acute fracture or change in alignment. There is no prevertebral\nsoft tissue swelling.\n\nMinimal anterolisthesis of C3 on C4 is unchanged from prior. Multilevel\ndegenerative changes again noted with intervertebral disc height loss,\nposterior osteophytes and uncovertebral joint hypertrophy most extensively\nC4-5, C5-6 and C6-7 most significant canal narrowing noted at C5-6. Up to\nmoderate foraminal narrowing is noted on the left C4-5 and C3-4 in part due to\nuncovertebral joint and facet joint hypertrophy.\n\nThere is no evidence of infection or neoplasm.\n\nLimited assessment of the bilateral lung apices and thyroid gland are\nunremarkable.", "output": "1. No acute fracture or change in alignment. Prevertebral soft tissue\nswelling.\n2. Multilevel degenerative changes of the cervical spine, unchanged from ___." }, { "input": "For numbering purposes, similar numbering system is used as on prior exam\nnoting for non rib-bearing lumbar type vertebral bodies, and a small ___ at\nL1.\n\nThere is normal lumbar alignment. The vertebral body heights are preserved. \nThere scattered chronic endplate Schmorl's nodes there is endplate sclerosis\nmost prominent at the anterior aspect T11-T12 and T12-L1. There bulky\nanterior marginal osteophytes. There is no fracture or osseous lesion. There\nis mild loss of intervertebral disc height T11 through L2 and posterior L4-5. \nNo focal lytic or sclerotic lesion is identified at the inferior endplate of\nL4 to correlate with signal changes on prior MRI.\n\nAt T12-L1 through L2-3 there is no significant canal or foraminal narrowing.\nAt L3-L4 there is disc bulge with mild bilateral neural foraminal stenosis.\nAt L4-L5 there is disc bulge and intervertebral osteophyte formation causing\nmild bilateral neural foraminal stenosis.\nAt L5-S1 there is disc bulge, intervertebral and facet osteophytes without\nsignificant neural foraminal stenosis.\n\nThere is sclerosis with joint space narrowing at the bilateral sacroiliac\njoints.\n\nThere is calcification of the abdominal vasculature. The paravertebral soft\ntissues are unremarkable.", "output": "1. Multilevel degenerative changes of the lumbar spine, as described.\n2. No CT correlate to hypointense signal seen on prior lumbar spine MRI." }, { "input": "Alignment is normal. No fractures are identified. There is a small bone\nossicle inferior to the arch of C1, better depicted in the sagittal\nreformations (image 31, series 602b). There is mild spondylosis at C2/C3 and\nC5/C6 levels. There is no evidence of spinal canal or neural foraminal\nnarrowing. The airway appears patent, the lung apices are clear. The\nvisualized paravertebral structures are grossly unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is no fracture or acute alignment abnormality. Endplate degenerative\nchanges characterized by endplate sclerosis, loss of intervertebral disc\nheight, and marginal osteophyte formation is worst at C5-6 and C6-7. No\nprevertebral soft tissue swelling. The aerodigestive tract is normal. The\nvisualized lung apices are notable for a 4 mm left apical pulmonary nodule as\ndescribed on CT scan of the chest. The thyroid gland is homogeneous.", "output": "Multilevel cervical spine degenerative changes, worst at C5-6 and C6-7, with\nno fracture or acute malalignment." }, { "input": "The patient is status post laminectomy with posterior fusion from L3-S1. Bony\nfusion has occurred between L3-L5. However, between L5 and S1, persistent\nlinear lucent areas are noted (series 6, image 42). Mild perihardware\nlucencies about the S1 pedicle screws bilaterally are noted. There is no sign\nof hardware loosening or failure elsewhere. No new fractures are identified.", "output": "1. Bony fusion not contiguous between L5 and S1 bilaterally. Small areas of\nlucency about the bilateral S1 pedicle screws.\n2. Bony fusion contiguous from L3-L5. No sign of hardware failure at these\nlevels." }, { "input": "Alignment is normal. No fractures identified. Moderate multilevel\ndegenerative changes are most prominent at C5-6 and C6-7, similar to the prior\nstudy. Degenerative changes with disc protrusions and intervertebral\nosteophytes narrowing the spinal canal at C3-4, 4 5, 5 6 and 6 7 are unchanged\nsince the previous study. There is no prevertebral edema.\nDegenerative changes of bilateral temporomandibular joints noted.\nThe thyroid and included lung apices are unremarkable.\nLeft apical 4 mm pulmonary nodule is unchanged since ___.", "output": "1. No evidence of fracture or malalignment.\n2. Unchanged multilevel degenerative changes, similar to the prior study.\n3. Stable left apical 4 mm pulmonary nodule." }, { "input": "At L1-2 level there is a posterior disc osteophyte and facet degenerative\nchanges resulting in moderate-to-severe spinal stenosis is seen on the\nprevious MRI study.\n\nAt L2-3 level, at the upper margin of laminectomy moderate-to-severe spinal\nstenosis is identified due to disc bulging and facet degenerative changes.\n\nAt L3-4 level, there is mild anterolisthesis of L3 over L4. The spinal canal\nis patent due to laminectomy. There appears to be moderate-to-severe right\nforaminal narrowing at this level without compromise of the left foramen.\n\nAt L4-5 level, there is also spinal fusion with pedicle screws. The spinal\ncanal is patent with mild anterolisthesis of L4 over L5.\n\nAt L5-S1 level, spinal canal is patent secondary to laminectomy and spinal\nfusion is identified with pedicle screws.\n\nPedicle screws are seen at L3, L4, L5 and S1 levels. Mild lucencies are seen\nsurrounding the pedicle screws at S1 level which are less than 2 mm in width. \nThere appears to be spinal bony fusion between the facet joints at L3-4, L4-5\nand L5-S1 levels.", "output": "1. Spinal stenosis is seen at L1-2 and L2-3 levels as seen on the previous MRI\nstudy. Spinal fusion is seen from L2-3 to S1 level with fusion of the facet\njoints at this levels. There is no significant change in the alignment and\nappearance of the implants compared to the CT of ___." }, { "input": "Evaluation is severely limited by motion. Within these confines:\n\nAlignment appears grossly preserved. No definite cervical spine fractures are\nidentified.Question cervical prominent lymph nodes versus volume averaging\nartifact.", "output": "1. Severely limited by motion.\n2. Insert limit definite fractures are identified.\n3. Question nonspecific prominent cervical lymph nodes versus volume averaging\nartifact. If not artifactual, finding may be reactive.\n4. Consider repeating the exam when the patient is more amenable to remaining\nstill if there is persistent concern for fracture." }, { "input": "Limited evaluation due patient body habitus causing significant photon\nstarvation artifact from C6 to below.\n\nThere is mild straightening of the cervical lordosis, likely due to\npositioning within the scanner. No acute cervical spine fractures are\nidentified.There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nC2-3 and C3-4: Unremarkable\n\nC4-5: Right uncovertebral hypertrophy causes moderate to severe right neural\nforaminal narrowing (series 2, image 51).\n\nC5-6: Bilateral uncovertebral hypertrophy causes moderate bilateral neural\nfemoral narrowing (series 2, image 58). There is anterior longitudinal\nligament calcification at this level.\n\nC6-7: Bilateral uncovertebral hypertrophy produces moderate to severe\nbilateral neural foraminal narrowing (series 2, image 64).\n\nThere is a focus of calcification in the right thyroid lobe (series 3, image\n71). Limited evaluation of bilateral lung apex", "output": "1. Right C4-5 uncovertebral hypertrophy with severe right neural foraminal\nnarrowing as described above.\n2. Bilateral uncovertebral hypertrophy at C5-6 and C6-7 with moderate to\nsevere bilateral neural foraminal narrowing.\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\n___, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation.\n\nNOTIFICATION: A wet read was requested. Multiple attempts to page the\nrequest physician without calling back. The impression and recommendation\nabove was entered by Dr. ___ on ___ at 17:01 into the Department\nof Radiology critical communications system for direct communication to the\nreferring provider." }, { "input": "There are 12 rib-bearing vertebrae. The bones are demineralized. No\ndisplaced fracture is seen. There is mild loss of height involving T7\nvertebral body, and minimal loss of height involving T8 and T9 vertebral\nbodies. There are Schmorl's nodes in the endplates from T4-T5 through T12-L1.\nAllowing for the limitations of CT compared to MRI for evaluation of the\nspinal canal, no evidence for spinal canal stenosis. Tiny disc bulges or\nprotrusions may be present at several levels, best seen from T5-T6 through\nT8-T9. Small anterior endplate osteophytes are present at multiple levels.\n\nEvaluation of the included portions of the lungs is limited by dependent\natelectasis; no consolidation or nodule is otherwise seen. There is mild\nsubpleural fibrotic change in the medial aspect of the posterior basal right\nlower lobe along the thoracic spine osteophytes.\n\nThe thyroid is unremarkable. No lymphadenopathy in the visualized portion of\nthe mediastinum. Coronary artery calcifications are partially imaged. \nCalcified plaque is seen at the great vessel origins and throughout the\ndescending thoracic and included upper abdominal aorta.", "output": "1. No evidence of a fracture.\n2. Coronary artery calcifications." }, { "input": "There are 5 lumbar-type vertebrae. The bones are demineralized. No displaced\nfracture is seen. Vertebral body heights are preserved. There is 1 mm\nretrolisthesis of L1 on L2, 1-2 mm anterolisthesis of L4 on L5, and 4-5 mm\ngrade 1 anterolisthesis of L5 on S1. There is loss of disc height from L2-L3\nthrough L5-S1, up to moderate at L2-L3 and L4-L5, with associated vacuum\nphenomenon.\n\nEvaluation of the spinal canal and neural foramina by CT is limited compared\nto MRI.\n\nT12-L1: Mild disc bulge without significant spinal canal narrowing. Mild\nbilateral neural foraminal narrowing.\n\nL1-L2: Minimal retrolisthesis. Mild disc bulge and facet arthropathy. No\nsignificant spinal canal narrowing. Mild-to-moderate bilateral neural\nforaminal narrowing.\n\nL2-L3: Disc bulge, infolding of the ligamentum flavum, mild right and moderate\nleft facet arthropathy. Mild to moderate narrowing of the thecal sac. \nNarrowing of the subarticular zones with suspected mass effect on the\ntraversing L3 nerve roots. Moderate to severe left and mild right neural\nforaminal narrowing.\n\nL3-L4: Disc bulge, infolding of the ligamentum flavum, and moderate facet\narthropathy. Moderate narrowing of the thecal sac. Suspected mass effect on\nthe traversing L4 nerve roots in the subarticular zones, right more than left.\nModerate to severe bilateral neural foraminal narrowing.\n\nL4-L5: Minimal anterolisthesis. Disc bulge and severe facet arthropathy. No\nsignificant narrowing of the thecal sac. Subarticular zones are narrowed. \nModerate to severe right and moderate left neural foraminal narrowing.\n\nL5-S1: Grade 1 anterolisthesis with an uncovered and bulging disc. Severe\nfacet arthropathy. No significant mass effect on the thecal sac. Traversing\nS1 nerve root sleeves may be contacted in the subarticular zones. Moderate to\nsevere bilateral neural foraminal narrowing.\n\nThere are degenerative changes of the partially included bilateral sacroiliac\njoints.\n\nThere are extensive vascular calcifications. There is a 3.0 x 2.6 cm aneurysm\nof the distal aorta at the level of the inferior mesenteric artery origin. \nBilateral common iliac arteries are ectatic. 2 mm linear calcification in the\ncentral right kidney, images 4:38, 601:44, may be vascular or may represent a\nnonobstructing stone.", "output": "1. No evidence for a fracture.\n2. Multilevel lumbar degenerative disease. Narrowing of the thecal sac\nappears mild-to-moderate at L2-L3 and moderate at L3-L4. Neural foraminal\nnarrowing appears moderate to severe from L3-L4 through L5-S1 bilaterally, and\nat L2-L3 on the left.\n3. 3.0 x 2.6 cm aneurysm of the distal aorta at the level of the inferior\nmesenteric artery origin.\n4. Possible 2 mm nonobstructing stone in the central right kidney, versus\nvascular calcification.\n\nNOTIFICATION: The distal aortic aneurysm was reported to ___, M.D.\nby ___, M.D. on the telephone on ___ at 1:04 pm, 2 minutes\nafter discovery of the findings." }, { "input": "The bones are demineralized. No acute displaced fracture is seen. Mild\ndiffuse loss of height involving C4, C5, and C6 vertebral bodies is a common\nage-related finding.\n\nAt C4-C5, there is a 3 mm anterolisthesis and only mild uniform disc space\nnarrowing, compared to severe uniform disc space narrowing at C3-C4, C5-C6,\nand C6-C7. There are bilateral anterior osteophyte fragments at C4-C5, most\nlikely chronic. No evidence for prevertebral edema. These findings are most\nlikely degenerative, particularly given the moderate right and severe left\nfacet arthropathy at this level, though there are no comparison exams to\nconfirm chronicity.\n\nThere is a 1 mm retrolisthesis of C5 on C6, almost certainly degenerative in\netiology.\n\nDisc protrusions and endplate osteophytes indent the ventral thecal sac at\nmultiple levels. Spinal canal stenosis appears moderate at C4-C5 and C5-C6,\nand mild-to-moderate at C6-C7. Advanced multilevel neural foraminal narrowing\nby uncovertebral and facet osteophytes is noted.\n\nVisualized lung apices are clear. Visualized thyroid is unremarkable. There\nis calcified plaque in the visualized proximal subclavian arteries, in the\nvisualized proximal right common carotid artery, and at bilateral common\ncarotid artery bifurcations extending into the proximal internal carotid\narteries. No lymphadenopathy by CT criteria.\n\nConcurrent CT head and concurrent CT thoracic spine are reported separately.", "output": "1. Bilateral C4-C5 anterior osteophytes fractures are most likely chronic,\nthough there are no comparison exams to confirm chronicity. 3 mm\nanterolisthesis of C4 on C5 is most likely chronic, particularly given the\nmoderate right and severe left facet arthropathy at this level, and absence of\nprevertebral edema, though there are no comparison exams to confirm\nchronicity.\n2. 1 mm retrolisthesis of C5 on C6 is almost certainly degenerative in\netiology.\n3. Otherwise, no evidence for an acute fracture.\n4. Multilevel degenerative disease. Spinal canal stenosis appears moderate at\nC4-C5 and C5-C6, and mild-to-moderate at C6-C7.\n\nRECOMMENDATION(S): If there is a high clinical suspicion for ligamentous\ninjury at C4-C5, then MRI could be performed for further evaluation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "No evidence of fracture or malalignment." }, { "input": "Dental amalgam streak artifact limits study.\n\n Vertebral body alignment is preserved. There is a nondisplaced fracture of\nthe right anterior inferior C6 vertebral body. There is minimal overlying\nprevertebral soft tissue swelling. There is no evidence of spinal canal or\nneural foraminal stenosis.\n\n Within the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Nonspecific prominence of the adenoid tissues\nnoted, which may be within the normal limits for the patient's age. \nVisualized portion of bilateral lung apices are grossly preserved. Left\nmaxillary sinus probable mucous retention cyst is noted.", "output": "1. Dental amalgam streak artifact limits study.\n2. Nondisplaced right anterior-inferior corner fracture of the C6 vertebral\nbody as described. Please note MRI of the cervical spine is more sensitive\nfor the evaluation of ligamentous injury.\n3. Paranasal sinus disease , as described." }, { "input": "There is mild retrolisthesis of C3 on C4 and mild anterolisthesis of C5 on C6,\nunchanged since ___. No acute subluxation. The bones are diffusely\ndemineralized. No displaced fracture is seen. No change in vertebral body\nheights compared to the prior MRI. Unchanged sclerotic focus in the posterior\naspect of the C6 vertebral body, consistent with a bone island. Disc\nprotrusions and endplate osteophytes indent the ventral thecal sac at multiple\nlevels with moderate spinal canal narrowing from C3-C4 through C6-C7, grossly\nsimilar to the prior MRI allowing for differences in modalities. There is\nalso multilevel neural foraminal narrowing by uncovertebral and facet\nosteophytes.\n\nParanasal sinus disease is partially visualized, better assessed on the\nconcurrent head CT. The thyroid is grossly unremarkable. Concurrent chest CT\nis reported separately.", "output": "1. No evidence for a fracture allowing for loss of bone mineralization. No\nacute subluxation.\n2. Multilevel degenerative disease with moderate spinal canal stenosis.\n3. Partially visualized paranasal sinus disease is better assessed on the\nconcurrent head CT." }, { "input": "Alignment is normal. No fractures are identified. No paravertebral edema.\n\nDegenerative changes cervical spine. No significant central canal narrowing. \nMultilevel probably moderate foraminal narrowing. Incomplete fusion posterior\nC1 arch, developmental variant. Advanced facet arthritis right C4-C5 level\nwith subchondral cystic changes, no adjacent edema.\n\nMinimal paraseptal emphysema upper lungs. A trophic, fatty replaced left\nparotid gland. Mild fullness post cricoid hypopharynx may be from secretions,\nsuboptimally aerated.", "output": "1. No fracture.\n2. Degenerative changes.\n3. Mild fullness post cricoid hypopharynx, suboptimally evaluated, may be from\nsecretions." }, { "input": "Alignment is normal. No fractures are identified.Mild multilevel degenerative\nchanges are seen.There is no prevertebral edema.\n\nA 2.9 cm hypodense nodule is seen in the right thyroid lobe (3:64). Scarring\nis noted in the imaged lung apices.", "output": "1. No acute fracture or traumatic subluxation.\n2. 2.9 cm hypodense right thyroid nodule. If not previously evaluated,\nrecommend nonemergent thyroid ultrasound for further evaluation.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no acute fracture or malalignment in the cervical spine. Lucency\ninvolving the right C2 transverse process is unchanged and may reflect an old\ninjury. The visualized outline of the thecal sac is unremarkable. There is\nmultilevel degenerative disc disease which is stable from prior. No\nprevertebral edema. The aerodigestive tract appears patent. Lung apices are\nclear. Thyroid gland appears normal. Partially visualized right IJ central\nvenous catheter is noted in the upper chest.", "output": "No acute fracture or malalignment. Degenerative changes similar to prior. \nMotion artifact somewhat limits evaluation through the lower C-spine at C7-T1." }, { "input": "Alignment is normal. No acute fractures are identified.Mild-to-moderate\ndegenerative changes are noted with intervertebral disc space narrowing,\nsubchondral sclerosis and cystic changes, and osteophyte formation. \nMultilevel uncovertebral and facet joint arthropathy results in mild to\nmoderate vertebral canal narrowing. There is no significant neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm. Multiple hypodense lesions are seen in the thyroid\ngland, measuring up to 1.2 cm on the left and 2.2 cm on the right. The lung\napices appear grossly clear without focal consolidation.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild-to-moderate cervical spondylosis with multilevel mild-to-moderate\nvertebral canal narrowing\n3. Multiple hypodense lesions in the thyroid gland, measuring 2.2 cm on the\nright, previously assessed as benign on dedicated thyroid ultrasound from\n___." }, { "input": "Alignment is normal. No fractures are identified. Multiple levels of mild\nbroad-based disc bulges. No evidence of critical spinal canal or neural\nforaminal stenosis. No prevertebral soft tissue swelling.", "output": "Normal study.\n\nNOTIFICATION: The findings, images, impression were discussed with ___\n___, M.D. by ___, M.D. on the telephone on ___ at 9:35 ___, 1\nminutes after discovery of the findings." }, { "input": "No evidence for a fracture or suspicious bone lesion. Vertebral body heights\nare preserved. Approximately 5 mm anterolisthesis of C3 on C4, approximately\n2 mm retrolisthesis of C5 on C6, and approximately 3 mm retrolisthesis of C6\non C7 are similar to the ___ radiographs and ___ MRI. Severe\nloss of disc height is again seen at C3-C4, C5-C6, and C6-C7, with mild loss\nof disc height at C4-C5. Facet joint fusion secondary to severe arthropathy\nseen at C2-C3 and C4-C5.\n\nThe spinal canal or neural foramina are are not optimally assessed by CT\ncompared to MRI. Allowing for this limitation, moderate to severe spinal\ncanal stenosis at C3-C4, mild-to-moderate spinal canal stenosis at C5-C6, and\nsevere spinal canal stenosis at C6-C7 (secondary to disc protrusions and\nendplate osteophytes) appear unchanged to the recent MRI from ___. \nAdvanced multilevel neural foraminal narrowing by uncovertebral and facet\narthropathy is also again seen, as detailed in the MRI report.\n\nVisualized lung apices are clear. Enlarged multinodular thyroid is again\npartially imaged. The left lobe is larger than the right. The largest\nvisible nodule measures approximately 17 mm in the left lobe on image 3:51. \nThe thyroid was last assessed by ultrasound on ___.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma posterior fossa; no concerning abnormalities are seen. Presumed\ncerumen is noted in the right external auditory canal. Visualized portions of\nthe mastoid air cells are well aerated.", "output": "1. Approximately 5 mm anterolisthesis at C3-C4, 2 mm retrolisthesis at C5-C6,\nand 3 mm retrolisthesis at C6-C7, similar to ___ and ___.\n2. Advanced multilevel degenerative disease. Allowing for differences in\nmodalities, moderate to severe spinal canal stenosis at C3-C4,\nmild-to-moderate spinal canal stenosis at C5-C6, and severe spinal canal\nstenosis at C6-C7 appear unchanged to the recent MRI from ___.\nAdvanced multilevel neural foraminal narrowing by uncovertebral and facet\narthropathy is also again noted.\n3. Multinodular goiter is again partially imaged, last assessed by ultrasound\non ___." }, { "input": "Alignment is normal. No fractures are identified. Mild-to-moderate multilevel\ndegenerative changes of the cervical spine with osteophyte formation and\nintervertebral disc height loss. There is no evidence of high-grade spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.Visualized lung apices are unremarkable.", "output": "No evidence of acute fracture or subluxation." }, { "input": "Vertebral body alignment is preserved. No acute fractures are identified.There\nis mild multilevel vertebral canal narrowing due to posterior disc bulges with\nnarrowing of the ventral CSF space. There is no evidence of significant\nneural foraminal stenosis. There is no prevertebral soft tissue\nswelling.Within the limits of this noncontrast study there is no paravertebral\nor paraspinal mass identified. The thyroid gland is preserved. No focal\nconsolidation is seen in the lung apices. Scattered subcentimeter nonspecific\nlymph nodes are noted throughout the neck bilaterally, without definite\nenlargement by CT size criteria.", "output": "1. No acute fracture or traumatic malalignment.\n2. Nonspecific subcentimeter cervical lymph nodes, which may be reactive." }, { "input": "Alignment is normal. No fractures are identified.Vertebral body heights and\nintervertebral disc spaces are maintained. There is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nImaged lung apices and thyroid gland are within normal limits.", "output": "No acute fracture or malalignment." }, { "input": "No fractures are identified. Alignment is maintained. Mild anterolisthesis\nof C3 on C4, retrolisthesis of C4 on C5, and anterolisthesis of C7 on T1, are\nunchanged. There are multilevel moderate to severe degenerative changes, with\nnear complete loss of disc height at C4-C5, C5-C6, and C6-C7, endplate cystic\nchange and sclerosis, and osteophyte formation. Mild multilevel central canal\nnarrowing is most pronounced at C4-5. There is multilevel moderate neural\nforaminal narrowing, worst at C4-C5 and C5-C6.There is no prevertebral edema.\n\nPunctate hypodense nodule seen within the left thyroid gland measuring 4 mm. \nThere is a 2 mm calcified granuloma at the left lung apex, unchanged.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No acute fractures are identified.There is no\nprevertebral soft tissue swelling.Moderate degenerative changes from C4\nthrough C7 including disc space height loss, endplate sclerosis, and\nosteophytosis. These cause moderate left neural foraminal narrowing at C4-C5,\nmoderate to severe bilateral neuroforaminal narrowing at C5-C6, and bilateral\nneural foraminal narrowing at C6-7. No abnormalities appreciated in the\nthyroid gland or lung apices", "output": "1. No acute fracture or traumatic malalignment in the cervical spine.\n2. Degenerative changes as described." }, { "input": "Alignment is normal. No acute fractures are identified.Multilevel\ndegenerative changes are seen, most extensive at C4-C5 and notable for\nosteophyte formation, disc space loss, and facet arthropathy. There is no\nprevertebral edema.\n\nTrace fluid with air-fluid level noted in the sphenoid sinus. Severe\natherosclerotic calcification of the bilateral carotid bifurcations and\npartially visualized right subclavian artery.\n\nThe thyroid contains a 0.7 cm nodule on the left (03:59). The included lung\napices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Trace fluid in the sphenoid sinus.\n3. Subcentimeter thyroid nodule. No follow-up recommended.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal.Vertically oriented lucencies through the bilateral L5\npedicles could suggest subtle acute nondisplaced fractures, slightly more\nconvincing on the right (601:38; 602:31) than the left (602:31; 601:49). No\nother fractures are identified. Sclerotic focus in the L4 vertebral bodies\ncompatible with a bone island. A salt and pepper lucent lesion in the L1\nvertebral body is compatible with a hemangioma. Multilevel degenerative\nchanges are present including osteophytosis, vacuum phenomena, and facet\narthropathy. No evidence of severe spinal canal narrowing. No prevertebral\nsoft tissue swelling. Posterior paraspinal muscle atrophy noted. Severe\natherosclerotic calcification in the visualized abdominal aorta with focal\nectasia in the infrarenal region measuring 2.2 cm. Bilateral renal\n\nIncidentally noted in the body of the pancreas, is a cystic lesion which\nmeasures 3.8 x 3.8 cm and 6 ___ (102:24).", "output": "1. Possible acute nondisplaced bilateral L5 pedicle fractures. No other\nfractures. No traumatic malalignment.\n2. Severe atherosclerotic disease with focal infrarenal abdominal aortic\nectasia to 2.2 cm.\n3. 3.8 cm pancreatic cystic lesion may represent an IPMN and could be further\ncharacterized with MRCP if clinically indicated." }, { "input": "Alignment is normal.No acute fracture is seen.Mild-to-moderate multilevel\ndegenerative changes include disc space narrowing, worst at C5-C6. Multilevel\nsmall osteophytes are seen. Facet arthropathy is seen bilaterally, worst on\nthe left at C2 through C5. No prevertebral soft tissue swelling is seen. \nStreak artifact courses through the thyroid 2, making it difficult to assess. \nDifficult to exclude a 1.7 cm hypodense nodule in the left lobe of the\nthyroid. Aerosolized debris are seen in the partially imaged upper thoracic\nesophagus, which is patulous.", "output": "No acute fracture or dislocation of the cervical spine.\n\nMultilevel degenerative changes.\n\nPartially imaged upper thoracic esophagus is patulous and contains aerosolized\ndebris.\n\nStreak artifact courses through the thyroid, making it difficult to assess. \nDifficult to exclude a 1.7 cm hypodense nodule in the left lobe of the thyroid\ngland. Thyroid ultrasound would further assess if clinically appropriate\ngiven patient age.\n\nRECOMMENDATION(S): Streak artifact courses through the thyroid, making it\ndifficult to assess. Difficult to exclude a 1.7 cm hypodense nodule in the\nleft lobe of the thyroid gland. Thyroid ultrasound would further assess if\nclinically appropriate given patient age." }, { "input": "Alignment is normal. No fractures are identified.There is hypodensity of the\nbones and prominent striations of the vertebral body marrow space suggesting\nosteopenia.\nAxial imaging from T11-L2 demonstrates no significant abnormalities.\nAt L2-3, mild bulging of the disc and small intervertebral osteophytes\nminimally encroach on the spinal canal. The neural foramina appear normal.\nAt L3-4, bulging of the disc and intervertebral osteophytes mildly narrow the\nspinal canal. These processes also contributes to the narrowing of the distal\nright neural foramen.\nAt L4-5, bulging of the disc mildly encroaches on the spinal canal and\ncontacts the traversing L5 nerve roots bilaterally. Disc bulging also\ncontacts the exiting L4 nerve roots in the neural foramina.\nAt L5-S1, there is minimal bulging of the disc with no compression of the\nnerve roots. There are facet osteophytes but the neural foramina appear\nnormal.\nAgain seen is cyst in the upper pole of the right kidney.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "1. Osteopenia.\n2. Mild degenerative disc disease." }, { "input": "There is mild anterior wedging of T12 vertebral body, stable compared with\nplain film radiograph ___, new since MRI in ___. There is\nsclerosis along the inferior T12 endplate and some new bone formation. There\nis no paravertebral edema. Findings favor late subacute to chronic\ncompression fracture, probably chronic, clinically correlate for pain at this\nlevel. No retropulsion. Multilevel mild tibial body height loss at T6, T7,\nT8, T9. Mild left paravertebral edema at left T6, T8 costochondral junctions,\nlikely degenerative, no osseous destructive lesions.\n\nAlignment is normal. No fractures are identified.No CT evidence of significant\ncentral canal narrowing. Multilevel mild-to-moderate foraminal narrowing.\n\nSurgical clips left axilla. Advanced degenerative changes in the visualized\ncervical spine, partially seen. T6 inferior endplate Schmorl's node with\nsurrounding sclerosis. Demineralization. 0.6 cm focus of sclerosis left L1\npedicle, stable since ___, consistent with benign bone island inhomogeneous\nthyroid gland, with few nodules, largest measures 1.2 cm, no further follow-up\nis indicated according to guidelines. Cardiac enlargement. Coronary artery\ncalcifications. Low-attenuation lesion right hepatic dome, suboptimally\nevaluated, likely benign cyst in the absence of history of malignancy or\nhepatic risk factors such as cirrhosis, hepatitis, infectious symptoms. There\nis chronic fracture of the right L1, L2 transverse process. Metallic foreign\nbody in the posterior right paraspinal musculature at T8-T9 level few chronic\nbilateral rib fractures. Mild basilar scarring and atelectasis.", "output": "1. Mild T12 compression fracture, likely late subacute to chronic, no\nparavertebral edema or retropulsion.\n2. Degenerative changes cervical, thoracic spine. Additional multilevel mild\nvertebral body height loss in the thoracic spine, appears chronic, no acute\ncompression fractures." }, { "input": "There is no acute subluxation. Alignment is unchanged compared to ___, including a mild levoconvex scoliosis of the cervical spine, as well as\nmild anterolisthesis of C2 on C3, C3 on C4, and C7 on T1. There is also\nunchanged right lateral subluxation of the lateral mass of C1 relative to the\nright lateral mass of C2, which appears to be related to the severe\nosteoarthritis at the articulations between the lateral masses of C1 and C2.\n\nAllowing for loss of bone mineralization and extensive degenerative disease,\nno displaced fracture is seen. There is no evidence for prevertebral edema.\n\nDisc protrusions and endplate osteophytes indent the ventral thecal sac at\nmultiple levels. A large disc herniation at C7-T1 appears to cause moderate\nspinal canal narrowing. Posterior endplate osteophytes at C5-C6 also cause\nmoderate spinal canal narrowing. Multilevel facet and uncal vertebral\narthropathy results in multilevel neural foraminal narrowing.\n\nThere is minimal pleural/parenchymal scarring at the visualized lung apices,\nand a punctate calcified granuloma at the right apex. The thyroid gland is\nheterogenous without evidence for an nodule exceeding 9 mm.", "output": "1. No evidence for fracture allowing for demineralized bones.\n2. No acute subluxation.\n3. Multilevel degenerative disease, as detailed above. Moderate spinal canal\nnarrowing at C5-C6 and C7-T1." }, { "input": "There is mild anterolisthesis C4 over C5 most likely due to degenerative\nchanges.No acute fractures are identified.There is anterior and posterior\nbridging osteophyte formation throughout the cervical spine most severe at\nC5-6 and C6-7. There is to severe loss of disc heights at C5-6, C6-7, and\nC7-T1. There is no spinal canal stenosis. Uncovertebral and facet\nosteophytes cause mild left neural foraminal narrowing at C3-4, bilateral mild\nneural foraminal narrowing at C4-5, mild right neural foraminal narrowing at\nC5-6 and C6-7.There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm. The thyroid is unremarkable. Visualized\nbilateral lung apices demonstrate mild scarring with calcification on the\nleft.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine most severe at C5-6\nand C6-7." }, { "input": "The alignment is unchanged from prior exam from ___. The\nalignment is overall anatomic. No acute fractures are identified.Irregularity\nat C5 superior endplate is similar to prior exam. The vertebral body height\nin the disc spaces are overall well preserved, aside from mild height loss C4,\nC5 and C6 vertebral bodies.\n\nAt C2-3, there is no significant spinal canal or neural foraminal narrowing.\nAt C3-4, there is mild spinal canal narrowing due to uncovertebral hypertrophy\nand disc protrusion.\nAt C4-5, there is mild narrowing of the right neural foramina and mild\nnarrowing of the spinal canal due to uncovertebral hypertrophy and facet\narthropathy.\nAt C5-C6, there is moderate narrowing of the bilateral neural foramina and\nmild narrowing of the spinal canal due to disc protrusion, uncovertebral\nhypertrophy and facet arthropathy.\nEvaluation of bilateral neural foramina and spinal canal C6 through T1 is\nlimited due to severe border doses of the cervical curvature.\n\nThere is no prevertebral soft tissue swelling. Dense calcifications of the\nbilateral carotid siphons are noted. There is moderate degree of\ncalcification in the aortic arch, extending to the origin of the neck vessels.\nThere is no supraclavicular lymphadenopathy. Mild air trapping at the apices\nare noted.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine, worst at C5-C6 with\nmoderate narrowing of the bilateral neural foramina and mild narrowing of the\nspinal canal." }, { "input": "Alignment is anatomic.No acute fractures are identified. There is no\nprevertebral soft tissue swelling. There are moderate multilevel degenerative\nchanges including osteophytosis and intervertebral disc space narrowing most\npronounced at C4-C5.\n\nThere is mild multilevel disc bulge and posterior osteophytes resulting in\nmild spinal canal narrowing most pronounced at C4-C5.\nMultilevel uncovertebral and facet joint hypertrophy results in mild to\nmoderate neural foraminal narrowing most pronounced at the right facet joint\nat C4-C5.\n\nThe lung apices demonstrate no nodularity or focal consolidation. The\nvisualized thyroid is unremarkable.", "output": "No acute fracture or or traumatic malalignment of the cervical spine.\nModerate multilevel degenerative changes as described above are most\npronounced at C4-C5." }, { "input": "Dental amalgam streak artifact limits study.\n\nThere is minimal anterolisthesis of C2 on C3 and minimal retrolisthesis of C3\non C4, age indeterminate, but likely degenerative. There is no prevertebral\nedema. No acute fractures are identified within the limitations of diffuse\nosseous demineralization and extensive degenerative changes.\n\nMultilevel degenerative changes of the cervical spine are noted, including\nloss of intervertebral disc height, Schmorl's nodes, endplate sclerosis, facet\njoint hypertrophy, disc osteophytes, with at least mild vertebral canal\nnarrowing at C3-4 and C6-7.\n\nA 0.7 cm hyperattenuating nodular density about the deep aspect of the right\nthyroid lobe may represent accessory thyroid tissue or exophytic thyroid\nnodule. Limited imaging lungs demonstrate approximately 2 mm right upper lobe\npulmonary nodule (see 2:54), not definitely seen on ___ chest CT. \nAtherosclerotic vascular calcifications are noted. Bilateral maxillary sinus\nprobable mucous retention cysts are noted.", "output": "1. Dental amalgam streak artifact and diffuse osteopenia limits study.\n2. Age-indeterminate minimal anterolisthesis of C2 on C3 and minimal\nretrolisthesis of C3 on C4, likely degenerative in etiology. Please note MRI\nof the cervical spine is more sensitive for the evaluation of ligamentous\ninjury.\n3. Multilevel cervical spondylosis as described.\n4. 0.7 cm hyperattenuating nodular density about and possibly extending beyond\nthe deep aspect of the right thyroid lobe may represent an exophytic thyroid\nnodule or accessory thyroid tissue. If clinically indicated, consider thyroid\nultrasound for further evaluation.\n5. Paranasal sinus disease , as described.\n6. Approximately 2 mm right upper lobe pulmonary nodule, not definitely seen\non ___ chest CT. Please see recommendation below.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 14:16 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. No evidence of acute cervical spine fractures.There is\nmild to moderate multilevel anterior, posterior, uncovertebral, and facet\nosteophytosis. Grossly unchanged multilevel, multifactorial degenerative\nchanges are again visualized.\n\nAt C2-C3 level, there is spondylosis and partially calcified disc associated\nwith disc bulging, causing anterior thecal sac deformity (image 29, series 2),\nmild bilateral uncovertebral hypertrophy is present, however there is no\nevidence of nerve root compression or significant spinal canal narrowing.\n\nAt C3-C4 level there is mild disc bulge and mild spondylosis with no evidence\nof spinal canal stenosis or neural foraminal narrowing.\n\nAt C4-C5 level, there is narrowing of the intervertebral disc space, unchanged\nsince the prior study, posterior spondylosis and bilateral uncovertebral\nhypertrophy resulting in mild left and moderate right neural foraminal\nnarrowing which appears also unchanged.\n\nAt C5-C6 level, there is anterior and posterior spondylosis, narrowing of the\nintervertebral disc space, bilateral uncovertebral hypertrophy resulting in\nmoderate bilateral neural foraminal narrowing, unchanged since the prior\nstudy.\n\nAt C6-C7 level, there is anterior and posterior spondylosis, mild bilateral\nuncovertebral hypertrophy causing mild bilateral neural foraminal narrowing,\nthere is no evidence of spinal canal stenosis or significant neural foraminal\nnarrowing.\n\nAt C7/T1 level, there is mild anterior posterior spondylosis with no evidence\nof neural foraminal narrowing or spinal canal stenosis.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. Carotid bifurcation calcifications are mild. The\nthyroid gland appears unremarkable, the lung apices are clear.", "output": "1. No evidence of cervical spine fracture or malalignment.\n\n2. Multilevel, multifactorial degenerative changes throughout the cervical\nspine, grossly unchanged since the prior examination and more significant from\nC2-C3 through C6-C7 levels." }, { "input": "Alignment is normal. No acute fractures are identified.There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.\n\nIncidentally noted is widening of the right jugular foramen with ill-defined\nhigh-density material in the region of the sigmoid sinus and irregular contour\nof the inner cortex of the mastoid air cells/jugular spine which may reflect\nan underlying mass such as a paraganglioma (glomus jugulare) (2:6).", "output": "No acute fracture or traumatic malalignment.\n\nAsymmetric widening of right jugular foramen may represent a underlying mass\nsuch as a paraganglioma/glomus jugulare. MRI with contrast may be considered\nif clinically warranted." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes include\nintervertebral disc height loss, posterior osteophytes, and uncovertebral\njoint hypertrophy spanning C3-4 through C6-7 resulting in up to mild canal\nnarrowing is and mild-to-moderate foraminal narrowing, worst at C5-6\nbilaterally and C6-7 on the left.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Calcified pleural based biapical scarring is\nnoted.", "output": "Degenerative changes without fracture or malalignment." }, { "input": "No evidence of traumatic malalignment. No fractures are identified.Multilevel\ndisc protrusions are noted without significant spinal canal narrowing except\nat C4-C5 and C5-C6 where small protrusions results in mild spinal canal\nnarrowing. There is no significant neural foraminal narrowing. There is no\nprevertebral soft tissue swelling.The lung apices are clear. There is no\ncervical lymphadenopathy by CT size criteria. The visualized aerodigestive\ntract is unremarkable.", "output": "1. No fracture or traumatic malalignment." }, { "input": "There is no prevertebral soft tissue swelling. The alignment is unremarkable.\nNo acute cervical spine fractures are identified.\n\nModerate multilevel degenerative changes are seen throughout the cervical\nspine, with anterior and posterior osteophytes. Intervertebral disc space\nnarrowing is seen at multiple levels, worst from C6/C7.\n\nThe thyroid is unremarkable. The visualized apices of lungs are clear. There\nis no cervical lymphadenopathy.\n\nRe demonstrated is the patient's anteriorly dislocated, comminuted left\nmandibular condyle fracture as well as partially visualized right orbital\nfloor fracture, better evaluated on the dedicated CTs of the face. There is a\nsubcutaneous right neck nodlue, perhaps an old granuloma, as the C3-4 level\n(series 3 image 29).", "output": "1. No acute cervical spine fractures identified. Moderate degenerative\nchanges seen throughout the cervical spine.\n2. Left mandibular condyle fracture, and right orbital floor fracture, better\nevaluated on the dedicated CTs of the face." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Incidentally noted is a punctate calcification in the left\nsubmandibular gland, possibly a sialolith.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Cervical lordosis is exaggerated. Alignment of the cervical spine is\notherwise unremarkable. No fractures are identified. Multilevel degenerative\nchanges and noted throughout the cervical spine including anterior/posterior\nosteophytes, loss of intervertebral disc space height and uncovertebral\nhypertrophy, which results in up to mild spinal canal narrowing at C5-C6 and\nC6-C7. No prevertebral soft tissue swelling.\n\nThyroid gland is not well visualized. Pleural parenchymal scarring is noted\nat the bilateral lung apices.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No evidence of acute fracture..There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture. \nIntervertebral disc space heights are maintained. No acute alignment\nabnormality is identified. There is no prevertebral soft tissue swelling.\n\nModerate, multilevel degenerative changes are seen throughout the cervical\nspine, with anterior osteophyte formation most significant at the levels of\nC2-C6. There is no critical spinal canal stenosis identified.\n\nThe thyroid is grossly unremarkable in appearance. No lymphadenopathy is\npresent by CT size criteria. The visualized lung apices are clear.", "output": "1. No evidence of acute fracture or dislocation.\n2. Moderate, multilevel degenerative changes of the cervical spine." }, { "input": "Moderate multilevel degenerative changes are noted including minimal\nanterolisthesis of C4 on C5 and C5 on C6. Alignment is otherwise normal. No\nfractures are identified. Moderate multilevel degenerative changes with\nintervertebral disc space narrowing, anterior and posterior osteophytic\nspurring, and endplate sclerosis is present, most pronounced at C3-4, C4-5,\nand C5-6. There is no evidence of critical spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling.\n\nA spiculated density in the left upper lung may represent scarring, however\ndedicated chest CT is recommended for further evaluation. A benign bone\nisland is incidentally noted in the left second rib (6b:40). Imaged thyroid\ngland is unremarkable.", "output": "1. No acute fracture.\n2. Moderate multilevel degenerative changes including mild anterolisthesis of\nC4 on C5 and of C5 on C6.\n3. Left apical lung spiculated density may represent scarring. Consider\ndedicated chest CT for further evaluation.\n\nRECOMMENDATION(S):\nLeft apical lung spiculated density may represent scarring. Consider dedicated\nchest CT for further evaluation." }, { "input": "There is no evidence of fracture or subluxation. Cervical vertebral bodies are\nnormal in height and alignment. There is generalized demineralization, likely\ndue to osteoporosis. Multilevel degenerative changes are similar to the prior\nexamination and worst at the C3-4 level with loss of disc height, endplate\nsclerosis, and posterior osteophytes resulting in mild to moderate spinal\ncanal narrowing and mild bilateral neural foraminal narrowing. There is no\nprevertebral soft tissue thickening.", "output": "No evidence of acute fracture or subluxation." }, { "input": "There is no evidence of acute fracture or dislocation. The vertebral bodies\nare normally aligned. Multilevel degenerative changes are again noted,\nincluding intervertebral osteophytes and vacuum disc phenomenon. There is no\ncritical central spinal canal narrowing. There is multilevel neural foraminal\nnarrowing due to uncovertebral osteophytes and facet arthropathy, worst at\nC3-4 and C4-5, moderate. There is no prevertebral soft tissue swelling.", "output": "No evidence of acute fracture or dislocation." }, { "input": "There is mild anterolisthesis of C7 on T1, grossly unchanged. The visualized\nosseous structures are osteopenic. No definite fractures are\nidentified.Multilevel degenerative changes of the cervical spine are most\npronounced at C3-C4, C4-C5, C5-C6, and C6-C7, were there is endplate\nsclerosis, severe disc space narrowing, and osteophytosis. No evidence of\nbony spinal canal stenosis. There is no prevertebral soft tissue swelling. \nPostsurgical changes related to prior right mandibular surgery are noted.\n\nA 1.1 cm nodule in the left thyroid lobe is noted (3:54). Limited imaging of\nlungs demonstrates approximately 3 mm right upper lobe ground-glass opacity.", "output": "1. No definite evidence of cervical spinal fracture.\n2. 1.1 cm left thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest that in the absence of risk factors for thyroid cancer, no\nfurther evaluation is recommended.\n3. Multilevel severe degenerative changes of the cervical spine as described.\n4. Nonspecific right upper lobe 3 mm ground-glass opacity. he ___\nSociety guidelines for pulmonary nodule guidelines suggest for ground glass\nnodules less than or equal to 5 mm no CT followup is required." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "Normal study." }, { "input": "Dental amalgam streak artifact limits study. Alignment is normal. No\nfractures are identified. There is no definite bony vertebral canal\nnarrowing.There is no prevertebral soft tissue swelling. Within the limits of\nthis noncontrast study, there is no evidence of infection or neoplasm. \nBilateral maxillary sinus mucosal thickening is present.", "output": "1. Dental amalgam streak artifact limits study.\n2. No acute fracture or dislocation.\n3. Paranasal sinus disease , as described.\n4. Please see concurrently obtained maxillofacial CT and noncontrast head CT\nfor description of non cervical structures." }, { "input": "The bones are relatively demineralized. Lucency involving the L2 vertebral\nbody paralleling the inferior endplate is compatible with previously\nidentified fracture. There is mild distraction of the fracture fragments\nnoting discontinuity in the anterior osteophytes in association with this\nfracture without associated vertebral body height loss. There is no interval\nfracture. Vertebral bodies are preserved in alignment throughout. Multilevel\ndegenerative changes are noted including intervertebral disc height loss,\nendplate sclerosis with osteophyte formation. Anterior flowing osteophytes\nare seen spanning the visualized thoracic spine through L4. Prior T11\nvertebroplasty changes are also noted.\n\nAtherosclerotic calcifications noted in the abdominal aorta which is normal in\ncaliber. Nonobstructing left renal calculi versus vascular calcifications\nseen at the left renal hilum. Peripherally calcified low-density structure\nseen posteriorly at the lower pole the right kidney is better seen on prior CT\nscan. Included paravertebral retroperitoneal soft tissues are otherwise\nunremarkable.", "output": "No significant interval change of the L2 vertebral body fracture. No interval\nfracture." }, { "input": "There is no fracture or traumatic malalignment. There is no prevertebral soft\ntissue swelling. Mild multilevel degenerative changes are noted with\nsubchondral sclerosis, disk space narrowing, and vertebral body osteophyte\nformation, most pronounced at C5-C6 and C6-C7 levels. There is also mild\nbilateral neural foraminal narrowing at C5-C6 and C6-C7 due to uncovertebral\nhypertrophy. There is no significant spinal canal stenosis.\n\nThe thyroid gland is unremarkable. Visualized lung apices are clear. There is\nno cervical lymphadenopathy.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. There is reversal of the normal cervical lordosis. No\nfractures are identified.There is no significant canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is minimal anterolisthesis of C7 on T1 which is likely degenerative. No\nfractures are identified. Diffuse sclerosis of the T2 vertebra is consistent\nwith osseous metastatic disease. Spinal canal narrowing is worst and mild at\nthe C6-7 level due to endplate osteophytosis. There is multilevel neural\nforaminal narrowing which is worst and severe at the right C6-7 level. There\nis no prevertebral soft tissue swelling.\n\nA peripherally calcified 1.8 cm thyroid nodule seen in the left thyroid lobe.\n\nThere is trace partial opacification of the bilateral mastoid air cells which\nis nonspecific.", "output": "1. Minimal anterolisthesis of C7 on T1 is of indeterminate chronicity but is\nlikely degenerative. If available, comparison with prior studies is\nrecommended to assess stability.\n2. No acute fracture.\n3. Sclerosis of the T2 vertebra is consistent with metastatic disease.\n4. Peripherally calcified 1.8 cm thyroid nodule in the left thyroid lobe. If\nnot previously known, non urgent ultrasound may be obtained for further\nevaluation.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. Small anterior endplate spurs are present. A\nposterior spur is noted at C6 which causes indentation along the the anterior\nthecal sac. No prevertebral edema. The aerodigestive tract appears patent.\nLung apices are clear. Thyroid gland appears normal.", "output": "No fracture or malalignment. Degenerative changes, mild." }, { "input": "The bones are demineralized evaluation of C5 through T1 is limited by motion\nartifact related to the vocal cords and upper trachea. No displaced fracture\nis seen. Vertebral body heights are preserved. Minimal retrolisthesis of C4\non C5 is present. There is no evidence for prevertebral soft tissue swelling,\ndisc space widening, or distraction of the posterior elements. There is disc\nspace narrowing from C4-C5 through C6-C7. Posterior endplate osteophytes and\ndisc protrusions indent the ventral thecal sac from C3-C4 through C6-C7 with\nmild spinal canal narrowing. There is multilevel neural foraminal narrowing\nby uncovertebral and facet osteophytes. There is an incompletely visualized\nlevoconvex curvature of the thoracic spine which affects the cervical spine.\n\nIntracranial and paranasal sinus abnormalities are described in the concurrent\nhead CT report. There is some paraseptal emphysema at the included left lung\napex. Partially visualized thyroid gland is grossly unremarkable. There are\ncalcifications within bilateral distal common carotid and proximal internal\ncarotid arteries, but this exam does not quantify carotid stenosis.", "output": "1. Motion artifact from C5 through T1.\n2. No evidence for displaced fracture.\n3. Minimal retrolisthesis of C4 on C5 is almost certainly degenerative, though\nthere are no comparison exams to confirm chronicity.\n4. Multilevel degenerative disease.\n5. Paraseptal emphysema at the included left lung apex." }, { "input": "Please note that evaluation of the lower cervical spine is limited secondary\nto patient body habitus, as well as motion artifact from the epiglottis. \nGiven this limitation, no fracture is identified. There is no evidence for\nprevertebral soft tissue swelling. Alignment is normal. The spinal canal is\nsuboptimally evaluated. Disc osteophyte complexes indent the ventral thecal\nsac at multiple levels.\n\nAllowing for motion artifact, visualized upper lungs are clear. There is a\n1.7 x 1.7 cm rounded dependent soft tissue density within the upper trachea\n(3:64) at the level of C7-T1, which appears new since ___. \nAtherosclerotic calcifications of the carotid bifurcations are noted\nbilaterally.\n\nConcurrent head CT and facial bone CT are reported separately.", "output": "1. Limited evaluation of the lower cervical spine due to body habitus and\nmotion artifact. No evidence for a fracture. Normal alignment.\n2. Multilevel degenerative disease with disc osteophyte complexes indenting\nthe ventral thecal sac.\n3. 1.7 x 1.7 rounded soft tissue lesion within the upper trachea at the level\nof C7-T1, not fully characterized on this study, new compared to ___\n\nRECOMMENDATION(S): Bronchoscopy should be considered for further evaluation\nof the tracheal abnormality." }, { "input": "No fractures are identified. There is slight reversal of the normal cervical\nlordosis, due to multilevel, multifactorial degenerative changes, most\nprominent at the C5-6 level, where there is anterior and posterior\nosteophytosis, disc height loss, endplate sclerosis, and subchondral cystic\nchange, with mild central canal narrowing at these levels. Fusion of the\nbilateral C2-3 facets are also noted. There is minimal anterolisthesis of C3\non C4. The thyroid gland is heterogeneous. The prevertebral soft tissues are\nunremarkable. There is no evidence of infection or neoplasm.", "output": "No cervical spine fracture or traumatic malalignment. Multilevel degenerative\nchanges, as described above." }, { "input": "Alignment is overall unchanged compared to prior. There is stable minimal\nanterolisthesis of C3 on C4. No fractures are identified. Multilevel\ndegenerative changes are seen, most extensive at C5-6 and notable for endplate\nsclerosis, osteophytosis, loss of disc height. Fusion of bilateral C2-3 facet\njoints are noted. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine." }, { "input": "There is no evidence of acute fracture or traumatic malalignment of the\ncervical spine. No prevertebral or paraspinal soft tissue swelling or large\nhematoma is detected. The vertebral body heights and alignment are preserved.\nModerate multilevel degenerative changes are noted throughout the cervical\nspine, most pronounced at the C3-C4, C4-C5 and C6-C7 vertebral levels with\nposterior disc osteophyte complexes, loss of intervertebral disc space,\nuncovertebral and facet joint arthropathy with resultant mild narrowing of\nneural foramina at effected level. The atlanto-occipital and atlanto-axial\narticulations are maintained.\n\nThe thyroid gland is unremarkable. The visualized lung apices show right\nbiapical scarring. The mastoid air cells are clear bilaterally.", "output": "1. No evidence of fracture or malalignment.\n\n2. Moderate degenerative changes of the cervical spine are slightly more\npronounced than in ___." }, { "input": "Alignment is normal. No acute fractures are identified. There is bilateral L5\nspondylolysis without spondylolisthesis. Congenital nonfusion of the\nposterior elements also noted at L5. There is a new chronic appearing mild\nanterior wedge compression deformity of L1 vertebral body which is not seen in\nthe most recent prior to ___ lumbar spine radiograph. An old healed L3\nleft transverse process fracture (02:56) is also noted. There is no evidence\nof spinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nPartially visualized retroperitoneal soft tissues is notable for moderate\naortoiliac atherosclerotic vascular calcifications.", "output": "1. No acute fracture or traumatic malalignment of the lumbar spine.\n2. Mild chronic appearing anterior wedge compression deformity of L1." }, { "input": "This study is limited by motion artifact. Within these limitations there is no\nacute fracture, traumatic malalignment or prevertebral soft tissue swelling.\nThe vertebral body heights and alignment is maintained. There is multilevel\ndegenerative changes worst at C5-C6 where there is disc space narrowing and\nbilateral neural foraminal narrowing. 4 mm lung nodule at the left lung apex\nis seen on the prior exam. There is scarring in the left lung apex. The\nthyroid gland is unremarkable in the soft tissues are unremarkable.", "output": "No acute fracture traumatic malalignment within the limitations of motion\nartifact." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Grade 1 4 mm anterolisthesis of L4 on L5 is unchanged from prior examination. \n5-6 mm left lateral listhesis of L 2 on L3 is noted. There is progressive loss\nof L2 vertebral body height particularly anteriorly, from examination of ___. Milder loss L3 superior endplate, is similar. Endplate sclerosis\nand cortical irregularity at this level is re-identified. Small pockets of\nair are noted within the residual L2-L3 disc space. There remains mild\nprevertebral soft tissue at this level, not significantly changed from prior\nexamination. No evidence of associated psoas muscle edema at this time.\n\nL1-L2: No significant spinal canal or neural foraminal narrowing.\n\nL2-L3: There is 3 mm retrolisthesis of the L2 inferior endplate, which results\nin mild spinal canal narrowing. The loss of vertebral body height and facet\narthropathy and residual disc results in mild bilateral neural foraminal\nnarrowing.\n\nL3-L4: A disc bulge does not significantly narrow the spinal canal. In\nconjunction with facet arthropathy there is mild bilateral neural foraminal\nnarrowing.\n\nL4-L5: The disc is uncovered secondary to anterolisthesis. In combination\nwith a disc bulge and thickening of the ligamentum flavum, there is mild\nspinal canal narrowing. In conjunction with facet arthropathy, there appears\nto be mild to moderate left and mild right neural foraminal narrowing.\n\nL5-S1: There is no significant spinal canal or neural foraminal narrowing.\n\nThe remainder of the visualized prevertebral and paraspinal soft tissues are\nunremarkable allowing for atherosclerotic calcifications of the abdominal\naorta.", "output": "1. Continued loss of L2 vertebral body height, which is now severe anteriorly,\ncompatible with evolving sequela of discitis osteomyelitis. Loss of L3\nsuperior endplate cortical irregularity and associated sclerosis of the L2 and\nL3 vertebral bodies is also compatible with sequela of discitis osteomyelitis.\n2. No enlarging soft tissue or fluid collections identified.\n3. Additional findings described above." }, { "input": "There is an acute to subacute nondisplaced L3 left transverse process fracture\nas well as a subacute to chronic nondisplaced L5 left transverse process\nfracture. Additionally subtle cortical step-off is visualized anterosuperior\naspect of S2 which could represent a fracture of indeterminate age but may not\nbe acute. Alignment is normal. No prevertebral soft tissue edema is\nvisualized. Multilevel degenerative changes are visualized most notable at\nL4-L5 with at least moderate canal stenosis.There is no evidence of infection\nor neoplasm.", "output": "Coccyx not included on this lumbar spine CT.\n\n1. Acute to subacute nondisplaced left transverse process fracture of L3.\n2. Subacute to chronic nondisplaced left transverse process fracture of L5.\n3. Subtle cortical step-off at the anterosuperior aspect of S2 which could\nrepresent a fracture of indeterminate age and may not be acute." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. A right mandibular ramus fracture is better assessed on the\nconcurrently performed CT of the facial bones.", "output": "No C-spine fracture or malalignment. Partially visualized right mandibular\nramus fracture better assessed on same-day CT facial bones.\n\nNOTIFICATION: D/w Dr. ___" }, { "input": "Alignment is normal. No fractures are identified. Mild degenerative changes\nof the cervical spine are most pronounced at C5-C6 and C6-C7, where there is\ndisc space narrowing and osteophyte formation.Mild bilateral neuroforaminal\nstenosis is also identified at C5-C6. There is no evidence of severe spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling.\n\nVisualized thyroid is unremarkable. Incidental note made of biapical lung\nscarring.", "output": "1. No cervical spinal fracture or traumatic malalignment.\n\n2. Mild degenerative changes of the cervical spine, as described above.\n\n3. Incidental note of biapical lung scarring." }, { "input": "There is no evidence of fracture or malalignment. Multilevel degenerative\nchanges are seen throughout the cervical spine with large anterior osteophytes\nat C5, C6, and C7. The visualized outline of the thecal sac is unremarkable.\nNo significant degenerative disease. No prevertebral edema. Lung apices are\nclear. The patient is intubated.", "output": "1. No evidence of fracture or malalignment.\n\n2. Multilevel degenerative change." }, { "input": "Examination is limited secondary to substantial patient motion and related\nartifact.\n\nThere is no definite evidence of traumatic malalignment. 2 mm anterolisthesis\nof C7 on T1 is likely degenerative in the absence of prevertebral edema. \nThere is no definite evidence of acute fracture. There are moderate to severe\nmultilevel degenerative changes seen throughout the cervical spine including\nbony ankylosis of the left lateral masses C1 and C2. In addition, there is\nmultilevel anterior osteophytosis, uncovertebral hypertrophy and facet\narthropathy which contribute to multilevel canal narrowing and neural\nforaminal narrowing. There is loss of intervertebral disc space at C3-C4,\nC4-C5 and C5-C6 as well as C6-C7.\n\nThe thyroid and included lung apices are unremarkable. Note is made of\nmedialization of the bilateral ICAs.", "output": "1. Limited examination secondary to patient motion. Within that limitation\nthere is no definite evidence of traumatic malalignment, prevertebral edema or\nacute fracture.\n2. Multilevel moderate to severe degenerative changes as described above." }, { "input": "No fractures are identified and alignment is normal. There is no evidence of\nspinal canal or neural foraminal narrowing. No prevertebral soft tissue\nswelling is identified. Bilateral prominent lymph nodes are detected, from\nlevel 2 through of the circular region (for example image 45, series 3),\nplease correlate clinically.", "output": "No evidence of acute fracture or traumatic subluxation. Bilateral prominent\nlymph nodes throughout the neck and supraclavicular regions as described\nabove." }, { "input": "There is no evidence of subluxation or fracture. Compared to prior exam,\nthere is interval development of large anterior osteophyte at C2-3 along with\nossification of the anterior longitudinal ligament. Otherwise, no significant\ndegenerative changes are seen in the cervical spine. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Debris within the bilateral external ear canals are\nnonspecific, though likely represent cerumen. The thyroid gland is slightly\nheterogeneous with a suggestion of 5 mm hypodensity in the right lobe (3:70).\nThe paraseptal emphysema is minimal on the left.", "output": "1. No evidence of fracture or subluxation.\n2. Since the prior examination, development of anterior osteophytes and\nossification of the anterior longitudinal ligament." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "1. Normal study." }, { "input": "There is no evidence of acute fracture or subluxation in the cervical spine.\nThe vertebral body height and alignment are well maintained. There is a\nminimal cervical spondylosis.\n\nThere are multiple hypodense thyroid nodules, ultrasound could be performed\nfor further evaluation, as clinically warranted. The remaining major glandular\nand muscular structures throughout the neck appear unremarkable.", "output": "1. No evidence of acute fracture or subluxation within the cervical spine.\n2. Bilateral hypodense thyroid nodules, ultrasound could be performed for\nfurther evaluation, as clinically warranted.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___\nby telephone on ___ at 11:33 AM, 5 minutes after discovery of the\nfindings." }, { "input": "There is mild loss of cervical lordosis. Otherwise the alignment is\nunremarkable.No fractures are identified.Mild degenerative changes cervical\nspine, with probably mild central canal narrowing C3-C4, C4-C5 levels. \nMultilevel mild-to-moderate foraminal narrowing. The vertebral body and disc\nheights are preserved. No high-grade spinal canal stenosis or neural\nforaminal narrowing.There is no prevertebral soft tissue swelling.The thyroid\nand bilateral lung apices are unremarkable. Periodontal disease. Partial\nopacification bilateral mastoid air cells, with areas of contraction and\nossification, consistent chronic inflammation.\nAcute fracture of the distal left clavicle, seen on shoulder x-ray.", "output": "1. Left clavicle fracture, seen on shoulder x-ray.\n2. No spine fracture.\n3. Degenerative changes." }, { "input": "There is no thoracic spine fracture. Note is made of a chronic left L1\ntransverse process fracture. There are mild multilevel degenerative changes. \nThere is no critical canal spinal canal narrowing. Incidental note is made of\na calcified granuloma in the posterior right lower lobe and at the right lung\napex. There is a small hiatal hernia.", "output": "No thoracic spine fracture." }, { "input": "There is no evidence of acute fracture. There is a chronic fracture versus\ncongenital variant of the left L1 transverse process which is somewhat\nirregular in contour. Note is made of mild retrolisthesis of L3 on L4 and\ngrade ___ anterolisthesis of L4 on L5 likely due to facet joint hypertrophy.\n\nAt L4-5, there is a posterior disc bulge, facet joint hypertrophy and\nthickening of the ligamentum flavum resulting in moderate canal narrowing. At\nL5-S1, the anterolisthesis with a superimposed disc bulge and thickening of\nthe ligamentum flavum contribute to severe canal narrowing.\n\nThere are non-obstructing stones in the left kidney. There is moderate\natherosclerotic disease of the abdominal aorta. There is no abdominal aortic\naneurysm. Patient is status post cholecystectomy. Dilation of the common\nbile duct to 15 mm in central intrahepatic biliary ductal dilatation,\npartially visualized may be due to post cholecystectomy state.", "output": "1. No evidence of lumbar spine fracture.\n2. Chronic left L1 transverse process fracture.\n3. Multilevel degenerative changes including moderate canal narrowing at L4-5\nand severe canal narrowing at L5-S1.\n4. Non-obstructing left renal stones." }, { "input": "There is 2-3 mm of retrolisthesis of C4 on C5 and 1-2 mm of retrolisthesis of\nC5 on C6. No acute fractures are identified.There are multilevel mild to\nmoderate degenerative changes, evidenced by disc space narrowing, endplate\nsclerosis, facet and uncovertebral hypertrophy and osteophytosis.There is no\nprevertebral edema.\nThere is moderate atherosclerotic calcification of the bilateral common\ncarotid arteries. The thyroid and included lung apices are unremarkable. \nPartially visualized sinus disease noted in the imaged paranasal sinuses. \nLeft mastoid and middle ear opacification is also noted as well as partial\nopacification of right inferior mastoid air cells. Intracranial hemorrhage\nbetter assessed on same-day head CT.", "output": "1. No acute fracture. Subtle alignment abnormality at C4-5 and C5-6 likely\nchronic due to underlying degenerative disease. Multilevel degenerative\nchanges of the imaged spine.\n2. Sinus disease, left mastoid and middle ear opacification better assessed on\nsame-day head CT.\n3. Please refer to same-day head CT for intracranial findings." }, { "input": "There is 3 mm anterolisthesis of C4 on C5 and 2 mm anterolisthesis of C7 on\nT1, which are most likely degenerative in nature. Alignment of the cervical\nspine is otherwise normal. No acute cervical spine fracture. Degenerative\nchanges are mild in the form of anterior/ posterior osteophytes, loss of\nintervertebral disc space height and uncovertebral hypertrophy. Mild facet\njoint arthropathy at C3-C5 on the left. Mild spinal canal narrowing at C6-C7.\nLigamentum flavum calcifications are incidentally noted at C7-T1. No\nprevertebral soft tissue swelling. Note is made of a 5 x 4 mm lucency in the\nright lateral aspect of C4 vertebral body (602b:28), appears benign.\n\nThyroid gland is unremarkable. Mild centrilobular emphysema is noted in the\nimaged lung apices.", "output": "1. No acute cervical spine fracture. Minimal anterolisthesis of C4-C5 and\nC7-T1, likely degenerative.\n2. Mild centrilobular emphysema in the lung apices.\n3. 5 x 4 mm right lucent bone lesion noted in C4, without aggressive features,\nlikely cyst." }, { "input": "Alignment is normal.No definite acute fracture is identified. Deformity of\nthe superior endplate of the T6 vertebral body is stable since ___. There is\nno prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "1. There is no evidence of thoracic spine fracture or evidence of\nmalalignment." }, { "input": "There is 3 mm of anterolisthesis of C3 over C4, likely degenerative in\netiology, without prevertebral swelling. No fractures are identified. There\nis marked disc space narrowing with partial ankylosis at C4-5 and C5-6. \nMultilevel posterior disc osteophyte complex formation and endplate sclerosis\nat multiple levels of the cervical spine is also noted. There is mild central\ncanal narrowing at the C4-C5 and C5-C6 levels. There is moderate bilateral\nneural foraminal narrowing, most pronounced at C5-C6 and C6-C7.\n\nThe thyroid is diffusely enlarged and heterogeneous with multiple hypodense\nnodules and punctate calcifications, the largest measuring up to 11 mm in the\nright lobe (03:59). Minimal scarring at the lung apices.", "output": "1. No fracture.\n2. 3 mm of anterolisthesis of C3 over C4 likely degenerative in etiology.\n3. Multilevel moderate to severe degenerative changes with partial ankylosis\nat C4-C5 and C5-C6. Mild central canal narrowing at C4-C5 and C5-C6 and\nmoderate bilateral neural foraminal stenosis at C5-C6 and C6-C7.\n4. Multinodular thyroid gland." }, { "input": "Dental amalgam streak artifact and patient body habitus limits study.\n\nThere is straightening of cervical lordosis. Vertebral body heights are\npreserved. There is no prevertebral soft tissue swelling. There is no definite\nevidence of acute cervical spine fracture.\n\nMultilevel cervical spondylosis is noted, including loss of intervertebral\ndisc height, endplate sclerosis, Schmorl's nodes, facet joint hypertrophy, and\ndisc osteophyte complexes with at least mild vertebral canal narrowing at C4-5\nthrough C6-7.\n\nWithin limits of this noncontrast study, there is no definite evidence of\nparavertebral or paraspinal mass.\n\nThe imaged lung apices are clear. The thyroid is grossly preserved. An\napproximately 1.3 cm right level 3 lymph node is seen. Additional, scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria. \nAtherosclerotic vascular calcifications are noted.", "output": "1. Dental amalgam streak artifact and patient body habitus limits study.\n2. No acute fracture traumatic malalignment.\n3. Multilevel cervical spondylosis as described.\n4. Enlarged left level 3 lymph node measuring up to 1.3 cm, and additional\nnonspecific cervical lymph nodes as described, which may be reactive." }, { "input": "There is no evidence of acute cervical spine fracture or traumatic\nsubluxation. No abnormal prevertebral soft tissue swelling is identified. No\nappreciable degenerative changes are visualized. There is no evidence of\ncritical spinal canal stenosis.\n\nThe visualized lung apices are grossly clear bilaterally. The thyroid is\nhomogeneous in attenuation. There is no evidence of pathologic cervical\nlymphadenopathy.", "output": "No evidence of acute cervical spine fracture or traumatic subluxation." }, { "input": "Alignment is normal.Aside from the fractures of the right temporal bone, no\nother fractures are identified. Facet joints are aligned normally. There is\nno prevertebral hematoma. Subcutaneous emphysema is noted in the right\nparapharyngeal space. The remaining soft tissues of the neck are normal. The\nlung apices are clear.\nThere are minimal changes of degenerative disc disease with small\nintervertebral osteophytes at C3-4 that slightly encroach on the spinal canal.\nAt this level, a small midline and left-sided disc protrusion also encroaches\non the the spinal canal. The neural foramina appear normal. Tiny\nintervertebral osteophytes at C4-5 minimally narrow the spinal canal.", "output": "No evidence of fracture or subluxation. Minimal changes of degenerative disc\ndisease." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Surgical\nhardware abuts the left mandibular ramus.", "output": "Normal study" }, { "input": "Alignment is maintained.No fractures are identified. There is no prevertebral\nsoft tissue edema. Mild degenerative changes are seen in the cervical spine\nwith loss of intervertebral disc space and osteophyte formation. Multilevel\nmild vertebral canal narrowing is noted due to posterior osteophytes and disc\nbulges. There is multilevel uncovertebral and facet joint arthropathy without\nsignificant neural foraminal stenosis. There is no evidence of infection or\nneoplasm. The lung apices appear grossly clear. The thyroid gland is\nunremarkable.", "output": "1. No acute fracture or traumatic malalignment\n2. Mild cervical spondylosis with multilevel mild vertebral canal narrowing." }, { "input": "Minimal anterolisthesis of C5 on C6 and C7 on T1.No fractures\nidentified.Moderate multilevel degenerative changes include osteophytosis,\nintervertebral disc height loss, and posterior disc bulges and/or protrusions.\nMultilevel spinal canal narrowing is mild to moderate and worst at C5-C6,\nmild-to-moderate. No severe osseous neural foraminal narrowing.No\nprevertebral soft tissue swelling.", "output": "1. No evidence of fracture.\n2. Minimal anterolisthesis of C5 on C6 and C7 on T1, possibly chronic given\nmoderate cervical spine osteoarthritis.\n3. Osteophytes and disc bulges and/or protrusions result in multilevel spinal\ncanal narrowing, moderate and worst at C5-C6." }, { "input": "Minimal anterolisthesis of C7 on T1 as described on concurrent cervical spine\nCT. Thoracic spine is otherwise well aligned.No fractures are identified.Mild\nmultilevel degenerative changes include intervertebral disc height loss and\nosteophytosis. Mild multilevel spinal canal narrowing worst in the upper\nthoracic spine. No severe osseous neural foraminal narrowing.There is no\nprevertebral soft tissue swelling.\n\nIncidental severe enlargement of the main pulmonary artery. Incidental left\natrial enlargement. Incidental small hiatal hernia. Incidental focal\nfibrosis in the posterior basal segment of the right lower lobe associated\nwith traction bronchiectasis. 9 mm low-density nodule arising from the medial\nlimb of the left adrenal gland is likely an adenoma. A subcentimeter\nhypodensity near the porta hepatis within the liver is incompletely\ncharacterized but potentially a cyst.", "output": "1. No evidence of fracture.\n2. Severe enlargement of the main pulmonary artery raises the possibility of\nchronic pulmonary hypertension. Recommend correlation with nonemergent\nechocardiogram, if not previously performed.\n\nRECOMMENDATION(S): Severe enlargement of the main pulmonary artery raises the\npossibility of chronic pulmonary hypertension. Recommend correlation with\nnonemergent echocardiogram, if not previously performed." }, { "input": "Alignment is normal. No fractures are identified. Compared with ___,\nthere is slight interval increase in size of a posterior disc bulge at the\nL3-L4 level, resulting in mild canal narrowing. Irregularity and sclerotic\nchanges at the inferior endplate of the L4 vertebral body, with vacuum disc\nphenomenon in the L4-L5 disc space, are similar to MRI L-spine ___,\nand again consistent with a Schmorl's node. Diffuse disc bulge and prominent\nepidural fat at the L4-L5 level is not significantly changed, and is again\ncausing severe canal narrowing at that level. Diffuse disc bulge at the L5-S1\nlevel is unchanged. There is no prevertebral soft tissue swelling. There is\nno evidence of infection or neoplasm.\n\nIncidental note is made of a 1.7 cm simple right renal cyst. A subcentimeter\nleft renal cyst is too small to characterize. There is mild atherosclerotic\ndisease in the intra-abdominal aorta.", "output": "1. No acute fracture or traumatic dislocation.\n2. Slight interval increase in size of a posterior disc bulge at the L3-L4\nlevel, resulting in mild canal narrowing.\n3. No significant change in degenerative disc disease at the L4-L5 level, with\ndiffuse disc bulge and prominent epidural fat causing severe canal narrowing.\n4. Diffuse disc bulge at L5-S1 is unchanged." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified.Mild degenerative changes consistent with mild anterior and\nposterior spondylosis, more significant at C6-C7 level, with is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is a 1.5 cm right thyroid nodule, previously measuring\napproximately 1.1 cm in ___.", "output": "1. No acute traumatic subluxation or fractures.\n2. Slightly larger 1.5 cm right thyroid nodule.\n\nRECOMMENDATION(S): Further evaluation with thyroid ultrasound recommended if\nnot recently performed.\n\nThyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Please note the study is mildly degraded by motion. There is minimal\nretrolisthesis of C3 on C4. Cervical vertebral body heights are maintained. \nVertebral body heights are preserved. There is no fracture. The visualized\nosseous structures are overall osteopenic. No prevertebral soft tissue\nabnormality of the cervical spine is identified.\n\nNarrowing of the intervertebral disc space, most prominent at the C3-4 level,\nis noted. Multilevel degenerative changes are noted, most prominent at the\nC3-4 level posteriorly and C6-7 level anteriorly. Mild canal stenosis with\nright greater than left neural foraminal narrowing is present at the C3-4\nlevel.\n\nWithin limits of this noncontrast study, there is no evidence of infection or\nneoplasm, within the limits of this noncontrast study. The visualized portion\nof the posterior fossa are preserved. There is complete opacification of the\nright sphenoid sinus with hyperdense material and adjacent bony sclerosis. The\nvisualized portion the lungs demonstrate patchy opacities and septal\nthickening. Limited imaging of trachea suggest presence of soft tissue density\narising from the left lateral tracheal wall measuring up to 5 x 5 mm (see\nseries 2, image 63). Atherosclerotic vascular calcifications are noted of\nbilateral cavernous portions of internal carotid arteries.", "output": "1. Study is mildly degraded by motion.\n2. No acute fracture or prevertebral soft tissue abnormality.\n3. Minimal retrolisthesis of C3 on C4 that is nonspecific. While this finding\nmay be degenerative in nature, ligamentous injury cannot be excluded on the\nbasis of this examination due to the absence of prior examinations. Recommend\nclinical correlation. If clinically indicated, further evaluation may be\nobtained via cervical spine MRI.\n4. Multilevel degenerative changes, most prominent at the C3-4 level, with\nnarrowing of the intervertebral disc space, mild canal stenosis, and mild\nright greater than left neural foraminal narrowing at this level.\n5. Suggested approximately 5 x 5 mm right tracheal wall soft tissue mass\nversus secretion. Recommend clinical correlation and correlation with\ndedicated chest imaging.\n6. Limited lung imaging suggests septal thickening and nonspecific patchy\nopacities. Recommend clinical correlation and correlation with dedicated chest\nimaging.\n7. Paranasal sinus disease of right sphenoid sinus as described, concerning\nfor chronic sinusitis with potential fungal component. Recommend clinical\ncorrelation. If clinically indicated, further evaluation may be obtained via\nCT sinus study.\n\nRECOMMENDATION(S): RE 5, 6: Recommend clinical correlation and correlation\nwith dedicated chest imaging.\n\n RE 7: Recommend clinical correlation." }, { "input": "For the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level. Please note that this method is inappropriate for\nsurgical planning and that prior to any intervention appropriate levels must\nbe established.\n\nThere is mild levoscoliosis of the thoracic spine with apex at the T8 level.\nThe visualized osseous structures are osteopenic. There is anterior loss of\nvertebral body height at the T3 and T11 levels. There is suggested\ncompression deformity of the inferior endplate of T10 and superior endplate of\nT11.\n\nThere is compression deformity of the T12 vertebral body. There is mild\nretropulsion at the T12 level, without significant bony canal stenosis.\n\nMultiple areas of hypodensity in the T12 vertebral body appear to have\nsclerotic edges and are near the endplates, suggestive of degenerative\nchanges, although lytic lesions cannot be excluded.\n\nThere is no evidence of bony spinal canal or neural foraminal stenosis.\n\nWithin the limits of this noncontrast study, there is no evidence of\ninfection.\n\nThere are bilateral simple pleural effusions, moderate on the right and small\non the left, with associated atelectasis. Foci of increased opacity in the\nbilateral lungs (for example, 03:29, 28) could represent infectious or\ninflammatory processes. Ground-glass opacity and septal thickening bilaterally\nis suggestive of volume overload.", "output": "1. Anterior loss of vertebral body height at the T3 and T11 levels.\n2. Compression deformity of the T12 vertebral body with mild retropulsion but\nno significant bony spinal canal stenosis.\n3. Suggested inferior endplate T10 and superior endplate of T11 compression\ndeformity.\n4. Bilateral pleural effusions, moderate on the right and small on the left,\nwith right sided atelectasis. Recommend clinical correlation and correlation\nwith dedicated chest imaging.\n5. Foci of increased opacity in the bilateral lungs could represent an\ninfectious or inflammatory process.\n6. Pulmonary finding suggestive of volume overload. Recommend clinical\ncorrelation.\n7. Nonspecific T12 vertebral body bony lucencies which may represent\ndegenerative changes, however other etiologies not excluded on the basis\nexamination. Recommend clinical correlation. If clinically indicated, consider\nbone scan for further evaluation.\n8. Please refer to concurrently obtained CT of the cervical spine (accession\n___ and CT of the lumbar spine (accession ___ for description of\nnon thoracic spine structures." }, { "input": "There is dextroscoliosis of the lumbar spine with the apex at the T12-L1\nlevel.\n\nOverall, the visualized osseous structures are osteopenic. There is suggestion\nof superior endplate deformity of the T11 vertebral body.\n\nAgain seen is a compression deformity of the T12 vertebral body, with\napproximate 2 mm retropulsion of bone fragment, without significant spinal\ncanal stenosis.\n\nThere is a chronic right transverse process fracture (see series 2, image 31).\n\nThere is a compression deformity of the L3 vertebral body extending through\nthe entire vertebral body, with approximately 3 mm retropulsion of the\ninferior vertebral body bone fragment. There is no significant spinal canal\nstenosis at this level.\n\nA compression deformity of the superior endplate of the L5 vertebral body is\nalso noted, without evidence of retropulsion.\n\nAn approximately 5 x 7 x 5mm right sacral lytic lesion is noted (see series 2,\nimages 90-91, series 601b, image 28 and series 602b, image 9). There is no\nassociated soft tissue\n\nThere is no evidence of bony spinal canal or neural foraminal narrowing. \nMultilevel degenerative changes noted throughout the lumbar spine. Within the\nlimitations of this noncontrast study, there is no evidence of infection or\nneoplasm.\n\nPartially visualized lungs demonstrate a large right and small left pleural\neffusions and right lower atelectasis. There is suggestion of scarring with\npleural thickening in the left lower lobe. Diffuse thickening of the left\nadrenal gland versus a small nodule. Air is seen within the collecting systems\nbilaterally, which may be related to pigtail tubes which are incompletely\nimaged. A large simple left renal cyst is noted arising from the lower pole\nthere is marked calcified atherosclerotic disease of the aorta and is sigmoid\ndiverticulosis without evidence of acute diverticulitis.", "output": "1. Compression deformities of the T12 and L3 vertebral bodies, with\napproximately 3 mm retropulsion of bone fragment, but no significant bony\nspinal canal stenosis.\n2. Compression deformity of the superior endplate of the L5 vertebral body,\nwithout retropulsion.\n3. Chronic right L1 transverse process fracture.\n4. Pulmonary findings within partially visualized lung fields as described,\nincluding large right and small left pleural effusion and right lower lobe\natelectasis. Recommend clinical correlation and correlation with dedicated\nchest imaging.\n5. Additional intra-abdominal findings as described above, including\nnonspecific thickening for small nodule of left adrenal gland. Recommend\nclinical correlation and correlation with dedicated abdominal / pelvic\nimaging.\n6. Approximately is 5 x 7 x 5 mm lytic nonspecific right sacral lesion as\ndescribed. Recommend clinical correlation. If clinically indicated, further\nevaluation may be obtained via contrast enhanced MRI of the pelvis." }, { "input": "There is extensive multilevel degenerative change of the cervical spine and\nmild anterolisthesis of C2 on C3 of uncertain chronicity, probably\ndegenerative in nature. There is no evidence of acute cervical fracture. No\nprevertebral hematoma. Multilevel facet arthropathy is moderate. Small\nossific densities adjacent to the tip of the dens may be sequela of prior\ntrauma. Compression deformity of the T3 vertebral body and evaluation of the\nlungs is performed on the concurrent chest CT", "output": "Multilevel multifactorial degenerative changes, but no evidence of acute\ncervical spine fracture." }, { "input": "Evaluation of the C2 and C3 levels is slightly limited by streak artifact from\ndental amalgam. Within this limitation, no definite acute fracture or\nsubluxation is present. Loss of height of the T1 vertebral body is new in the\ninterval, though likely chronic as there is no adjacent soft tissue swelling. \nModerate to severe multilevel degenerative changes with intervertebral disc\nspace narrowing, endplate cysts and sclerosis,, and anterior and posterior\nosteophyte formation are noted. There is no evidence of high-grade spinal\ncanal. Mild-to-moderate bilateral neural foraminal narrowing is most\npronounced at C5-6. There is no prevertebral soft tissue swelling. There is\nno evidence of infection or neoplasm.\n\nA small left apical pneumothorax is noted. There are moderate centrilobular\nemphysematous changes. A left pleural effusion is incompletely imaged. The\nimaged thyroid gland is unremarkable.", "output": "1. No acute cervical spine fracture or malalignment.\n2. Moderate to severe cervical spondylosis.\n3. New mild compression deformity of the T1 vertebral body, age indeterminate,\nbut likely chronic given the lack of adjacent soft tissue swelling.\n4. Left apical pneumothorax, incompletely imaged. Please refer to subsequent\nchest CT for further details." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThe thyroid and lung apices are within normal limits.", "output": "No fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C6-C7 and notable for moderate spinal\ncanal stenosis.There is no prevertebral edema.\n\nThe thyroid is heterogeneous and contains a small 6 mm right thyroid lobe\nnodule. The included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "No acute fracture or subluxation. Linear lucencies involving the left pillar\nof C7 appear to have sclerotic margins and are likely chronic. No\nprevertebral soft tissue swelling. The airway is intact. Alignment is\nnormal. Mild multilevel degenerative changes with intervertebral disc space\nnarrowing and endplate irregularity with osteophyte formation is present. \nThere is a posterior disc bulge at C3-4 which results in mild central canal\nnarrowing. No high-grade neural foraminal stenosis.\n\nLimited views of the bilateral apices demonstrate diffuse scarring and\nemphysema. There is a left apical bullae, incompletely imaged. A right\napical bleb is incompletely imaged. The thyroid is normal. Right\nzygomaticomaxillary complex fracture as well as a displaced inferior right\norbital wall fracture are better characterized on dedicated maxillofacial CT.", "output": "1. No acute cervical spine fractures or traumatic subluxation.\n2. Bilateral apical bullae and scarring, incompletely imaged.\n3. Right zygomaticomaxillary complex fracture as well as a displaced inferior\nright orbital wall fracture are better characterized on dedicated\nmaxillofacial CT." }, { "input": "No acute fracture or alignment abnormality. Degenerative changes are most\npronounced at C5-6 with at least moderate loss of disc space and small\nendplate osteophytes. No significant/critical central spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling. The\nthyroid gland is unremarkable. Lung apices are clear. Significant right TMJ\narthritis noted.", "output": "1. No fractures or malalignment.\n2. Stable degenerative changes of the cervical spine, most pronounced at C5-6." }, { "input": "There is minimal anterolisthesis of C4 on C5, which may be on a degenerative\nbasis.Multilevel degenerative changes are noted, worst at C5-C6, with\nintervertebral disc space narrowing and osteophytosis. No definite fracture\nis identified. Posterior osteophytes at this level mildly narrow the spinal\ncanal. Multilevel uncovertebral joint hypertrophy also mildly narrows the\nneural foramina bilaterally, worse C5-C6. There is no prevertebral soft\ntissue edema.\n\nThe imaged thyroid is normal. The lung apices are unremarkable.", "output": "1. No evidence of acute cervical spine fracture.\n2. Degenerative changes throughout the cervical spine as described above." }, { "input": "No acute fractures. No traumatic subluxation. No prevertebral soft tissue\nswelling. Diffuse mild degenerative changes throughout the cervical spine are\nnoted, including intervertebral disc height loss, osteophytosis and\nsubchondral sclerosis, most prominent at C5/6 and C6/C7. No high-grade\ncentral canal or bilateral neural foraminal stenosis.\n\nThe bilateral lung apices demonstrate streaky and patchy opacities. The\nthyroid has been surgically resected. Diffuse calcifications are again\ndemonstrated within carotid bulbs, worse on the right, with surgical staples\nseen along the right carotid canal. Two left parotid soft tissue masses each\nmeasure 1.8 cm, 1 of which is calcified, and are unchanged from prior. \nProminent supraclavicular lymph nodes measuring up to 0.8 cm in the short axis\nappear similar to the prior study. Right facial reconstruction and right globe\nenucleation is re-demonstrated with cerclage wire seen in the right zygomatic\narch.", "output": "1. No acute fracture or traumatic subluxation.\n2. Nodular and patchy opacities at the bilateral lung apices are new from\nprior. Please refer to patient's chest radiograph obtained earlier in the\nday.\n3. Redemonstration of two parotid soft tissue masses measuring up to 1.8 cm.\nRecommend correlation with ultrasound or histology if available.\n4. Postsurgical changes at the right neck and face are stable." }, { "input": "No fracture or alignment abnormality. Mild degenerative disease most focally\nnoted at C6-7 with disc space narrowing and small endplate osteophytosis. No\nprevertebral edema. Thyroid is unremarkable. Lung apices appear clear.", "output": "No fracture or malalignment." }, { "input": "Mild C6 on C7 anterolisthesis is likely degenerative in etiology.No fractures\nare identified.There are multilevel severe degenerative changes throughout the\ncervical spine with loss of intervertebral disc height, endplate sclerosis,\nosteophyte formation, uncovertebral and facet hypertrophy, most severe at\nC4-5. multilevel moderate central canal narrowing is worst C3-4, C4-5, and\nC5-6 with moderate to severe neural foraminal stenosis demonstrated on the\nleft at C4-5. There is no prevertebral soft tissue swelling.There is no\nevidence of infection or neoplasm. Imaged thyroid gland and lung apices are\nunremarkable.", "output": "1. No acute fracture.\n2. Severe cervical spondylosis, most pronounced at C4-5 with moderate central\ncanal narrowing and severe left-sided neural foraminal stenosis.\n3. Mild C6 on C7 anterolisthesis, likely degenerative in etiology." }, { "input": "Alignment is normal. No acute fractures are identified. Anterior cervical\nfixation hardware seen spanning C5 through C7. There is no evidence of\nlucency surrounding the hardware nor hardware fracture. Compression of the\nsuperior endplate of T1 is again noted as previously detailed. There is no\nprevertebral soft tissue swelling.\n\nThyroid is unremarkable. There is partially visualized right pleural\neffusion.", "output": "1. No acute fracture or malalignment.\n2. Superior endplate compression deformity of T1 as recently described on\nprior CT scan.\n3. Partially visualized right pleural effusion." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nsevere spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.The lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment the cervical spine." }, { "input": "There is stable minimal retrolisthesis of C5 on C6. Otherwise, the remaining\nalignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, not significantly changed since ___. There is no\nprevertebral edema.\n\nThe upper neck and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Overall extent of\ndegenerative disease appears similar to the prior study with disc disease at\nC4-5 and C5-6 with loss of disc space, endplate sclerosis and irregularity and\ntiny osteophytes noted. There is loss of cervical lordosis. No prevertebral\nedema. The aerodigestive tract appears patent. Lung apices are clear. Thyroid\ngland appears normal.", "output": "No fracture or malalignment. Degenerative changes as stated." }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture.\n\nThere is loss of intervertebral disc height at C4-5 and C5-6, not\nsignificantly changed since ___.\n\nMild retrolisthesis of C5 on 6 appears unchanged. No acute alignment\nabnormality is seen.\n\nNo prevertebral soft tissue abnormality. No lymphadenopathy is present by CT\nsize criteria. The thyroid is unremarkable. The visualized lung apices are\nclear.", "output": "No cervical spine fracture, acute alignment abnormality, or prevertebral soft\ntissue abnormality. Degenerative changes are no worse than on ___." }, { "input": "Severe compression deformity of the T12 vertebral body is unchanged since ___. Endplate degenerative changes are seen at L1-L2, with marginal\nosteophytes and vacuum disc phenomenon demonstrated. Intraosseous hemangioma\nof the L5 vertebral body is again demonstrated. Multilevel disc osteophyte\ncomplexes are noted, most severe at L3-4 and L4-5. No evidence of new\nfracture. Unchanged levoscoliosis with concavity on the right and maximum\nangulation at the level of L3.\n\nThe imaged portions of the abdomen and retroperitoneum demonstrate a\nlow-density cyst in the interpolar region of the right kidney, likely a simple\ncyst. Scattered calcified granulomas in the liver and spleen are prior\ncharacterized on the concurrently obtained CT of the chest.", "output": "Stable severe compression deformity of the T12 vertebral body since ___. No evidence of new lumbar spine fracture." }, { "input": "Alignment is normal. No fractures are identified. There are multilevel\ndegenerative changes with loss of disc height, disc bulge, and posterior\nosteophytes, worst at C3-C4, with no significant canal narrowing. Multilevel\nuncovertebral osteophytes and facet arthropathy result in up to mild to\nmoderate neural foraminal narrowing, worst at C5-C6 on the right8. There is\nno prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThyroid gland appears normal. The imaged portion of the lung apices are\nunremarkable.", "output": "1. No evidence of acute cervical spine fracture or dislocation." }, { "input": "Mild anterolisthesis of C2 on C3 and C7 on T1, progressed since ___, but\nlikely degenerative in nature. Otherwise, alignment is normal. No fractures\nare identified.There is no prevertebral soft tissue swelling.\n\nSevere degenerative disc disease at C4-5, C5-6, and C6-7. Moderate narrowing\nof the spinal canal at C4-5 due to a posterior intervertebral osteophyte,\neccentric to the right. Multiple moderate to severe neural foraminal stenosis\nat multiple levels due to a combination of uncovertebral and facet\nosteophytes.\n\nLinear atelectasis or scarring within the left upper lobe. No cervical\nlymphadenopathy. The patient is status post right hemithyroidectomy. \nMultiple hypodense nodules are seen within the left lobe of the thyroid\nmeasuring up to 11 mm. Partial opacification of the nasopharynx is seen.", "output": "1. Mild anterolisthesis of C2 on C3 and C7 on T1, progressed since ___, but\nlikely degenerative in nature. No evidence of traumatic malalignment or\nfracture.\n2. Multilevel multifactorial degenerative changes causing moderate narrowing\nof the spinal canal at C4-5 and multilevel bilateral moderate to severe neural\nforaminal stenosis.\n3. Hypodense nodules within the left lobe of the thyroid measuring up to 11\nmm, for which no specific follow up is recommended per ACR guidelines." }, { "input": "Bones appear slightly demineralized. There is no acute fracture or\nmalalignment in the cervical spine. The visualized outline of the thecal sac\nis unremarkable. No significant degenerative disease. No prevertebral edema. \nThe aerodigestive tract appears patent. Lung apices are clear. Thyroid gland\nappears normal.", "output": "Demineralized bones without fracture or alignment abnormality." }, { "input": "Dental amalgam streak artifact limits study.\n\nThere is minimal anterolisthesis of C5 on C6, which is likely degenerative. \nAlignment is otherwise anatomic. No fractures are identified. There is no\nprevertebral soft tissue swelling.\n\nThere is mild to moderate degenerative change of the cervical spine with loss\nof intervertebral disc height and facet arthropathy, most severe at C4-5.\nthere is no definite evidence of bony vertebral canal narrowing.\n\nOTHER:\nAgain seen is nondisplaced linear occipital fracture as well as\nintraparenchymal hemorrhage in the left cerebellar hemisphere with subdural\nand likely subarachnoid components.\n\nQuestion approximately 2.1 cm right thyroid lobe nodule (see 03:58). There is\nmild pleuroparenchymal scarring at the bilateral lung apices without focal\nconsolidation. Left temporomandibular joint degenerative changes are noted. \nAtherosclerotic vascular calcifications are seen in bilateral carotid\nbifurcations. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", "output": "1. Dental amalgam streak artifact limits study.\n2. No acute fracture or traumatic subluxation of the cervical spine.\n3. Mild-to-moderate degenerative changes, most notable at C4-5. Minimal\nanterolisthesis of C5 on C6 is likely degenerative as opposed to sequela of\ntrauma. If concern for ligamentous injury, consider dedicated cervical spine\nMRI.\n4. Please see concurrently obtained noncontrast head CT for description of\ncranial structures.\n5. Question approximately 2.1 cm right thyroid lobe nodule. Please see\nrecommendation below.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:16 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "No evidence of traumatic cervical malalignment. No acute fractures are\nidentified. There is no evidence of severe spinal canal or neural foraminal\nstenosis. Moderate to severe degenerative changes of the cervical spine are\nseen including facet joint hypertrophy most severe on the right side at C3-C4.\nThere is no evidence of prevertebral soft tissue swelling.\n\nQuestion of a hypodensity in the right thyroid lobe measures up to 1.4 cm\n(03:54). Lung apices are unremarkable aside for mild biapical scarring.", "output": "1. No evidence of traumatic cervical malalignment or acute fracture.\n2. Question of a 1.4 cm hypodensity in the right thyroid lobe.\n3. Left occipital craniectomy.\n\nRECOMMENDATION(S):\n Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no evidence of traumatic malalignment and alignment appears overall\nsimilar to ___. There is no evidence of acute fracture. There is no\nevidence of severe spinal canal or neural foraminal stenosis. Multilevel\nmoderate to severe degenerative changes are noted including facet joint\nhypertrophy, most prominent at C3-C4 on the right. There is no prevertebral\nsoft tissue swelling.\n\nFocus of calcification in the left lung apex is similar to prior. Thyroid is\nsomewhat heterogeneous though without discrete nodule. Slightly enlarged\ncervical lymph nodes measuring up to 1.2 cm along the left internal jugular\nchain are similar compared to ___. Dense atherosclerotic\ncalcifications noted at the carotid bulbs.", "output": "No evidence of traumatic malalignment or acute fracture. Multilevel\ndegenerative changes are similar to ___.\nMild cervical adenopathy, nonspecific, similar compared to prior." }, { "input": "Moderate rotatory levoscoliotic curvature of the cervical spine is noted, with\napex and mild anterolisthesis at C5-6 level. There is no acute fracture\nidentified. Vertebral body heights are maintained.\n\nAt C2-3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-4, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C4-5, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C5-6, a large left paracentral \"hard disc\" or osteophyte indents the left\nanterolateral aspect of the spinal cord and encroaches on the left neural\nforamen, likely impinging upon the exiting left C6 nerve root.\n\nAt C___, broader-based disc-osteophyte complex, eccentric to the left, causes\nslight deformity of the ventral cord. There is no significant neural foraminal\nnarrowing.\n\nC7/T1, there is no significant abnormality seen.\n\nThe thyroid gland is unremarkable. There is no lymphadenopathy by CT size\ncriteria. The visualized paranasal sinuses and lung apices are clear.", "output": "Multilevel cervical spondylosis, most pronounced at C5-6, where a left\nparacentral \"hard disc\" and/or osteophyte indents the left ventral spinal cord\nand encroaches on the left neural foramen, impinging upon the exiting left C6\nnerve root." }, { "input": "There is no fracture. There is 1 mm of anterolisthesis of C7 on T1, most\nlikely degenerative. There are degenerative change at the cervical spine\nconsisting of intervertebral disc space narrowing, vacuum space phenomena,\nendplate sclerosis, anterior osteophyte formation, and intervertebral\nosteophytes, most apparent at levels C3 through C7. There is no prevertebral\nsoft tissue swelling. Right mastoid air cell opacification is re-\ndemonstrated, better characterized on previous head CT. Motion through the\nlung apices makes the evaluation of the lungs sub-optimal. No thyroid nodule\nis seen.", "output": "1. 1 mm of anterolisthesis C7 on T1, likely degenerative. No comparison\nstudies are available for comparison, correlate clinically.\n2. No fracture." }, { "input": "There is no cervical spine fracture. There is a nondisplaced fracture through\nthe left transverse processes of C6 (601b:32), C7 (601b:36), T1 and T2. There\nare mild multilevel degenerative changes without significant canal narrowing.\nThere is no prevertebral soft tissue swelling.\n\nThe thyroid is unremarkable. The lung apices are clear.", "output": "Nondisplaced fractures through the left C6, C7, T1 and T2 transverse\nprocesses. No additional fractures identified.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 9:34 ___, 5 minutes after discovery of\nthe findings." }, { "input": "There is no acute fracture or traumatic malalignment. Mild anterolisthesis of\nC6 of C7 is unchanged since prior study. There is no prevertebral soft tissue\nswelling. Significant left facet arthropathy is noted. Disc spaces appear\nrelatively preserved. The thyroid gland is unremarkable. There is no\ncervical lymphadenopathy. There is biapical scarring.", "output": "1. No acute fracture or traumatic malalignment.\n2. Significant asymmetric left facet hypertrophy." }, { "input": "No evidence of traumatic malalignment or acute fracture.Moderate multilevel\ndegenerative changes of the cervical spine including posterior osteophytes and\nleft-sided facet joint arthropathy and uncovertebral joint hypertrophy\nresulting in mild spinal canal stenosis at C4-C5 with moderate left-sided\nneural foraminal narrowing. Mild anterolisthesis of C6 on C7 is unchanged. \nThere is no prevertebral soft tissue swelling.\nBiapical scarring is unchanged.", "output": "1. No evidence of traumatic malalignment or acute fracture.\n2. Stable moderate multilevel degenerative changes of the cervical spine." }, { "input": "There is straightening of cervical lordosis. The visualized osseous\nstructures are osteopenic. There is fusion of the C5 through C7 vertebral\nbodies. There is fusion of the left C3-4 facet joint. Within limits of\nstudy, no definite evidence of acute cervical spine fracture. There is no\nprevertebral soft tissue swelling. There is no prevertebral soft tissue\nswelling.\n\nThere is severe multilevel degenerative disease, including loss of\nintervertebral disc height, endplate sclerosis, facet joint hypertrophy, and\ndisc osteophyte complexes, with at least mild vertebral canal narrowing at\nC3-4. There is ossification of the anterior longitudinal ligaments extending\nfrom C5 to T2. There is no severe vertebral canal or severe neural foramina\nnarrowing.\n\nOther:\nLimited imaging the teeth demonstrate a single left mandibular molar cavity\nand periapical lucency (see 602:40). Right subclavian stent is partially\nimaged. Atherosclerotic vascular calcifications are seen in bilateral carotid\nbifurcations. Limited imaging of the lungs demonstrate bilateral patchy\nopacities. Scattered subcentimeter nonspecific lymph nodes are noted\nthroughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", "output": "1. Study limited secondary to diffuse osteopenia.\n2. Within limits of study, no definite evidence of acute fracture or traumatic\nmalalignment.\n3. Multilevel cervical spondylosis as described.\n4. Dental disease of single left maxillary molar.\n5. Limited imaging of the lungs demonstrate nonspecific bilateral patchy\nopacities. Differential considerations include infectious, inflammatory, and\nneoplastic etiologies. Please see concurrently obtained torso CT for\ndescription of thoracic findings.\n6. Nonspecific subcentimeter cervical lymph nodes as described, which may be\nreactive.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 07:50 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Compared with the prior MRI, and allowing for differences in technique and\nslice selection, the L1 vertebral body pathologic fracture has worsened with\ndecreased vertebral body height, and increased right-greater-than-left\nretropulsion causing 40-50% spinal canal stenosis (3:19 compared with 12:8 on\nthe prior MRI). These changes appear new from the prior CT of the abdomen and\npelvis dated ___.\n\nMultilevel degenerative changes including severe spinal canal stenosis at\nL4-L5 and multilevel moderate neural foraminal narrowing are unchanged. Bony\nmetastatic disease is better assessed on the recent MRI, though a large right\niliac lytic metastasis was outside of the field of view on that study.\n\nBilateral pleural effusions, right greater than left, bilateral adrenal\nmasses, a soft tissue nodule inferior to the right kidney, and a large\npartially necrotic retrocaval lymph node are better assessed on recent CT of\nthe abdomen and pelvis dated ___.", "output": "1. Interval worsening of L1 vertebral body pathologic fracture causing about\n50% spinal canal narrowing and right greater than left retropulsion.\n2. Unchanged severe multilevel degenerative changes are unchanged and better\nassessed on recent MRI of the lumbar spine.\n3. Multiple metastatic foci within the lumbar spine and partially visualized\nsoft tissues." }, { "input": "There is no evidence of fracture or malalignment. Multilevel degenerative\nchanges are noted with mild anterior and posterior osteophyte formation. \nThere is ossification of the nuchal ligament. There is no evidence of spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling. Within the limitations of this noncontrast study, there is no\nevidence of infection or neoplasm.", "output": "Mild changes of degenerative disc disease. Otherwise normal study. ." }, { "input": "Dental amalgam streak artifact limits study.\n\nThere is straightening of the cervical lordosis. There is no acute fracture. \nLeft C1 transverse process probable bone island is noted (see 02:14). There\nis no prevertebral soft tissue swelling.\n\nMultilevel degenerative changes of the cervical spine is noted, including loss\nof intervertebral disc height, facet joint hypertrophy, anterior bridging\nosteophytes, disc osteophyte complexes, with at least mild vertebral canal\nnarrowing at C6-7. Within the limits of this noncontrast study, there is no\nevidence of infection or neoplasm. Right-sided IJ catheter is partially\nvisualized.", "output": "1. Dental amalgam streak artifact limits study.\n2. Within limits of study, no acute fracture or acute malalignment.\n3. Multilevel cervical degenerative changes as described with at least mild\nvertebral canal narrowing at C6-7. If clinically indicated, consider\ndedicated cervical spine MRI for further evaluation." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. There are digestive tract\nappears patent. Lung apices are clear. Thyroid gland contains tiny nodules.", "output": "Normal cervical spine CT exam." }, { "input": "Alignment is anatomic.No fractures are identified.\nModerate multilevel degenerative changes of the cervical spine include\nintervertebral disc space narrowing, posterior osteophytes and uncovertebral\njoint hypertrophy. No significant canal or foraminal narrowing. Mild\nforaminal narrowing noted on the right at C5-6 and on the left at C3-4.\n\nThere is no prevertebral soft tissue swelling.\n\nThere is mild biapical pleuroparenchymal scarring. The thyroid is slightly\natrophic but otherwise unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no acute fracture or alignment abnormality. There is no prevertebral\nsoft tissue swelling. There are multilevel degenerative changes of the spine\nbut no severe spinal canal narrowing. There are atherosclerotic calcifications\nof bilateral carotid arteries. There is severe emphysema of the included lung\napices.", "output": "No evidence of acute cervical spine injury." }, { "input": "Alignment of the cervical spine is maintained. No fracture is seen. \nDegenerative changes of the cervical spine are noted, most significant at\nC5-C6 with disc height loss. There is no significant spinal canal narrowing. \nThere is a well-circumscribed lucent lesion within the left C4 vertebral body\nand pedicle (series 602b:image 27) contiguous with and likely due to\nenlargement of the transverse foramina at this level.\n\nThe thyroid gland is heterogeneous and enlarged, particularly on the right. \nThe visualized lung apices are clear but notable for centrilobular emphysema.", "output": "No acute fracture or traumatic malalignment.\nRight-sided thyroid enlargement\n\nRECOMMENDATION(S): Dedicated thyroid ultrasound suggested." }, { "input": "Alignment is within normal limits.No acute fractures are identified.There are\nmultilevel degenerative changes including anterior osteophytosis and\nintervertebral disc space narrowing. There is no evidence of critical central\ncanal or neural foraminal narrowing. Redemonstration of a lucency in the left\nC4 vertebral body and pedicle which is contiguous with the transverse foramen,\nunchanged, and again likely reflective of an enlarged transverse foramen. \nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nHeterogeneous enlarged multinodular thyroid gland is incompletely imaged with\ncoarse calcifications in the inferior isthmus. Centrilobular emphysema is\nseen in the visualized lung apices with scarring.", "output": "1. No acute fracture or malalignment.\n2. Mild multilevel degenerative changes without critical central canal or\nneural foraminal narrowing.\n3. Incompletely imaged multinodular thyroid gland." }, { "input": "Mild retrolisthesis of C5 on C6, likely degenerative. Otherwise, the\nalignment is normal. No acute cervical spine fractures are identified. \nMild-to-moderate, multilevel degenerative changes, include intervertebral disc\nheight narrowing, osteophyte formation, endplate sclerosis, and uncovertebral\njoint space narrowing. Mild vertebral canal narrowing at C3-C4 due to a\nposterior disc bulge. Mild to moderate vertebral canal narrowing at C5-C6 and\nC6-C7. Mild left neural foraminal narrowing at C5-C6\n\nThe included lung apices are unremarkable. A hypodense right thyroid nodule\nmeasures 1.1 cm.", "output": "No acute cervical spine fracture or traumatic malalignment.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___,\nM.D. in person on ___ at 10:00 pm, 0 minutes after discovery of the\nfindings." }, { "input": "Alignment is normal. No acute fractures are identified. There mild to\nmoderate multilevel changes from C4 through C7 are noted with slight\nintervertebral disc space narrowing and anterior and posterior osteophyte\nformation. Mild multilevel disc bulges and posterior osteophytes result in\nmild central canal narrowing, but no critical stenosis. No prevertebral soft\ntissue swelling.\n\nThe thyroid is unremarkable. There is minimal scarring or atelectasis at the\nright apex. An endotracheal tube is noted within the trachea.", "output": "No fracture or traumatic malalignment." }, { "input": "The patient is status post anterior fixation of the C4 through 7 vertebral\nbodies, with intervertebral disc spacers. There is no acute fracture or\nmalalignment. There is no significant spinal canal stenosis. Bilateral\nneural foraminal narrowing is noted at the C3-4, C4-5, ___, and C6-7 levels.\nThere is no prevertebral soft tissue swelling.There is a 5 mm sclerotic focus\nin the right T1 lamina, unchanged from prior MRI of ___, and is\npartially visualized on MRIs dating back to ___, most compatible with a bone\nisland.", "output": "1. No acute fracture, malalignment, or prevertebral soft tissue abnormality.\n2. Anterior fixation of the C4 through 7 vertebral bodies, without evidence of\nhardware malfunction.\n3. 5 mm sclerotic focus of the right T1 lamina, unchanged from prior MRI of ___, likely representing a bone island." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. There is\nloss of disc height spanning L3-L4 through L5-S1 with vacuum discs phenomenon\nat the L5-S1. No evidence for acute fracture or traumatic malalignment.\n\nT11-T12 through L2-L3: Mild degenerative changes do not result in significant\nspinal canal or neural foraminal narrowing.\n\nL3-L4: A disc bulge results in mild spinal canal narrowing. There is mild\nright and mild to moderate left neural foraminal narrowing.\n\nL4-L5: A disc bulge and thickening of the ligamentum flavum results in mild\nspinal canal narrowing. There is mild to moderate left and mild right neural\nforaminal narrowing secondary to the disc and facet arthropathy.\n\nL5-S1: A disc bulge results in mild spinal canal narrowing. In conjunction\nwith facet arthropathy there is moderate bilateral neural foraminal narrowing.\n\nExtensive atherosclerotic calcification of the abdominal aorta and iliac\nvessels are noted without evidence for aneurysm. Within the confines of\nnoncontrast enhanced technique, visualized abdominal and pelvic visceral and\nparaspinal soft tissues are unremarkable.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality of\nthe lumbar spine." }, { "input": "There is minimal anterolisthesis of C3 on C4 and C7 on T1. No fractures are\nidentified.There are extensive multilevel degenerative changes, worst at C5-C6\nand C6-C7 with disc space narrowing, vacuum disc phenomenon, osteophytosis,\nendplate sclerosis, facet and uncovertebral hypertrophy. There is multilevel\nsevere neural foraminal narrowing and moderate central canal narrowing, worst\nat C4-C5, C5-C6, and C6-C7.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Please see separately dictated CT torso for\ndescription of emphysematous changes and other findings in the lung apices.", "output": "1. No fracture or prevertebral soft tissue swelling.\n2. Extensive multilevel degenerative changes. Mild anterolisthesis of C3 on\nC4 and C7 on T1 is likely degenerative in etiology." }, { "input": "Multilevel degenerative changes of the cervical spine are extensive and most\nsevere at C1-C2 and C5 through C7. Overall alignment of the cervical spine is\nsimilar to the exam from ___. No evidence of acute cervical spine\nfracture. Posterior disc protrusions and osteophytes at at C5-C6 and C6-C7\nresults in narrowing of the anterior spinal canal (Series 2, image 47, 49,\n52). No severe neural foraminal narrowing. Mild anterolisthesis of C2 on C3\nis unchanged and likely degenerative. Slight anterior wedging of C5 vertebral\nbody and loss of C6 vertebral body height are also unchanged, likely chronic\nand degenerative. No prevertebral soft tissue swelling. No suspicious\nosseous lesion. The thyroid is heterogeneous and nodular particularly in the\nisthmus and left lobe, unchanged (series 2, image 63) with a 4.5 cm dominant\nnodule in the left lobe. Some coarse calcifications of nodules are\ndemonstrated in the thyroid. Vascular calcifications are diffuse and moderate\nbut most extensive at the right carotid bifurcation, unchanged.\n\nTMJ degenerative changes are worse on the right.\n\nThe left maxillary sinus is partially opacified and appears to have air slice\nsecretions, suggesting a component of active sinus disease. Thickening of the\nleft maxillary sinus bones indicates a complement of chronic sinusitis as\nwell. Mucosal thickening of the right maxillary sinus is mild. \nWell-corticated sclerotic lesion in the right maxilla is likely a bone island\n(series 601b, image 5).", "output": "1. No cervical spine fracture.\n2. Severe multilevel degenerative changes of the cervical spine, overall\nunchanged in appearance in alignment from ___. Narrowing of the anterior\nspinal canal indenting the spinal cord at C5-C6 and C6-C7.\n3. Unchanged multinodular thyroid. Prominent 4.5 cm nodule is noted in the\nleft lobe of the thyroid.\n4. Acute on chronic paranasal sinus disease as above.\n\nRECOMMENDATION(S): If not already performed, further evaluation of\nmultinodular thyroid with dominant 4.5 cm nodule in the left lobe of the\nthyroid is suggested by current ACR recommendations for incidentally noted\nthyroid nodules." }, { "input": "No evidence for a fracture or prevertebral soft tissue swelling. Normal\nalignment. Small central disc protrusion at C4-C5 without significant spinal\ncanal narrowing. No evidence for significant neural foraminal narrowing.\n\nMild prominence of the midline nasopharyngeal soft tissues is normal for the\npatient's young age. The thyroid and included lung apices are unremarkable. \nConcurrent head CT is reported separately.", "output": "No evidence for a fracture. Normal alignment." }, { "input": "Alignment is normal. No fractures are identified.Osteoarthritic degenerative\nchanges of the cervical spine are moderate to severe, most pronounced at C4-C5\nand C5-C6, where there is severe disc space narrowing, large osteophytosis,\nand endplate sclerosis. At C4-C5, there is mild bilateral neuroforaminal\nnarrowing. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nThe imaged thyroid and lung apices are unremarkable.", "output": "No evidence of fracture or malalignment. Degenerative disc disease" }, { "input": "The patient is status post bilateral C1 laminectomy. There is gas and\nsubcutaneous soft tissues consistent with postoperative period. There is some\nrotation of the C1 and C2 arches, likely positional in nature. A drain is seen\nnoted posterior to the arch of C2. The patient is intubated and an orogastric\ntube is seen. Multilevel degenerative changes in the cervical spine are\nunchanged from the prior MRI examination none. ___. There is no\nevidence of lymphadenopathy.", "output": "Status post C1 laminectomy. Unchanged degenerative changes in cervical spine\nfrom the prior examination." }, { "input": "There is a heterogeneous density surrounding the lateral aspect of the\nodontoid process (03:28, measuring approximately 7 x 28 mm which appears to\nimpinge the thecal sac. This density is not significantly changed from the\nprior examination. Multilevel degenerative changes re- demonstrated. The\npatient is status post posterior instrumentation with screws seen through the\narch of C1. There is no sign of fracture or abnormal alignment. No other\nsignificant change from the prior exam.", "output": "Heterogeneous density around the lateral aspect of the odontoid process\nmeasuring 7 x 28 mm, which appears to impinge the thecal sac and not\nsignificantly changed from the prior exam." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal narrowing.There are mild degenerative changes throughout the\ncervical spine, most prominent at C6-C7. There is bilateral neural foraminal\nnarrowing, severe on the right, moderate on the left at C3-4 due to\nuncovertebral and facet osteophytes.\nAt C4-5, intervertebral osteophytes mildly encroach on the spinal canal well\nuncovertebral osteophytes produce moderate right neural foraminal narrowing.\nAt C5-6, intervertebral osteophytes encroach on the spinal canal and likely\ncontact the spinal cord. Uncovertebral osteophytes produce moderate bilateral\nneural foraminal narrowing.\nAt C6-7, intervertebral osteophytes encroach on the spinal canal and likely\ncontact the anterior surface of the spinal cord. There is moderate right and\nsevere left neural foraminal narrowing due to uncovertebral osteophytes.\nAt C7-T1 and the included portions of the upper thoracic spine there is no\nspinal canal or neural foraminal narrowing. Mild spinal canal narrowing at\nC5-C6 is unchanged from prior. No prevertebral soft tissue swelling.\n\n3 mm pulmonary ground-glass nodule in the left lung apex is unchanged since\n___. Multiple linear metallic densities in the subcutaneous tissues of both\nsides of the neck are again seen.", "output": "No evidence of fracture or subluxation.\nDegenerative disease." }, { "input": "Alignment is normal. No fractures are identified. Mild degenerative changes\nare seen along the cervical spine, including osteophyte formation,\nintervertebral disc space narrowing, Schmorl's nodes, uncovertebral/facet\nhypertrophy, and endplate sclerosis. Bilateral moderate to severe neural\nforaminal narrowing is seen at C3-C4, right greater than left, as well as at\nC5-C6 and C6-C7. There is moderate right neural foraminal narrowing at C4-C5.\nMild spinal canal narrowing at C5-C6 is unchanged. There is no prevertebral\nedema.\n\nThe thyroid and included lung apices are unremarkable. Multiple linear\nradiopaque densities are seen along the sternocleidomastoid muscles\nbilaterally, unchanged.", "output": "Mild degenerative changes along the cervical spine with no evidence of acute\ncervical fracture or traumatic malalignment." }, { "input": "Of note, motion artifact somewhat limits evaluation of skullbase and superior\ncervical spine. Alignment is normal. No acute fracture is identified. There\nis mild degenerative change throughout the cervical spine, most significant at\nC6-7. There is mild central canal narrowing at C5-6 and C6-7. A 3 mm\npulmonary nodule at the apex of the left lung is identified. Of note, few\nlinear metallic densities seen in the subcutaneous tissues of the neck are\nre-demonstrated and overall similar from ___. Of note, the esophagus is\nsomewhat patulous.", "output": "1. No acute cervical spine fracture or dislocation. Motion artifact limits\nevaluation at the skullbase and of the superior cervical spine.\n2. 3 mm pulmonary nodule at the apex of the left lung. If the patient is high\nrisk for pulmonary malignancy, recommend chest CT in 12 months. If the\npatient is low risk, no specific follow-up is required." }, { "input": "Minimal anterolisthesis of C2 on C3, similar to the prior study. Otherwise,\nthe alignment is normal. No fractures are identified. Mild, multilevel\ndegenerative changes of the cervical spine, including anterior and posterior\nosteophyte formation and intervertebral disc height narrowing, are most\nprominent at C4-C6. Mild central canal narrowing is noted at C5-C6. Neural\nforaminal narrowing is most pronounced on the left at C5-6 due to facet\narthropathy and uncovertebral spurring. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm. Evaluation of the\nlung apices is limited by respiratory motion, but there is emphysema noted in\nthe lung apices along with a calcified granuloma.", "output": "1. No acute cervical spine fracture. Minimal anterolisthesis of C2 on C3,\nsimilar to the prior study from ___.\n2. Mild, multilevel degenerative changes of the cervical spine, most\npronounced at C4-C6." }, { "input": "Alignment is unchanged.No fractures are identified.Mild multilevel\ndegenerative changes are again seen with mild intervertebral disc space\nnarrowing, and anterior and posterior osteophyte formation. Mild neural\nforaminal narrowing is demonstrated at C5-6 bilaterally due to facet\nhypertrophy and uncovertebral spurring. There is no evidence of high-grade\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. An enteric\ntube enters the right nare and extends outside of the field of view within the\nesophagus. Evaluation of the lung apices is mildly limited by motion, but\napical emphysema is re-demonstrated. Bilateral cervical ribs are incidentally\nnoted (02:46, 51), unchanged. Thyroid gland is normal.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "Multilevel degenerative changes of the cervical spine are demonstrated. No\nsignificant spinal canal or neural foraminal narrowing is noted. There is no\nevidence of acute fracture or traumatic malalignment.\nThere is no prevertebral soft tissue swelling. A partially imaged nasogastric\ntube is noted.\nEmphysematous changes are noted in the lung apices bilaterally.", "output": "Multilevel degenerative changes in the cervical spine without evidence of\nacute fracture or traumatic malalignment." }, { "input": "No evidence of traumatic malalignment. There is loss of the normal cervical\nlordosis. Diffuse osteopenia limits detection of acute fractures. However,\npossible lucency through the T1 vertebral body at the anterior superior\nendplate as well as the posterior inferior endplate are noted, possibly\nrepresenting fracture though may be artifactual and related to the patient's\nosteopenia. Recommend correlation with focal pain. There is no prevertebral\nedema.\n\nThe partially imaged lung apices are unremarkable apart from mild biapical\nscarring. A 4 mm right thyroid lobe nodule is without suspicious features and\ndoes not require dedicated follow-up.", "output": "1. Diffuse osteopenia limits detection of acute fractures. However, possible\nlucency through the T1 vertebral body at the anterior superior endplate as\nwell as the posterior inferior endplate are noted, possibly representing\nfracture though may be artifactual and related to the patient's osteopenia. \nRecommend correlation with focal pain, with consideration of MRI if clinical\nconcern.\n2. No traumatic malalignment.\n3. 4 mm right thyroid lobe nodule, which does not require dedicated follow-up." }, { "input": "There is no evidence of acute fracture or traumatic malalignment. Moderate\nmultilevel degenerative changes are noted throughout the cervical spine, most\nsignificant at the the levels of C1-C2 and C6-C7. There is no evidence of\ncritical spinal canal or neural foraminal narrowing. No prevertebral soft\ntissue swelling is identified. A partially imaged portion of a known\nright-sided ventriculoperitoneal shunt is noted and appears intact. There is\na 1.6 cm hypodense left thyroid nodule, better depicted in the concurrent CT\nof the chest.", "output": "Moderate, multilevel degenerative changes of the cervical spine without\nevidence of acute fracture or traumatic malalignment.\n\nNOTIFICATION: Findings were conveyed by Dr. ___ to the ACS resident at\n05:30 on ___." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes are\nnoted including intervertebral disc height loss, uncovertebral joint\nhypertrophy and posterior osteophytes. Most significant secondary canal\nnarrowing is at C5-C6 and is moderate to severe. There is also moderate right\nforaminal narrowing at this level.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Degenerative changes without acute fracture or malalignment." }, { "input": "The study is limited by persistent motion artifact despite multiple\nacquisitions.\n\nVertebral body heights are maintained and there is no evidence of fracture. \nIntervertebral disc space heights are maintained. Multilevel degenerative\nchanges are noted. No acute alignment abnormality is identified. There is no\nprevertebral soft tissue abnormality.\n\nThe thyroid is grossly unremarkable in appearance. No lymphadenopathy is\npresent by CT size criteria. The visualized lung apices are clear.\n\nEndoluminal debris is seen within the pharynx.", "output": "No evidence of acute fracture or malalignment." }, { "input": "There is new anterior wedging of the T2 vertebral body with a lucent line\nextending from the superior end plate and possibly through the posterior\naspect of the vertebral body, concerning for an acute fracture (602b:54).\nThere is no bony retropulsion. There is no prevertebral soft tissue swelling. \nNo additional fractures are identified.\n\nThere are moderately severe multilevel multifactorial degenerative changes of\nthe cervical spine with posterior disc osteophyte formation, facet joint\nhypertrophy, uncovertebral hypertrophy, disc space narrowing, and canal\nnarrowing, which has overall progressed since ___. These degenerative changes\nare most pronounced at C6-7. Mild anterolisthesis of C4-C5 and C7-T1 is\nunchanged.\n\nThe thyroid is unremarkable. There is scarring at the lung apices.\nAdditionally, there is mild paraseptal emphysema. Aeorsolized secretions are\nnoted in the trachea (3:68).", "output": "1. New anterior wedging deformity of the T2 vertebral body with a lucent line\nwithin the superior endplate possibly extending in through the posterior\nvertebral body, concerning for an acute fracture. No retropulsion. MRI can be\nobtained if further assessment is needed.\n2. No other fractures identified.\n3. Moderate to severe degenerative changes, which have progressed from ___.\n4. Unchanged mild anterolisthesis of C4-5 and C7-T1." }, { "input": "Grossly stable reversal of cervical lordosis again noted. Vertebral body\nheights are preserved. There is no definite evidence of acute fracture. \nThere is no prevertebral soft tissue swelling. Multilevel degenerative\nchanges of the cervical spine are again noted, including loss of\nintervertebral disc height, endplate sclerosis, disc osteophyte complexes,\nfacet joint hypertrophy, and at least mild vertebral canal narrowing C5-6 and\nC6-7, grossly unchanged compared to prior exam.\n\nThe thyroid and included lung apices are preserved. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Grossly stable multilevel degenerative changes cervical spine as described\nwith at least mild vertebral canal narrowing at C5-6 and C6-7. If clinically\nindicated, consider cervical spine MRI for further evaluation.\n3. Nonspecific mildly prominent subcentimeter cervical lymph nodes as\ndescribed, which may be reactive.\n4. Please note MRI of the cervical spine is more sensitive for the evaluation\nof ligamentous injury." }, { "input": "The bones are demineralized.\n\nThe fracture of the left anterior arch of C1 demonstrates unchanged 4 mm\ndistraction of the fracture fragments and new sclerosis along the fracture\nmargins. The fracture through the right posterior arch of C1 demonstrates\nunchanged alignment of the fracture fragments with minimal elevation of the\nposterior fragment, image 7:44. Sclerotic appearance of the margins of this\nfracture is unchanged, presumably due to abundance of cortical bone in this\nlocation.\n\nType 2 odontoid fracture remains nondisplaced with unchanged minimal dorsal\nangulation of the distal odontoid fragment. There is new sclerosis along the\nfracture margins, and the fracture line remains visible. Distances between\nthe odontoid and the lateral masses of C1 are unchanged. Narrowing of the\nanterior atlantoaxial distance is also unchanged.\n\nFracture of C5 spinous process remains nondisplaced, with new sclerosis along\nthe fracture margins and a visible fracture line.\n\nVertebral body heights are preserved. Minimal retrolisthesis of C2 on C3,\nmild anterolisthesis of C7 on T1, and mild anterolisthesis of T1 and T2 are\nunchanged. A well corticated lucency along the inferior endplate of T1 is\nunchanged, image 7:39, and appears nonaggressive.\n\nDisc osteophyte complexes indent the ventral thecal sac at multiple levels\nwithout high-grade spinal canal narrowing, similar to prior. Extensive\nmultilevel neural foraminal narrowing by uncovertebral arthropathy and severe\nbilateral facet arthropathy is again seen.\n\nRight mastoid air cells are almost completely opacified, unchanged. Mild\npartial opacification of the left mastoid air cells has improved since ___. Bilateral middle ear cavities are well aerated, with resolution of left\nmiddle ear cavity opacification since ___.\n\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are seen on limited assessment.\n\nBilateral carotid siphon and carotid bifurcation calcifications are again\nseen.\n\nExtension of the right lobe is again noted, without tracheal narrowing. The\npreviously noted small left lower pole nodule is not included in the field of\nview.", "output": "1. Unchanged alignment of C1, C2, and C5 fracture fragments compared to ___, as detailed above.\n2. There is new sclerosis along the fracture margins, and the fracture lines\nremain visible.\n3. Multilevel cervical degenerative disease.\n4. Unchanged almost complete right mastoid air cell opacification. Mild,\ndecreased left mastoid air cell opacification and resolution of left middle\near cavity opacification since ___." }, { "input": "There is a minimally displaced fracture of the left aspect of the anterior\narch of C1, and a nondisplaced fracture of the posterior arch of C1. A\nnondisplaced, minimally angulated fracture is seen involving the base in the\nbody of the odontoid process. Additionally, there is a non-displaced fracture\nof the spinous process of C4. There is mild prevertebral soft tissue swelling\nat C1-2.\n\nThere are multilevel degenerative disc disease most severe at C6-7 and\nmultilevel degenerative facet changes. There are multilevel neural foraminal\nstenosis moderate to severe at C5-6 and C6-7. There is minimal\nanterolisthesis of C7 on T1, unchanged. Otherwise, alignment is normal. \nThere is no significant spinal canal stenosis.\n\nFibronodular changes are seen at the lung apices. Incidental note is made of\nfluid within the mastoid air cells bilaterally.", "output": "1. Fractures of the arch of C1, in addition to a nondisplaced minimally\nangulated fracture of the odontoid base and body, unchanged from prior outside\nhospital study from ___.\n2. Nondisplaced spinous process fracture C4 is also unchanged. No new\nfractures identified.\n3. Unchanged minimal C7-T1 anterolisthesis. Otherwise, normal unchanged\nalignment.\n4. Cervical spine degenerative changes, as detailed above." }, { "input": "Vertebral body heights and alignment are maintained. There is no cervical\nspine fracture or malalignment. There is congenital nonfusion of the\nposterior C1 arch. Minimal anterior endplate osteophyte is seen at C5-C6. \nOtherwise there is no significant degenerative change. There is no\nsignificant spinal canal or neural foraminal narrowing. There are trace facet\ndegenerative changes. Re-identified is a nondisplaced posterior right first\nrib fracture. There is no prevertebral soft tissue swelling.\n\nThe imaged lung apices are grossly clear. Thyroid gland is grossly\nunremarkable. There is no gross cervical lymphadenopathy.", "output": "1. No cervical spine fracture or malalignment.\n2. Unchanged nondisplaced right posterior first rib fracture." }, { "input": "OG and endotracheal tubes are seen descending along the anterior neck. \nPartially visualized fracture at the left pterygoid apex and left posterior\nmaxillary sinus, described in further detail on same-day CT facial bones.\n\nThere is posterior nonunion of the C1 ring, developmental. There is no acute\nfracture or malalignment in the cervical spine. There is a minimally\ndisplaced fracture of the right first rib along the posterior arch. Partially\nvisualized contusion is noted in the lung apices. Bilateral palatine\ntonsilliths are present. The thyroid is normal. There is no significant\ndegenerative disease.\n\nPlease refer to same-day facial bone CT relating to facial bone fractures.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Right first posterior rib fracture.\n3. Partially visualized contusion in the lung apices, please refer to CT torso\nfor further details.\n4. OG and ET tubes in place.\n5. Please refer to same-day facial bone CT for full detailed description\nregarding facial bone injuries." }, { "input": "Diffuse demineralization of the bones.\nLevoscoliosis.\nThere is anterolisthesis of C4-C5, and mild anterolisthesis of C7-T1 is also\nnoted. No acute fracture is seen. Multilevel degenerative changes are noted\nincluding disc height loss, endplate sclerosis and subchondral cyst formation,\nmost significant at C4-C5 and C6-C7. There is no significant spinal canal\nstenosis. Uncovertebral and facet hypertrophy causes bilateral moderate to\nsevere neural foraminal narrowing, most pronounced at C3-C4. Incidental note\nis made of medialization of the bilateral internal carotid arteries mother\nright indenting the right side of the oropharynx and atrophy of the right\nsubmandibular gland. Minimal fluid in the left inferior mastoid air cells.", "output": "1. No acute fracture of the cervical spine.\n2. Anterolisthesis of C4-C5 may be degenerative in nature though no prior is\navailable for comparison. Mild anterolisthesis of C7-T1. An MRI can be\nobtained to evaluate for possible ligamentous injury if not contra-indicated .\n3. Multilevel, multifactorial degenerative changes.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr.\n___ on the ___ ___ at 6:39 ___, 5 minutes after discovery\nof the findings." }, { "input": "No evidence of acute fracture is seen. There is mild anterolisthesis of C5\nover C6 and C6 over C7. Multi-level degenerative facet degenerative changes\nare seen, particularly on the left, and at C6, C7. Multilevel degenerative\nchanges are seen. These include disc space narrowing at home C5/C6 and to a\nlesser extent at other levels.. No prevertebral soft tissue swelling is seen.\nThe thyroid gland isheterogeneous, with multiple hypodense nodules seen,\nmeasuring up to 1.3 cm on the right and 1.7 cm on the left, though where there\nis also coarse calcification.. The lung apices demonstrated bilateral septal\nthickening and ground-glass opacity suggesting pulmonary edema..", "output": "No evidence of acute fracture. Mild anterolisthesis of C5 over C6 and C6 over\nC7. If concern for ligamentous injury, MRI is more sensitive.\n\nHeterogeneous, multinodular thyroid gland. Recommend non-urgent ultrasound as\nclinically indicated.\n\nPartially imaged pulmonary edema." }, { "input": "Alignment is normal.No definite fracture is identified. There is no\nprevertebral soft tissue swelling.Multilevel degenerative changes cervical\nspine, with probably mild central canal narrowing. Multilevel mild, moderate\nforaminal narrowing, most prominent at the left C5-C6, left C6-C7 foramina.\n\nMild partial opacification inferior left mastoids with ossification,\nconsistent with partial contraction from chronic inflammation. Mastoids are\notherwise clear. Mild opacification of the partially seen paranasal sinuses.", "output": "1. No fracture.\n2. Degenerative changes cervical spine." }, { "input": "No traumatic malalignment is identified. Dextroscoliosis of thoracic spine is\nnoted. Thoracic kyphosis. No fractures are identified. Degenerative changes\nof the thoracic spine is mild. There is no evidence of high-grade spinal\ncanal or neural foraminal stenosis. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nHiatal hernia is small. 1.4 cm hypodensity in the upper pole of left kidney\nlikely corresponds to the renal cyst seen on prior CT with contrast.\nSpiculated 0.9 cm x 0.9 cm nodule the below the right hilum series 2, image 79\nis similar compared with ___ CT chest. Small lingular nodule is\nstable. Coronary artery calcifications. Small esophageal hiatal hernia. \nSmall right pleural effusion.", "output": "1. No fracture is identified.\n2. Spiculated 0.9 cm lung nodule, similar to ___. Follow-up\nrecommended.\n\nNOTIFICATION: For incidentally detected single solid pulmonary nodule bigger\nthan 8mm, a follow-up CT in 3 months, a PET-CT, or tissue sampling is\nrecommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "Grade 1 anterolisthesis of L4 over 5 is degenerative. No fractures are\nidentified.There is no evidence of high-grade spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling.\nDegenerative changes lumbar spine. Probably moderate central canal narrowing\nL4-5 level. Multilevel mild-to-moderate foraminal narrowing, most prominent\nat L4-5, L5-S1 levels.\nBenign cyst left kidney.", "output": "1. No fracture.\n2. Degenerative changes lumbar spine." }, { "input": "Mild anterolisthesis of C2 on C3 and C7 on T1 is age indeterminate but likely\ndegenerative in etiology. Additionally, there is minimal retrolisthesis of C3\non C4, and C4 on C5, likely degenerative as well. No acute fractures are\nseen. Mild compression deformities of the C4, C5, and C6 vertebra are\nchronic. Multilevel degenerative changes are seen throughout the spine but\nare severe at the C3 to C6 level. Spinal canal narrowing is worst and\nmild-to-moderate at the C4-5 level due to hypertrophic endplate changes. \nNeural foraminal narrowing is mild throughout the bilateral C3-6 levels. \nThere is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture.\n2. Multilevel spondylolisthesis worst with mild anterolisthesis of C2 on C3\nand C7 on T1, all age indeterminate, but likely degenerative in etiology." }, { "input": "Alignment is normal. No cervical spine fractures are identified.Vertebral body\nheights and intervertebral disc spaces are maintained. There is no evidence\nof spinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nMultiple hypodense nodules are seen in the thyroid gland which measure up to 7\nmm on the left. Visualized lung apices are clear.", "output": "1. No evidence of acute fracture or subluxation.\n2. Multiple subcentimeter thyroid nodules. Please see recommendations below.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Reversal of the normal cervical lordosis is present. No subluxation.No\nfractures are identified. There is mild multilevel degenerative change,\nincluding anterior osteophytes, disc space narrowing most notable at C5-C6,\nand endplate sclerosis. Mild disc bulging results in mild multilevel central\ncanal narrowing, most pronounced at C3-4. There is mild neural foraminal\nnarrowing on the left at C3-C4 and on the right at C5-C6 secondary to\nuncovertebral osteophytes. There is no prevertebral soft tissue swelling.The\nthyroid is unremarkable. Partially visualized lung apices are within normal\nlimits. Nerve stimulator device leads terminate overlying the occipital bones\nbilaterally.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Mild multilevel degenerative change, most notably involving C3-C4 and\nC5-C6." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nsignificant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\nCorresponding to areas of vertebral body marrow signal abnormality on recent\nMRI of the cervical spine are numerous predominantly lytic lesions without\ncortical defect or soft tissue component or typical features of hemangiomas.\n\nIncidental note is made of a distended esophagus containing ingested material.\nNo hiatal hernia was noted on previous CT of the abdomen pelvis in ___ or\nrecent chest radiograph.", "output": "1. Numerous lytic lesions in the cervical spine vertebral bodies corresponding\nto abnormality on recent cervical spine MRI do not demonstrate typical CT\nappearance of hemangiomas. Differential considerations include brown tumor,\natypical hemangiomas, or multiple myeloma.\n2. Distended esophagus containing ingested material may suggest esophageal\ndysmotility disorder. If clinically indicated, further evaluation could be a\npursued with a barium esophagram." }, { "input": "Alignment is normal. No acute fractures are identified. There is superior\nendplate height loss at T1 and T2 which is new from prior chest CT dated ___ though without CT evidence to suggest acuity. There are mild\nmultilevel degenerative changes of the cervical spine with mild disc height\nnarrowing and small intervertebral osteophytes at C4-5 through C6-7 which\ncause mild canal narrowing at these levels, most significantly at C6-7 and\nC4-5. Uncovertebral hypertrophy causes mild neural foraminal narrowing\nbilaterally at C4-5 through C6-7. There is no prevertebral soft tissue\nswelling.\n\nThyroid appears homogeneous and enlarged without discrete nodularity and,\nalthough several calcifications are seen within. Partially visualized soft\ntissue nodule just inferior to the left lobe of the thyroid (59:301) was seen\non prior chest CT. Imaged lung apices are clear.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Superior endplate height loss at T1 and T2 which is new since ___ though\nappears chronic correlation with physical exam is suggested.\n3. Mild multilevel degenerative changes of the cervical spine as above.\n4. Partially visualized nodule just inferior to the left lobe of the liver\nwhich was seen on prior chest CT. At that time, ultrasound has been\nrecommended." }, { "input": "Cervical alignment is anatomic. No acute cervical spine fractures are\nidentified. There are mild multilevel degenerative changes including disc\nspace height loss and osteophytosis causing mild vertebral canal narrowing at\nC4-C5, mild left neural foraminal narrowing at C3-C4 and moderate left neural\nforaminal narrowing at C5-C6. There is no prevertebral soft tissue\nswelling.The visualized lung apices are grossly clear. There is no cervical\nlymphadenopathy by size criteria.\n\nThere is an incompletely imaged comminuted fracture of the left clavicular\nhead with anterior displacement of the distal fragment by approximately 4 mm.", "output": "1. There is an incompletely imaged, comminuted fracture of the left clavicular\nhead.\n2. No evidence of acute fracture or traumatic malalignment of the cervical\nspine.\n3. Mild multilevel degenerative changes including disc height loss and\nosteophytosis results in mild vertebral canal narrowing at C4-C5, mild left\nneural foraminal narrowing at C3-C4, and moderate left neural foraminal\nnarrowing at C5-C6." }, { "input": "There is no acute fracture or alignment abnormality. There is no prevertebral\nsoft tissue swelling. There are mild degenerative changes of the spine but\nno severe spinal canal narrowing. There is a 2.3 x 1.7 cm hypoattenuating\nthyroid nodule in the right lobe. No concerning abnormality is seen in the\nincluded upper lungs. CT is not able to provide intrathecal detail comparable\nto MRI; within this limitation, the outline of the thecal sac appears normal.", "output": "1. No evidence of acute cervical spine injury.\n2. Thyroid nodule for which comparison to prior examinations or outpatient\nultrasound is recommended." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "Alignment is normal. No fractures are identified. Lytic lesions are noted\nthroughout the osseous structures, consistent with known myeloma. There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Numerous diffuse lytic lesions, consistent with known myeloma." }, { "input": "Multilevel degenerative changes characterized by significant posterior\nosteophyte formation and intervertebral loss of height, most severe from C4\nthrough C7 with resultant severe central canal stenosis. No acute fracture or\nmalalignment. The prevertebral soft tissues are normal without swelling or\nhematoma.\nThe thyroid gland is homogeneous. The visualized lung apices are clear. No\ncervical lymphadenopathy.", "output": "1. Severe central canal stenosis from C4 through C7 as a result of exuberant\nuncovertebral arthropathy and posterior osteophytes. No acute fracture or\nmalalignment.\n2. Please note, in the setting of severe spinal stenosis, threshold for\nspinal cord injury is reduced in the setting of trauma, and MRI is more\nsensitive for evaluation of spinal cord abnormality." }, { "input": "Study is mildly degraded by motion. There is minimal stable anterolisthesis\nof C5 on C6. Multilevel degenerative changes are noted, including\nosteophytosis and intervertebral disc space narrowing, particularly at C5-C6. \nNo acute fracture is identified. The visualized osseous structures are\nosteopenic. Multilevel degenerative changes resulting in at least mild\nvertebral canal and neuroforaminal stenosis is noted.There is no prevertebral\nedema. Atherosclerotic vascular calcifications are seen in bilateral carotid\nbifurcations.\n\nHypodense nodule is seen in the right thyroid lobe. This measures\napproximately 6 mm. The visualized lung apices are unremarkable.", "output": "1. Study is mildly degraded by motion.\n2. Within limits of study, no definite cervical spine fracture identified. If\ncontinued concern for cervical spine fracture or ligamentous injury, MRI may\nbe considered for further evaluation.\n3. 6 mm nonspecific right thyroid lobe nodule. Recommend clinical\ncorrelation. If clinically indicated, consider thyroid ultrasound for further\nevaluation.\n4. Multilevel degenerative changes of cervical spine.\n\nRECOMMENDATION(S):\n1. Within limits of study, no definite cervical spine fracture identified. If\ncontinued concern for cervical spine fracture or ligamentous injury, MRI may\nbe considered for further evaluation.\n2. 6 mm nonspecific right thyroid lobe nodule. Recommend clinical\ncorrelation. If clinically indicated, consider thyroid ultrasound for further\nevaluation." }, { "input": "There is no acute fracture or traumatic malalignment. There is\nre-demonstration of anterior and posterior congenital fusion of C2 and C3.\nMultilevel degenerative changes are seen, centered about C5 and C6 with\nintervertebral disc space narrowing and no significant central spinal canal or\nneural foraminal stenosis. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema. The sclerotic\nfocus in the right sacrum likely compatible with a bone island.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fractures or malalignment." }, { "input": "Alignment is maintained, including minimal anterolisthesis of C7 on T1. New\nsince the prior study of ___, but of otherwise indeterminate age,\nthere is mild-to-moderate loss of height of the T1 vertebral body, consistent\nwith age indeterminate compression fracture. Finding may be subacute, but\nacute component is not excluded. There are multilevel degenerative changes in\ncervical spine with disc space narrowing and small posterior disc osteophyte\ncomplexes, resulting in up to mild central canal narrowing, worst at C5-C6,\nnot significantly changed. Multilevel facet arthropathy and uncovertebral\nhypertrophy results in up to mild neural foraminal narrowing, worst on the\nright at C5-C6. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Mild-to-moderate compression fracture of the superior endplate of the T1\nvertebral body, new since the prior study of ___, but of otherwise\nindeterminate age. Findings may be subacute, but acute component is difficult\nto entirely exclude. Correlate clinically for acuity. MRI could help further\nassess acuity.\n\nNo acute fracture seen elsewhere. No dislocation. Multilevel degenerative\nchanges.\n\nNOTIFICATION: Updated findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:50 pm, 3 minutes after\ndiscovery of the findings." }, { "input": "Diffuse demineralization of the bones.\nMinimal anterolisthesis of C7 over T1\nThere is no fracture or prevertebral swelling.\nThe imaged cervical vertebral bodies demonstrate normal alignment.\nThere are moderate multilevel, multifactorial cervical spine degenerative\nchanges, with multilevel severe disc height loss, endplate sclerosis, and\nintervertebral osteophytes, uncovertebral and facet degenerative changes.\nMild spinal canal narrowing is most prominent at C5-6 and C6/7 levels due to a\nprominent posterior intervertebral osteophyte and disc bulge/small extrusion \n(series 3, image 43).\nMultilevel severe neural foraminal narrowing is most prominent on the right\nalso at C3-4 C5-6 and C6-7 (series 2, image 43 and 40 47-48) and on the left\nat C4-5 level, secondary to uncovertebral osteophytosis and facet arthropathy.\nNo suspicious osseous lesions are noted.\nA few lucent foci noted scattered diffusely, can relate to fat deposit or\nsubchondral cysts, etc.\nTortuous carotid arteries left more than right.\nLimited assessment of the soft tissues of the neck on the noncontrast study. \nNo obvious mass like lesions noted. Thyroid not seen.", "output": "1. No fracture or prevertebral swelling.\n2. Moderate multilevel, multifactorial cervical spine degenerative change, as\ndetailed above with mild canal and moderate to severe foraminal narrowing. \nCorrelate clinically to decide on the need for further workup.\nOther details as above" }, { "input": "No fractures are identified. There is no prevertebral soft tissue\nswelling.Multilevel degenerative changes are present most prominent C3-4\nthrough C6-C7 with loss of disc height, osteophytosis, and endplate sclerosis\nsimilar appearance to ___. Mild anterolisthesis of C7 on T1 is\nagain noted and unchanged. Uncovertebral joint hypertrophy causes moderate\nright neuroforaminal narrowing at C5-C6 and C6-7. There is no severe spinal\ncanal narrowing.\n\nPartially visualized small bilateral, right greater than left, pleural\neffusions. In the right lung apex a ground-glass airspace opacity is new\nsince ___ (2:78). Left submandibular gland is fatty replaced. Calcification\nis noted in the region of the duct at the hilum, potentially a sialolith.", "output": "1. No fracture. Multilevel degenerative changes, unchanged from ___.\n2. Moderate to severe right neuroforaminal stenosis at C5-C6 and C6-C7.\n3. Bilateral small right greater than left pleural effusions, new since ___,\npartially visualized.\n4. Opacity at the right lung apex may suggest infection or aspiration." }, { "input": "There is unchanged anterolisthesis of C4 on C5 and C7 on T1. Multilevel\ndegenerative changes including anterior, posterior, and uncovertebral\nosteophytosis, and disc height loss are worst at C5-C6. Multilevel facet\njoint hypertrophy is also seen particularly spanning C2-3 through C4-5. There\nis mild osseous neural foraminal narrowing at C3-C4 and mild vertebral canal\nnarrowing at C3-C4 caused by a partially calcified posterior disc bulge. No\nfractures are identified. There is no prevertebral soft tissue swelling.\n\nVisualized lung apices are unremarkable. Carotid calcifications are noted.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "Again seen is mild anterolisthesis of C4 on C5 and C7 on T1 as well as mild\nretrolisthesis of C5 on C6, unchanged. No acute fractures are\nidentified.There are moderate to severe multilevel degenerative changes,\nincluding anterior, posterior and uncovertebral osteophytosis and disc height\nloss, worst at C5-C6. Again seen is multilevel facet joint hypertrophy. \nThere are posterior disc osteophyte complexes at C3-C4, C4-C5, C5-C6, and\nC6-C7 causing mild vertebral canal narrowing. Multilevel mild neural\nforaminal narrowing is also seen, worse at C5-6. There is no prevertebral\nedema.\n\nIncluded lung apices are unremarkable. Thyroid gland is within normal limits.", "output": "1. No acute fractures or change in alignment.\n2. Multilevel moderate to severe degenerative changes, not significantly\nchanged compared to ___." }, { "input": "Again seen is grade 1 anterolisthesis of C4 on C5 and C7 on T1, and grade 1\nretrolisthesis of C5 on C6, unchanged. No fractures are identified.Moderate\nto severe multilevel degenerative changes are seen, most extensive at C5-6 and\nnotable for loss of intervertebral disc space, anterior and posterior\nosteophytosis, uncovertebral hypertrophy and facet hypertrophy, similar to\nprior. There is mild canal narrowing at C4-5 through C6-7. Mild neural\nforaminal narrowing is most significant at C5-6. There is no prevertebral\nedema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine. \nModerate to severe compression deformities from C5-C7 are likely secondary to\nadvanced degenerative changes, not significantly changed compared to the prior\nexam.\n2. No significant change in moderate to severe multilevel degenerative\nchanges." }, { "input": "Alignment is normal.No acute fracture is seen.Prominent anterior osteophytes\nat multiple levels, including C3 through T1. Disc space narrowing is most\nnoted C5 through C7. There is no prevertebral soft tissue swelling.Left-sided\nsmall tonsilliths are noted. Thyroid gland appears unremarkable. Partially\nimaged lung apices show no focal consolidation. Partially imaged is a\nright-sided port catheter.", "output": "1. No acute fracture or dislocation of the cervical spine." }, { "input": "Dental amalgam streak artifact and mild motion limits study. Alignment is\nnormal. The visualized osseous structures are osteopenic. No fractures are\nidentified. Moderate disc bulge at C3-4 results in mild to moderate spinal\ncanal narrowing. Disc osteophyte complex at C4-5, C5-6, and C6-7 results in\nmild spinal canal narrowing. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.\n\nMultiple hypodense nodules in the thyroid, the largest measuring 1.7 cm in the\nright thyroid lobe. Limited imaging lungs demonstrate biapical scarring, and\nright upper lobe opacity (see 601b:47, 602b:13, 2:68). An approximately 7 x\n19 mm left occipital scalp lipoma is noted (see 3:8).", "output": "1. Dental amalgam streak artifact and mild motion limits study.\n2. No evidence acute fracture traumatic malalignment.\n3. Mild to moderate multilevel degenerative changes are noted with multilevel\nmild to moderate spinal canal narrowing.\n4. Multiple hypodense nodules in the thyroid, the largest measuring 1.7 cm in\nthe right thyroid lobe. The ___ College of Radiology guidelines suggest\nthyroid ultrasound for further evaluation, if not already performed.\n5. Limited imaging lungs demonstrate biapical scarring and nonspecific right\nupper lobe opacity.\n\nRECOMMENDATION(S): Thyroid US." }, { "input": "The bones are severely demineralized. There is grade 1 anterolisthesis of L3\non ___. Remaining vertebral bodies are aligned appropriately. There is a\ntransversely oriented fracture through the L4 vertebral body, new since ___ and likely acute given fracture line which is relatively well\ndemarcated and adjacent mild paraspinal swelling. Fracture lines seen to\ninvolve the midportion of the anterior and posterior aspects of the vertebral\nbody as well as extension to the superior endplate. There is no evidence of\nheight loss.\n\nThere is compression deformity of T12 without CT findings to suggest that is\nacute such as discrete fracture line or paraspinal soft tissue swelling.\n\nMultilevel degenerative changes including intervertebral disc height loss and\nvacuum disc phenomenon as well as extensive bilateral facet joint hypertrophy.\nCanal narrowing which appears moderate is worst at the L3-4 level. Moderate\nto severe right foraminal narrowing noted at L4-5.\n\nThere are 2.2 cm right and 2 cm left adrenal adenomas. Atherosclerotic\ncalcifications noted within a normal caliber abdominal aorta.", "output": "1. There is a transversely oriented fracture of the L4 vertebral body, new\nsince ___. Fracture line seen to involve the anterior posterior\naspects of the vertebral body as well as a superior endplate. No significant\nheight loss nor retropulsion.\n2. There is compression deformity of T12, with no CT findings to suggest that\nit is acute." }, { "input": "Mild anterolisthesis of C4 on C5 and retrolisthesis of C5 on C6 is\ndemonstrated.No fractures are identified.Moderate multilevel degenerative\nchanges with intervertebral disc space narrowing, endplate sclerosis and\nsubchondral cysts, and anterior and posterior osteophyte formations are most\npronounced at C5-6 and C6-7. Mild central canal narrowing at C4-5 due to a\ndisc bulge is present as well as at C5-6 and C6-7 due to posterior\nosteophytes. Mild bilateral multilevel neural foraminal stenosis is most\npronounced at C5-6 and C6-7 due to uncovertebral spurring.There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThe imaged thyroid gland and lung apices appear clear.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Moderate cervical spondylosis.\n3. Mild C4 on C5 and C5 on C6 subluxation, likely degenerative in etiology. \nIf there is concern for ligamentous injury, this would be better assessed with\nMRI of the cervical spine." }, { "input": "Alignment is normal. There is a non displaced fracture of the right anterior\narch of C1 (02:16, 02:17). No other fractures identified. Vertebral body\nheights and intervertebral disc spaces are maintained. There is no\nsignificant canal or foraminal narrowing. There is no prevertebral edema.\n\nMedial to the inferior right mandible is a dense osseous protuberance\nextending from the cortex and measures 2.1 x 1 5 x 3.6 cm (2:25, 601b: 3). \nThe posterior nasopharyngeal soft tissues are substantially enlarged.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. Nondisplaced fracture through the right anterior arch of C1. MRI could be\nobtained for more complete assessment of any ligamentous injury.\n2. No traumatic malalignment or prevertebral soft tissue swelling.\n3. Substantial posterior nasopharyngeal soft tissue enlargement. Correlation\nwith direct inspection is recommended.\n4. Right mandible osseous protuberance compatible with an exostosis.\n\nRECOMMENDATION(S): 1. MRI of the cervical spine.\n2. Direct inspection of posterior nasopharyngeal soft tissues." }, { "input": "There is no cervical spine fracture. There is no prevertebral soft tissue\nswelling. Mild widening of the bilateral craniocervical junction, likely\nsecondary to head position. The atlanto-dental interval is normal. There are\nmultilevel degenerative changes, moderate, most pronounced at C5-6, C6-7, and\nC7-T1 where there is disc space narrowing. There is minimal retrolisthesis of\nC6-7. There is retropharyngeal fluid, which likely relates to intubation. \nThere is mild biapical lung scarring. The thyroid is unremarkable.", "output": "No cervical spine fracture." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nsignificant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. The visualized lung apices appear clear. The thyroid gland is\nunremarkable.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Streak artifact from dental hardware limits evaluation of the upper cervical\nspine.\n\nAlignment is normal. No fractures are identified. There are multilevel\ndegenerative changes, worst and severe at the C6-7 level. The bilateral C3-4\nfacet joints are fused. Spinal canal narrowing is worst and mild at the C6-7\nlevel due to endplate osteophytosis. Neural foraminal narrowing is worst and\nsevere bilaterally at the C6-7 level due to uncovertebral and facet\nhypertrophy. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes with resultant spinal canal and neural\nforaminal narrowing as described above." }, { "input": "There is straightening of the cervical spine, likely positional. Atlantoaxial\nand atlantooccipital articulations are maintained. Odontoid process is\nintact. Vertebral body heights and intervertebral disc spaces are within\nnormal limits. Facet articulations are maintained. The posterior spinous\nprocesses are intact. No acute fracture or subluxation is identified. There\nis no spinal canal or neural foraminal stenosis. No significant degenerative\nchanges are present.\n\nNo prevertebral soft tissue swelling over the is noted. Visualized airway is\nclear. The included soft tissues of the neck are grossly unremarkable, within\nlimitations of a noncontrast enhanced examination. Thyroid gland is normal in\nappearance.\n\nFor details regarding included skull base and pulmonary apices, please refer\nto the reports for CT head and CT chest, respectively, performed on the same\nday.", "output": "1. Normal study." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are noted with flowing anterior osteophytes from C4 through C6 and\nmild canal stenosis in the lower cervical spine.There is no prevertebral\nedema.\n\nThe thyroid is unremarkable. A 4 mm pulmonary nodule is seen at the left lung\napex.", "output": "1. No acute fracture.\n2. Multilevel degenerative changes of the cervical spine.\n3. 4 mm nodule at the left lung apex. Followup CT chest in 12 months only if\npatient has elevated risk factors for malignancy.\n\nRECOMMENDATION(S): For the pulmonary nodule, in a high risk patient,\nfollow-up chest CT is recommended in 12 months according to ___ society\nguidelines." }, { "input": "No acute fracture or traumatic malalignment is identified.Retrolisthesis of L5\non S1 with left-sided disc extrusion results in moderate canal narrowing and\nimpingement of the left S1 nerve root. There is mild-to-moderate bilateral\nright greater than left neural foraminal narrowing.There is no prevertebral\nsoft tissue swelling.\n\nThe visualized kidneys are unremarkable. No substantial atherosclerotic\ndisease is identified.", "output": "1. Left-sided disc extrusion at L5-S1 results in moderate canal narrowing and\nimpingement of the left S1 nerve root.\n2. No acute fracture or traumatic malalignment identified." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. Thyroid gland appears normal. Partially imaged\nmaxillary sinuses demonstrate mucosal thickening, left greater than right.", "output": "No fracture or malalignment. Partially imaged sinus disease in the lower\nmaxillary sinuses." }, { "input": "There is asymmetric widening of the anterior aspect of C6-C7 intervertebral\ndisc space concerning for anterior longitudinal ligamentous injury (602b:50). \nIn addition, there is a fracture involving the left C7 transverse process,\nlamina, and superior articular process (02:55). A fracture fragment is\ndisplaced into the left neural foramen at this level. Stranding is noted\nwithin the posterior soft tissues at C6-7 concerning for injury to the\nposterior ligamentous complex. There is mild soft tissue prevertebral\nswelling at C3-C4.\n\nThere is abnormal circumferential soft tissue density surrounding the thecal\nsac from C1-2 through C7-T1, not apparent on the previous CT, concerning for\nhemorrhage.\n\nModerate multilevel degenerative changes are present with intervertebral disc\nspace narrowing, endplate sclerosis and cystic changes, and anterior and\nposterior osteophyte formation. Moderate central canal narrowing is noted at\nC5-6 along with moderate to severe left and moderate right neural foraminal\nstenosis at this level. Mild bilateral neural foraminal narrowing is noted\nmultiple other levels.\n\nEndotracheal tube is noted within the trachea. Fluid within the nasopharynx\nis likely due to intubation. Soft tissue stranding is noted anterior and\nsuperior to the right clavicle. Thyroid gland is normal without discrete\nnodule. There is no cervical lymphadenopathy by CT size criteria.", "output": "1. Hyperextension injury with widening of the anterior aspect of C6-C7\nintervertebral disc space is concerning for anterior longitudinal ligament is\ninjury. Posterior soft tissue stranding at C6-7 is also concerning for\nposterior ligamentous complex injury.\n2. Fractures of the left C7 transverse process, lamina, and superior articular\nprocess with displacement of the fracture fragment into the left neural\nforamen at this level.\n3. Mild soft tissue prevertebral swelling at C3-C4.\n4. Abnormal extensive circumferential soft tissue density surrounding the\nthecal sac along the entire cervical spinal cord, not apparent on the previous\nCT study, concerning for hemorrhage.\n5. Moderate to severe central canal narrowing at C5-C6 and moderate to severe\nleft and moderate right neural foraminal narrowing which may be related to the\nacute injury at this level.\n\nRECOMMENDATION(S): MR cervical spine for further evaluation for cord and\nligamentous injury." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.The patient is intubated and endotracheal/enteric tubes are\npartially visualized. The lung apices and thyroid gland are unremarkable.", "output": "No fracture or malalignment" }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nThe visualized lung apices are grossly clear bilaterally. The thyroid is\nhomogeneous in attenuation. Multiple prominent bilateral cervical lymph nodes\nare noted, none of which are pathologically enlarged by CT size criteria.", "output": "No evidence of fracture or traumatic subluxation." }, { "input": "Alignment of the cervical spine is unremarkable. There is no evidence of\nacute cervical spine fracture. No prevertebral soft tissue swelling. Large\nanterior osteophytes are noted between C4 through C7. No critical spinal\ncanal or neuroforaminal stenosis.\n\nThyroid gland is not well visualized. Lung apices are clear.", "output": "No acute cervical spine fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are noted throughout the cervical spine, worse at C4-C6 with moderate\nright neural foraminal narrowing and ossification of the posterior\nlongitudinal ligament at C6-C7 causing mild-to-moderate narrowing of the\nvertebral canal.There is no prevertebral edema.\n\nA large 2.3 cm dominant hypoattenuating nodule seen in the right thyroid lobe,\ncontaining coarse internal calcifications. Calcified granulomas are noted in\nthe imaged lung apices. There is circumferential thickening of the upper\nesophagus. There is asymmetric lateral angulation of the larynx.", "output": "1. No acute fracture or traumatic subluxation.\n2. Degenerative changes of the cervical spine with ossification of the\nposterior longitudinal ligament at C6-C7 causing mild-to-moderate narrowing of\nthe vertebral canal.\n3. 2.3 cm right thyroid nodule containing coarse internal calcifications. If\nnot previously evaluated, recommend nonemergent thyroid ultrasound for further\ncharacterization.\n4. Circumferential thickening of the upper esophagus is nonspecific. Please\ncorrelate for clinical symptoms of esophagitis.\n5. Asymmetrical lateral angulation of the larynx is of uncertain clinical\nsignificance.\n\nRECOMMENDATION(S): Nonemergent thyroid ultrasound for 2.3 cm right thyroid\nnodule." }, { "input": "Patient is status post C3-C7 left hemilaminectomy and C4-C7 anterior spinal\nfusion without evidence of hardware complication. There is evidence of\narthrodesis of C4-C7. There is minimal kyphosis of the cervical spine at\nthese fused levels, centered around C4-C5. Otherwise, alignment is normal. \nNo fractures are identified. There is no prevertebral edema.\n\nThe thyroid is unremarkable. Included lung apices are demonstrates mild\nbiapical paraseptal emphysema otherwise unremarkable.", "output": "1. No no evidence of fracture.\n2. Normal alignment peer\n3. Status post cervical fusion without evidence of hardware complication." }, { "input": "Alignment is normal. No fractures are identified.Anterior posterior\nosteophytes are seen from C4-C6. The vertebral body heights are preserved. \nThere is moderate loss of disc heights at C5-6. No high-grade spinal canal\nstenosis. Uncovertebral facet osteophytes cause mild bilateral neural\nforaminal narrowing at C5-6.There is no prevertebral soft tissue swelling.The\nthyroid is unremarkable. The bilateral lung apices are unremarkable. The\nesophagus is patulous.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine, worst at C5-6.\n3. Patulous esophagus." }, { "input": "There is no evidence of fracture, or prevertebral soft tissue swelling. There\nis no evidence of malalignment.\n\nMild degenerative changes are seen throughout the cervical spine. There is no\nevidence of significant neural foraminal at narrowing.\n\nThe thyroid is normal. There is no cervical lymphadenopathy. The visualized\napices of lungs are clear.", "output": "No acute cervical spine fracture or malalignment." }, { "input": "Alignment is normal.Subtle deformity of the right L3 transverse process,\nseries 3, image 45, is likely chronic in nature. No other fractures are\nidentified. There is no evidence of spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling.\n\nIncidental noted is a low-density lesion, likely cyst within the midpole of\nthe right kidney, measuring 2.5 cm x 1.9 cm. There is some thin peripheral\ncalcification at its medial border (03:25). Mild atherosclerotic vascular\ncalcifications are seen.", "output": "No evidence of an acute fracture. Subtle deformity of the right L3 transverse\nprocess, is likely chronic in nature, series 3, image 45." }, { "input": "The study is somewhat limited by motion in the lower cervical spine. \nAlignment is normal, noting reversal of usual cervical lordosis centered at\nC4-C5. No fractures are identified.There is mild multilevel osteophytosis and\na disc bulge at C4-C5. There is no evidence of significant vertebral canal or\nneural foraminal narrowing. There is no prevertebral soft tissue\nswelling.Asymmetric soft tissue thickening of the right oropharynx (series 7,\nimage 27), which may be physiologic. However, direct visualization is\nrecommended.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Nonspecific asymmetric soft tissue thickening of the right oropharynx\n(palatine tonsil), which may be physiologic however direct visualization\nclinical correlation is recommended." }, { "input": "Alignment is normal. No acute fractures are identified.Moderate multilevel\ndegenerative changes are demonstrated with intervertebral disc space\nnarrowing, diffuse disc bulging, and minimal osteophytic spurring. Mild\nmultilevel central canal narrowing is demonstrated, most pronounced at C3-4,\nC5-6, and C6- C7. Additionally, mild to moderate bilateral neural foraminal\nnarrowing is most pronounced at C5-6. Ossification of the transverse ligament\nis re- demonstrated. There is no prevertebral soft tissue swelling.Mild\natherosclerotic calcifications are noted at the carotid bifurcations. The\nimaged thyroid gland and lung apices are unremarkable.", "output": "1. No acute fracture or malalignment.\n2. Moderate cervical spondylosis." }, { "input": "No definite sign of acute fracture or malalignment. On series 5, image 24\nthere is a well corticated ossific density interposed between the left lateral\narch of C1 and C2. Appearance suggests an old injury. In addition, there is\nsubtle cortical irregularity along the lateral mass of C1 best seen on series\n4, image 33 likely a small spur in the setting of old trauma. There is also\nsubtle irregularity along the medial aspect of the right and left occipital\ncondyles which are most likely to represent tiny spurs. No prevertebral\nedema. No significant disc disease. Visualized lung apices are clear. \nThyroid gland is normal.", "output": "Findings as detailed above likely related to old injury. No acute fracture or\nmalalignment.\n\nNOTIFICATION: Findings were discussed in person with Dr. ___." }, { "input": "Alignment is normal. No fractures are identified. However there are foci of\nfree air visualized in the spinal canal at L4 and L3 level extending to\nbilateral L3-4 and L4-5 facet joint. Consistent with epidural emphysema. \nThere is moderate multilevel degenerative changes of the lumbar spine with\nsignificant bilateral facet arthropathy and mild central canal stenosis.\n\nThe partially visualized lung are clear. There is no pericardial effusion.\n\nThe partially visualized gallbladder, spleen, bilateral kidneys, urinary\nbladder, the partially visualized small and large bowels are grossly\nunremarkable.\n\nThere are bilateral adrenal glands nodules measuring 2.0 cm on the right side\nand 2.7 cm on the left side with less than 10 Hounsfield units consistent with\nadenomas. There are multiple low-attenuation lesions in the bilateral hepatic\nlobes measuring up to 1.2 cm incompletely characterized at the current study.", "output": "1. No acute lumbar spine fracture.\n2. Moderate degenerative changes of the lumbar spine.\n3. Epidural emphysema visualized at the L3 and L4 level most likely secondary\nto facet arthropathy.\n4. Bilateral adrenal adenomas." }, { "input": "Evaluation at and below the level of C4 is mildly limited by motion artifact\nrelated to the aerodigestive tract.\n\nThere is a chronic abnormality of the craniocervical junction and atlantoaxial\nregion. There is a well corticated os odontoideum located 5.5 mm cranial to\nthe base of the odontoid process. It abuts the posterior cortex of the\nanterior arch of C1. The anterior arch of C1 insinuates into the gap between\nthe os odontoideum and the base of the odontoid process. Lateral masses of C1\nare normally aligned with the occipital condyles, but their subluxed\nposteriorly relative to the lateral masses of C2. However, there is no\nstep-off in the spinolaminar line at C1-C2. There is no spinal canal\nnarrowing at the craniocervical junction or C1-C2.\n\nThere is no evidence for an acute fracture. There is mild retrolisthesis of\nC4 on C5, without prevertebral soft tissue swelling, disc space widening, or\nsplaying of the posterior elements, which is most likely degenerative. The\nspinal canal appears moderately narrowed at this level. There is also disc\nspace narrowing at C5-C6 and C6-C7 with small disc protrusions mildly\nindenting the ventral thecal sac.\n\nPulmonary opacities at the included lung apices are similar to the recent\nchest CT dated ___. Included brain parenchyma is grossly\nunremarkable, though this exam is not technically optimized for its\nevaluation.", "output": "1. Chronic abnormality of the craniocervical junction and atlantoaxial region,\nwhich may be congenital or acquired, including an os odontoideum. Lateral\nmasses of C1 are well aligned with the occipital condyles but subluxed\nposteriorly relative to the lateral masses of C2. No spinal canal narrowing\nat the craniocervical junction or C1-C2.\n2. No evidence for an acute fracture, allowing for mild motion artifact at and\nbelow the level of C4.\n3. Mild retrolisthesis of C4 on C5 is most likely degenerative, though there\nare no comparison exams to confirm chronicity. Associated moderate spinal\ncanal narrowing at C4-C5." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. An absent\nright maxillary molar is noted (02:19).", "output": "1. No acute fracture or malalignment the cervical spine.\n2. Absent right maxillary molar. Consider outpatient dental evaluation." }, { "input": "No fractures or traumatic malalignment identified. There is no prevertebral\nsoft tissue swelling. There is no significant evidence of spinal canal or\nneural foraminal narrowing. The lung apices are clear. The thyroid enlarged.", "output": "No acute fracture or traumatic malalignment. Enlarged thyroid.\n\nNOTE ON ATTENDING REVIEW :\n\nMultilevel, multifactorial degenerative changes are noted.\nAt C5-6 and C6-7: Disc space narrowing, endplate sclerosis, anterior and\nposterior osteophytes along with disc osteophyte complexes causing indentation\non the thecal sac outline with mild canal narrowing. Small foci of\nossification noted at the disc space anteriorly, may relate to obliquely\noriented osteophytes are ossification of the anterior longitudinal ligament.\nNo prior studies available for comparison.\nNo significant prevertebral soft tissue swelling appreciated.\n\nMultilevel moderate foraminal narrowing noted, in particular at C5-6 and C6-7\nlevels.\nUncovertebral and facet degenerative changes are noted at multiple levels.\nNo suspicious osseous lesions are noted.\n\nVascular calcifications are noted in the common carotid arteries extending\ninto proximal cervical internal carotid arteries on both sides.\n\nSmall anterior osteophytes and focus of ossification at the anterior disc\nquestion related to anterior longitudinal ligament also noted at T1-T2 level,\npartially imaged.\nLimited assessment of intrathecal details on CT.\nThis level is not adequately assessed as not targeted.\nCorrelate clinically to decide on the need for further workup" }, { "input": "No fractures or traumatic malalignment identified. There is no prevertebral\nsoft tissue swelling. There are calcified posterior disc bulges at the C5-C6\nand C6-C7 levels that cause mild to moderate narrowing of the central canal.\nAlso at the C5-C6 and C6-C7 level there is intervertebral disk space narrowing\nand endplate sclerosis. Moderate bilateral neural foraminal narrowing is noted\nat the C5-C6 and C6-C7 levels. There is emphysema noted in the lung apices.\nThe thyroid is normal.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no a cute cervical fracture. Alignment of the cervical spine is\nnormal. There are no significant degenerative changes. There is no abnormal\nprevertebral soft tissue swelling or edema. Lung apices are clear. Imaged\nthyroid gland is homogeneous in attenuation without focal nodularity. There\nis no cervical adenopathy.", "output": "Normal study." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices (allowing for respiratory motion) are\nunremarkable. An enteric tube and ET tube are partially visualized.", "output": "No evidence of acute fracture or malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. There is mild multilevel\nneural foraminal narrowing, most prominent bilaterally at C3-4 and C4-5 due to\nuncovertebral osteophytes and facet hypertrophy. There is also mild\nmultilevel canal narrowing, most pronounced at C4 due to ligamentum flavum\nhypertrophy and posterior osteophytes. There is no significant canal or\nforaminal narrowing.There is no prevertebral edema.\n\nThe included lung apices are unremarkable. There is a soft tissue nodule\nposterior and inferior to the right thyroid lobe measuring up to 2.1 cm\n(3:75).", "output": "1. No acute fracture or traumatic malalignment.\n2. 2.1 cm soft tissue nodule posterior and inferior to the right thyroid lobe\ncould represent a thyroid nodule versus parathyroid adenoma. Non-urgent\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S): Nonemergent thyroid ultrasound." }, { "input": "Fractures of the right superior articular processes of C5 and C7 are less\nconspicuous than on ___. The surrounding bone is also now sclerotic.\nThere is no acute fracture or malalignment of the cervical spine. The\natlanto-occipital/-axial articulations are intact. There is no prevertebral\nsoft tissue edema.\n\nThere is a right paracentral disc protrusion at C4-5 (4:56). This indents the\nthecal sac but there is no significant neural foraminal narrowing.\n\nDisc bulge and posterior osteophytes at C5-6 indents the thecal sac and also\ncauses bilateral neural foraminal narrowing (moderate on the right and mild on\nthe left).\n\nThere is no cervical lymphadenopathy. The thyroid gland is normal. The\nvisualized lung apices are clear.", "output": "1. Subacute fractures of the right C5 and C7 superior articular prosthesis.\nNo acute fracture or malalignment.\n\n2. Multilevel degenerative disc disease with indentation of the thecal sac\nand neural foraminal narrowing as described above." }, { "input": "There is no acute cervical fracture or subluxation. There is no evidence for\nprevertebral edema. Multilevel degenerative changes are again seen, with\nanterior osteophytosis, intervertebral disc space loss and endplate sclerosis.\nPosterior osteophyte complexes at C5-C6 and C6-C7 level cause moderate canal\nstenosis. There is multilevel neural foraminal narrowing by uncovertebral and\nfacet arthropathy. Neural foraminal narrowing at these levels. A hemangioma\nis again seen in the T1 vertebral body.\n\nThere is pleural/parenchymal scarring at the lung apices bilaterally. \nCentrilobular opacities at the right apex appear improved compared to ___ but similar compared to ___.", "output": "1. No fracture or subluxation.\n2. Multilevel degenerative disease with moderate spinal canal stenosis is\nagain demonstrated.\n3. Centrilobular opacities at the right lung apex appear improved compared to\n___ but similar compared to ___. Please correlate\nclinically." }, { "input": "There is retrolisthesis of L3 on L4 and anterolisthesis of L4 on L5. No\nfractures are identified. There have been laminectomies at L4 and L5.\nAnterior posterior osteophytes throughout the lumbar spine are worst at L2-3\nand L4-5. The vertebral body heights are preserved. There is severe loss of\ndisc heights at L2-3 with endplate sclerosis and cystic changes.\nFacet osteophytes and intervertebral osteophytes mildly narrow the spinal\ncanal at L2-3. The neural foramina appear normal.\nAt L3-4, intervertebral and facet osteophytes produce mild-moderate spinal\ncanal para narrowing. There is mild narrowing of the left neural foramen.\n\nFacet osteophytes cause severe spinal canal stenosis at L4-5. A right-sided\nforaminal and extraforaminal disc protrusion compromises the exiting L4 nerve\nroot. There is compression of the traversing L5 nerve roots bilaterally. \nFacet osteophytes produce severe narrowing of the lateral recesses\nbilaterally.\nDisc bulging and facet osteophytes at L5-S1 produce moderate-severe spinal\ncanal narrowing and severe bilateral neural foraminal narrowing.\nThere is no prevertebral soft tissue swelling.The partially visualized\nabdominal organs are unremarkable.", "output": "1. No fractures identified.\n2. Status post L4 and L5 laminectomies.\n3. retrolisthesis of L3 on L4 and entero L4 on L5.\n4. Multilevel degenerative changes of the lumbar spine with spinal canal and\nneural foraminal narrowing." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm.\n\nMultilevel degenerative changes of the cervical spine are re-demonstrated. \nThese are most severe at C4-5 and C5-6 where posterior osteophytes cause mild\nto moderate canal narrowing. Neural foraminal narrowing is also moderate to\nsevere on the right at C5-6 and moderate bilaterally at C6-7.\n\nThe imaged lung apices are clear. The imaged thyroid is unremarkable. No\ncervical lymphadenopathy by CT size criteria.", "output": "1. No fracture or traumatic subluxation.\n2. Multilevel degenerative changes of the cervical spine most severe at C4-5\nand C5-6, as described above." }, { "input": "There is minimal anterolisthesis of the C2-C3 and C3-C4, likely degenerative\nin etiology. No fractures are identified. Degenerative changes are seen in\nthe cervical spine, particularly at the C5-C6 and C6-C7 vertebral levels with\nloss of intervertebral disc height, subchondral sclerosis and cystic\nformation, and osteophyte formation. There is mild-to-moderate multifocal\nvertebral canal narrowing with osteophyte formation and posterior disc bulges\ncausing flattening of the spinal cord, particularly at the C5-C6 and C6-C7\nlevels. Additionally, there is moderate right neural foraminal stenosis at\nthe C5-C6 level. There is no prevertebral soft tissue swelling. There is a\nlarge ill-defined hypodense nodule in the right thyroid lobe, measuring 2.4 x\n3.1 cm (series 3: Image 58). The lung apices appear clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate degenerative changes seen in the cervical spine with multifocal\nvertebral canal stenosis and moderate right neural foraminal stenosis, worst\nat the C5-C6 vertebral level, as described in detail above.\n3. Large ill-defined hypodensity in the right thyroid lobe, measuring up to\n3.1 cm.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "A cervical collar is in place. No fractures are identified.There is mild\nanterolisthesis of C4 on C5, with apparent irregular widening of the right\nsided facet joint at this level (601b:14, 602b:13), likely due to degenerative\nchange. Mild multilevel degenerative changes are also seen at C3-4, C4-5,\nC5-6 and C6-7 with intervertebral disc space narrowing, disc bulging, endplate\nsclerosis, and anterior and posterior osteophyte formation. While mild\ncentral canal narrowing is most pronounced at C6-7, there is no evidence of\nsevere spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling. Mild paraseptal emphysema is seen within the imaged\nleft apex. Thyroid is slightly heterogeneous without focal lesion.", "output": "1. Mild cervical spondylosis with mild anterolisthesis of C4 on C5 and\nirregular widening of the right-sided facet joint at this level, likely due to\ndegenerative change.\n\n2. No acute cervical spinal fracture identified.\n\nNOTIFICATION: The above findings were communicated in person by Dr. ___\nto Dr. ___ the trauma surgical team at 20:40 on ___, 1 min\nafter discovery." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Mild degenerative changes\nwith anterior osteophyte formation are noted at C4-5, C5-6, and C6-7. There\nis no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Nuchal ossification is incidental noted at the C5 level\nposteriorly.\n\nImaged thyroid gland and lung apices are clear. Several prominent lymph nodes\nare not noted bilaterally within the neck, likely reactive, but none of which\nappear pathologically enlarged by size criteria.", "output": "No acute fracture or malalignment." }, { "input": "The patient has had a prior laminectomies at T4-8. Fluid collection indenting\nthe thecal sac is better characterized on same day MRI. There is a fracture of\nthe left T6 transverse process, which appears more displaced compared to\nCTA-Chest on ___ where there was a nondisplaced fracture (3:50).\nBony resorption along the left T6 pedical and medial aspect of the left\ntransverse process has increased compared to ___ (03:48). There is\nalso a fracture of the left T7 pedicle (602b:46). This is present on CT from\n___, but not on CTA-Chest of ___. The fracture\nquestioned in the right pedicle of T5 on MRI is not appreciated on this exam\n(602b:39).\n\nThe thoracic vertebral bodies are normal in height and alignment. The\nvisualized portions of the lungs are clear. There is no mediastinal\nlymphadenopathy.", "output": "1. Fracture of the left T6 transverse process with increased displacement\ncompared to ___.\n2. Fracture of the left T7 pedicle, not present in ___.\n3. No fracture visible in the right T5 pedicle as questioned on MR.\n4. Intrathecal structures and fluid collection are better assessed on same day\nMR." }, { "input": "Alignment is normal. No fractures are identified. There is no significant\ndegenerative change with no evidence of spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm. There is minimal atherosclerotic calcification of\nthe abdominal aorta.", "output": "No evidence of fracture of the lumbar spine." }, { "input": "There is mild anterolisthesis of C3 on C4, likely degenerative. No fractures\nare identified.Multilevel degenerative changes are seen, most extensive at\nC4-5 and C5-6 and notable for loss of intervertebral disc height, loss of\nvertebral body height, osteophytosis, and uncovertebral and facet hypertrophy\nwhich cause moderate neural foraminal narrowing. Posterior disc osteophyte\ncomplexes cause mild spinal canal narrowing.There is no prevertebral edema.\n\nA 5 mm nodule seen in the left thyroid lobe. Included lung apices are\nunremarkable.", "output": "1. Multilevel degenerative changes of the cervical spine without evidence of\nacute fracture.\n2. Mild anterolisthesis of C3 on C4 is likely degenerative, however, if there\nis a concern for ligamentous injury an MRI is more sensitive." }, { "input": "Vertebral body heights and alignment are maintained. There is no evidence of\nacute fracture or subluxation. Posterior fusion of C3 through C5 with\nposterior rods and pedicle screws is noted. There is no evidence of hardware\nloosening or fracture. The appearance of the hardware is overall unchanged\nfrom the prior radiographs of ___.\n\nAt C2-C3, there is no significant spinal canal or neural foraminal narrowing.\n\nAt C3-C4, a posterior disc protrusion results in mild narrowing of the spinal\ncanal. Bilateral neural foraminal narrowing is mild.\n\nAt C4-C5, irregularities along the endplates and multifocal calcifications\nwithin the disc may be related to prior trauma or degenerative changes. There\nis no spinal canal disc level. There is mild bilateral neural foraminal\nnarrowing.\n\nAt C5-C6, a broad posterior disc protrusion results in mild-to-moderate\nnarrowing of the spinal canal and moderate narrowing of bilateral neural\nforamina.\n\nAt C6-7, there is a broad posterior disc protrusion. An ossific fragment\nposterior to the vertebral body to the right of midline may be related to the\ndisc protrusion or represent a fractured fragment from prior trauma or\nsurgery. There is a right hemilaminectomy defect at this level. This results\nin mild narrowing of the spinal canal. There is mild right and moderate left\nneural foraminal narrowing.\n\nAt C7-T1, there is no significant spinal canal or neural foraminal narrowing.", "output": "1. Posterior fusion of C3 through C5, similar to the prior radiograph of ___ without evidence of hardware loosening or fracture.\n2. Multilevel degenerative changes as described above, most prominent at C5-6\nwhere a broad posterior disc protrusion results in mild-to-moderate narrowing\nof the spinal canal and moderate narrowing of bilateral neural foramina.\n3. No evidence of acute fracture or traumatic subluxation." }, { "input": "Alignment is normal. No cervical spine fractures are identified. Moderate\nmultilevel degenerative changes are noted, including loss of intervertebral\ndisc space, osteophyte formation. Age indeterminate posterior fractures of\nthe left-sided fifth, sixth, and seventh ribs are seen on the scout radiograph\nonly, clinical correlation is advised to exclude acute rib fractures. If\nnecessary, dedicated rib view radiographs or chest CT could be useful.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Posterior fractures through ribs ___ on the left seen on scout view only\nare incompletely evaluated and may be chronic. Clinical correlation for\nacuity is advised. If necessary, dedicated rib view radiographs or chest CT\ncould further evaluate." }, { "input": "There is a compression deformity of the T12 vertebral body involving the\nanterior and middle columns with approximately 20% loss of height (602:32). \nThere is minimal retropulsion into the spinal canal causing mild narrowing\n(3:114). A nondisplaced fracture of the left twelfth rib near the\ncostochondral junction appears to be present. There are no other levels with\nsignificant canal or neural foraminal narrowing. There is no prevertebral\nsoft tissue swelling. There is a hemangioma in the T8 vertebral body. There\nare no suspicious lytic or sclerotic osseous lesions. Minimal osteophytic\nspurring is noted at multiple levels with mild intervertebral disc height\nloss.\n\nVisualized lungs demonstrate mild dependent atelectasis. Diffuse coronary\nartery calcifications are seen.", "output": "1. Two column mild compression deformity of the T12 vertebral body with\nminimal retropulsion into the spinal canal causing mild central canal\nnarrowing. No additional vertebral body fractures are identified.\n2. Nondisplaced fracture of the left twelfth rib." }, { "input": "Dental amalgam streak artifact limits study. Alignment is normal. No\nfractures are identified.Multilevel, multifactorial mild degenerative changes\nare identified with disc space narrowing and endplate osteophyte formation,\nmost pronounced at C4-C5 and C5-C6 levels, where there is at least mild\nvertebral canal stenosis. There is also mild left neural foraminal narrowing\nat C4-C5 and C5-C6. There is no prevertebral soft tissue swelling.\n\nThe thyroid gland is unremarkable. Limited imaging of the lungs demonstrate\nbiapical pleural thickening and scarring.", "output": "1. Dental amalgam streak artifact limits study.\n2. No evidence of acute fracture or traumatic malalignment.\n3. Mild multilevel degenerative changes as described, most pronounced at C4-C5\nand C5-C6." }, { "input": "The patient has had laminectomies at L3-5 with posterior fusion hardware in\nplace and bone graft material. There is no perihardware lucency. There is\napproximately 9 mm of anterolisthesis of L3 on L4, worsened compared to\npreoperative CT on ___. There is no fracture. Postoperative\nchanges are noted in the overlying soft tissues. The are mild to moderate\nmultilevel degenerative changes, most pronounced at L4-5 with intervertebral\ndisc space narrowing and mild endplate irregularity.The vertebral bodies are\nnormal in height. The included abdominal aorta is normal in caliber. Clips\nare noted in the right upper quadrant of the abdomen compatible with prior\ncholecystectomy.", "output": "Status post L3 through L5 posterior fusion with grade I anterolisthesis of L3\non L4. No fracture or evidence of hardware loosening." }, { "input": "Streak artifact from the patient's L3 through L5 fusion hardware limits\nevaluation L3 through upper S1 levels. Postsurgical changes related to the\npatient's L3 through L5 laminectomies with posterior fusion and bone graft\nplacement are noted. Within limits of this study, no definite hardware\nfractures identified. Question extension of right L5 transpedicular screw\nbeyond anterior vertebral body margin (see series 302b, image 31 and series\n304, image 74-75). For difference in technique, this finding is grossly\nstable compared to the ___ prior CT lumbar spine (see series 2,\nimage 64 on the prior exam). Similarly question L4 level ventral vertebral\nbody cortical breakthrough of transpedicular screws (see series 304, image\n62), grossly similar to ___ prior CT exam (see series 2, image 52 on\nthe prior exam).\n\nThere is approximately 7 mm of anterolisthesis of L3 on L4, unchanged compared\nto prior study. The vertebral bodies are normal in height. There is no\nfracture. The conus medullaris is normal in morphology and terminates at\nL1-L2.\n\nThere are mild to moderate multilevel degenerative changes, most pronounced at\nL4-5 with intervertebral disc space narrowing, mild endplate irregularity, and\na vacuum disc phenomenon.\n\nEvaluation is limited by artifact from surgical hardware within these\nconfines:\n\nAt L2-L3, there is mild disc bulge without significant spinal canal stenosis.\n\nAt L3-L4, anterolisthesis results in uncovering of the posterior disc without\nsignificant spinal canal stenosis.\n\nAt L4-L5, there is no focal disc herniation without significant spinal canal\nstenosis.\n\nAt L5-S1, there is no focal disc herniation without significant spinal canal\nstenosis.\n\nThe included abdominal aorta is normal in caliber. Clips are noted in the\nright upper quadrant of the abdomen compatible with prior cholecystectomy. \nDiverticulosis is noted. The visualized portion of the sacroiliac joints are\npreserved.", "output": "1. Please note that evaluation of the L3 through upper S1 levels is limited\ndue to streak artifact secondary to posterior fusion hardware.\n2. Postsurgical changes related to patient's prior L3 through L5 laminectomies\nand posterior fusion.\n3. Within limits of study, no definite fracture of hardware identified.\n4. Question extension of right L5 transpedicular screw beyond L5 ventral\nvertebral body margin with cortical breakthrough. Recommend clinical\ncorrelation.\n5. Question extension of bilateral L4 transpedicular screws beyond ventral L4\nvertebral body. Recommend clinical correlation.\n6. Multilevel degenerative changes of lumbar spine as described, including\nstable grade 1 L3 on L4 anterolisthesis.\n7. Partially visualized bowel demonstrates diverticulosis.\n\nRECOMMENDATION(S): RE 4, 5: Recommend clinical correlation." }, { "input": "Streak artifact from the spinal fusion hardware from L3-L5 limits the\nevaluation and obscures the anatomical detail. Postsurgical changes related\nto prior laminectomies at L3, L4 and L5 are again seen with posterior fusion\nand bone graft in place. Within the limits of the study, no definite hardware\nfractures are seen. Again seen is extension of right L5 transpedicular screw\nout to the anterior vertebral body margin (600b:33). These findings are\ngrossly stable compared to the prior CT myelogram.\n\nThere is 4 mm anterolisthesis of L3 on L4, slightly decreased compared to the\nprior study. The vertebral bodies are normal in height with no fractures. \nThe conus medullaris is normal in morphology and terminates at L1-L2.\n\nThere is multilevel degenerative disc disease, most pronounced at L4-L5 with\nintervertebral disc space narrowing, mild endplate irregularity and vacuum\ndisc phenomenon.\n\nAt T12-L1, no spinal canal stenosis.\n\nAt L1-L2, mild diffuse disc bulge with no spinal canal stenosis.\n\nAt L2-L3, mild diffuse disc bulge with no spinal canal or neural foraminal\nnarrowing is seen.\n\nAt L3-L4, anterolisthesis on covering the posterior disc with diffuse\nbroad-based disc bulge without spinal canal narrowing.\n\nAt L4-L5, diffuse broad-based disc bulge with moderate bilateral facet\narthropathy. No spinal canal narrowing is seen. Note is made of clumping and\ncrowding of the nerve roots on the left (image 50-60, series 4), this findings\nsuggest arachnoiditis and apparently is new since the prior study.\n\nL5-S1, no focal disc herniation, no spinal canal stenosis.\n\nSurgical clips in the right upper quadrant in keeping with prior\ncholecystectomy. Diverticulosis is again seen. Visualized portions of the\nsacroiliac joint are unremarkable.", "output": "1. Status post laminectomy from L3-L5 with posterior fusion. Associated\nstreak artifact somewhat limits the evaluation.\n\n2. Probable extension of the right L5 transpedicular screw beyond the ventral\naspect of the vertebral body margin.\n\n3. There is clumping and crowding of the nerve roots at the level of L4/L5 on\nthe left, suggesting arachnoiditis, this finding is new since the prior\nexamination.\n\n4. Stable multi left degenerative disease of the lumbar spine as described\nabove with grade 1 anterolisthesis of L3 on L4, unchanged.\n\nRECOMMENDATION(S): If there is no clinical contraindication, correlation with\nMRI of the lumbar spine with and without contrast is recommended for further\ncharacterization of the thecal sac at L4/L5 level." }, { "input": "Subtle anterolisthesis of C4 relative to C5 is likely chronic. Significant\nfacet disease is noted on the right at C4-5. Disc disease is most pronounced\nat C5-6 with moderate disc space narrowing. No acute fracture. No\nprevertebral edema. Carotid calcification is noted. The thyroid is\nunremarkable though only partially imaged.", "output": "No fracture. Minimal anterolisthesis of C4 on C5, likely chronic." }, { "input": "Innumerable lytic lesions affecting all the vertebral bodies are again\ndemonstrated consistent with patient's known multiple myeloma. Compression\ndeformity of the T11 and T10 vertebral bodies is not changed from ___.\n\nThere is loss of the cortical margin along the posterior portion of the T5\nvertebral body. Although no soft tissue is detected extending into the spinal\ncanal on CT, this modality is quite limited for determining whether there is\ncanal encroachment at this level. If this is a clinical concern, MR may be\nhelpful.\n\nThere is now a defect in the anterior cortex of the T12 body that was not seen\non the CT of ___. This is also not detected on the MR of the lumbar\nspine of ___. The sensitivity of MR for detecting this would be\nexpected to be limited. However, the MR included images of this level that\ndid not demonstrate the anatomic abnormality. Thus, this finding suggests\nthat the anterior vertebral body fracture may be new. There is a defect in\nthe superior endplate of the T12 vertebral body posteriorly that may also be\nacute.\n\nAgain seen is kyphosis most marked at the T11 level, corresponding to the\nsevere compression fracture of the anterior portion of T11.\n\nThe innumerable lytic lesions throughout the thoracic spine are more prominent\non the current examination than on the chest CT of ___.\n\n\nThere is minimal atelectasis at the left base as well as a consolidative\nopacity seen at the right base which may represent atelectasis however\ninfection should be considered in the appropriate setting. A right interpolar\nhyperdense cyst may represent a proteinaceous or hemorrhagic cyst, unchanged\nfrom the most recent ___ MRI.", "output": "1. Multiple lucencies throughout the osseous structures and all vertebral\nbodies consistent with the patient's history of multiple myeloma. These have\nprogressed since ___.\n2. Acute-appearing T12 fracture. T11 and T10 compression deformities are\nstable from ___. No additional vertebral body fractures are\nidentified.\n3. Defect in the posterior cortex of T5 with possible extension of soft tissue\ninto the spinal canal. However, evaluation of the spinal canal is limited on\nCT. Consider MRI for further evaluation if clinically indicated.\n4. Consolidation at the the lung bases (predominantly at the right) could\nrepresent atelectasis or infection in the appropriate clinical setting.\n\nRECOMMENDATION(S): Consider MR to further evaluate the possibility of soft\ntissue spinal canal compromise at T5.\n\nNOTIFICATION: The revised findings of a cortical defect at T5 with possible\nsoft tissue involvement of the spinal canal and an acute-appearing fracture of\nT12 were discussed by telephone by Dr. ___ with Dr. ___ at 09:24 on\n___, 5 min after making the observations. The patient had been\nunable to tolerate an attempt at thoracic spine MR. ___ discussed the likely\nneed for anesthesia to make this possible." }, { "input": "Study is degraded by motion and limited by patient body habitus.\n\nThere is anterolisthesis of C2 on C3, C3 on C4, and C4 on C5, unchanged. \nWithin limits of study, there is no definite evidence of acute fracture\nidentified. The visualized osseous structures are osteopenic. Minimal\nanterior wedging at C6 is unchanged. Multilevel degenerative changes of the\ncervical spine are again noted, including loss of intervertebral disc height,\nendplate sclerosis, Schmorl's nodes, facet joint hypertrophy, and disc bulges.\nAt C4-5 there is a right paracentral osteophyte resulting in severe right\nneural foraminal narrowing and at least mild-to-moderate vertebral canal\nnarrowing (see 602:27; 601:48; 02:30). Disc osteophyte at C5-6 resulting at\nleast mild vertebral canal narrowing.\n\n There is no prevertebral soft tissue swelling.\n\nThe thyroid is enlarged with multiple nodules. Scattered subcentimeter\nnonspecific lymph nodes are noted throughout the neck bilaterally, without\ndefinite enlargement by CT size criteria. Atherosclerotic vascular\ncalcifications are seen in bilateral carotid bifurcations.", "output": "1. Study is degraded by motion and limited by patient body habitus and diffuse\nosteopenia.\n2. Within limits of study, no definite evidence of acute fracture is\nidentified.\n3. Grossly stable minimal C6 anterior compression deformity.\n4. Grossly stable extensive multilevel cervical spondylosis as described, with\nC4-5 right paracentral osteophyte resulting in severe right neural foraminal\nand at least mild to moderate vertebral canal narrowing, and disc osteophyte\nat C5-6 resulting in at least mild vertebral canal narrowing. If clinically\nindicated, consider cervical spine MRI for further evaluation.\n5. Enlarged multinodular thyroid gland as described. If not already\nperformed, dedicated thyroid ultrasound may be obtained for evaluation of\nthyroid nodules.\n6. Nonspecific subcentimeter cervical and supraclavicular lymph nodes as\ndescribed, which may be reactive.\n7. Please see concurrently obtained noncontrast head CT for description of\ncranial structures.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 10:27 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Degenerative changes are\nmost notable at C5-6 level with loss of disc space and small endplate spur\nformation. There is a small posterior disc bulge at C4-5 and C5-6. A small\nossific density is well corticated inferior to the anterior ring of C1, likely\na chronic finding. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. Thyroid gland appears normal.", "output": "No acute fracture or malalignment. Degenerative changes as stated." }, { "input": "Alignment is normal. No fractures are identified. No prevertebral soft\ntissue abnormality is seen. A non fusion defect is noted in the right lateral\nmass of C1 of C1, an anatomic variant. There are small central disc\nprotrusions minimally indenting the ventral thecal sac from C3-4 through C6-7.\nThere are small uncovertebral osteophytes at C3-4 without significant neural\nforaminal narrowing. Visualized upper lungs are clear.", "output": "1. No fracture or subluxation.\n2. Mild degenerative disease." }, { "input": "There are 12 rib-bearing vertebrae. No fracture is seen. Vertebral body\nheights are normal. There is a minimal dextroconvex curvature centered at\nT5-6, which could be positional. There is no subluxation. No CT evidence for\nspinal canal narrowing is seen.\n\nThere is mild dependent atelectasis in the visualized portions of the lungs.\nPartially visualized heart appears enlarged. The visualized aorta and main\npulmonary artery are normal in caliber. No mediastinal lymphadenopathy is\nseen. Evaluation for hilar lymphadenopathy on noncontrast CT is limited.\n\n 1.1 cm hypodense lesion in the lower right hepatic lobe is not adequately\ncharacterized in the absence of intravenous contrast, but statistically is\nlikely to represent a cyst or hemangioma. There are bilateral nonobstructing\nrenal stones, with the largest on the right measuring 1.2 cm in the upper\npole, and the largest on the left measuring 0.5 cm in the upper pole.", "output": "1. No fracture or subluxation.\n2. Bilateral nonobstructing renal stones." }, { "input": "There is no acute cervical fracture or subluxation. There is no prevertebral\nsoft tissue swelling. There are moderate multilevel degenerative changes with\nuncovertebral joint hypertrophy and loss of intervertebral disc space height,\nmost prominent at C4-C5 through and C6-C7. There is mild anterolisthesis of C3\non C4 which is likely degenerative given right greater than left facet joint\nhypertrophy at this level. There is at least mild canal narrowing at these\nlevels.\n\nThe thyroid gland is enlarged and heterogeneous. The right thyroid lobe\ncontains coarse calcifications. Multiple hypodensities are seen within the\nleft thyroid lobe.", "output": "No acute fracture. Mild anterolisthesis of the C3 on C4 likely degenerative." }, { "input": "There is no acute cervical fracture or subluxation. There is diffuse bony\ndemineralization. The vertebral body hemangioma is seen in the T7 and T9\nvertebral bodies. Multilevel degenerative changes are noted with disc height\nloss with adjacent adjacent endplate sclerosis and osteophytes. There is no\nprevertebral soft tissue swelling. Visualized portions of the lungs\ndemonstrate bibasilar atelectasis. The heart contains coronary artery\ncalcifications.", "output": "No acute fracture or subluxation." }, { "input": "There is diffuse bone demineralization. Hemangiomas identified in the T7 and\nthe T9 vertebral bodies. Moderate multilevel degenerative changes are noted\nwith loss of intervertebral disc space height, anterior osteophytosis and\nvacuum disc phenomenon. There is no acute thoracic fracture or subluxation.\nThere is no prevertebral soft tissue swelling.\n\nAtherosclerotic calcifications are seen within visualized portions of the\nintra-abdominal aorta and coronary arteries. There is a small hiatal hernia.\nA 1.5 cm hypodensity at the upper pole the right kidney may represent cysts.\nCalcified granuloma identified at the left lung base.", "output": "No acute fracture or subluxation." }, { "input": "There is no acute fracture or traumatic malalignment. There is irregularity\nof the dens compatible with a prior healed C2 fracture. There is no\nprevertebral soft tissue swelling. Mild degenerative changes are noted, most\nprominently at C3-C4 with disc space narrowing, anterior endplate osteophyte\nformation, and subchondral sclerosis. A posterior disc bulge is also noted at\nthis level causing mild spinal canal stenosis. There is also hypertrophy of\nthe right C5 superior articular process causing moderate right neural\nforaminal narrowing at C4-C5 as well as narrowing of the right transverse\nforamen.\n\nA 1.6 x 1.2 cm right thyroid nodule is identified containing central coarse\ncalcifications. There is no cervical lymphadenopathy.", "output": "1. No acute fracture or traumatic malalignment. Evidence of prior healed dens\nfracture.\n\n2. Multilevel degenerative disease as described above, most prominent at\nC3-C4.\n3. 1.6 x 1.2 cm right thyroid nodule for which a non-emergent thyroid\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S): Thyroid ultrasound" }, { "input": "No acute fracture or traumatic malalignment is identified. There is no\nprevertebral soft tissue swelling. Vertebral body heights are maintained. \nMild degenerative changes are seen in the lower thoracic spine. There is no\nsignificant spinal canal stenosis. Evaluation of the paravertebral soft\ntissues is unremarkable. Right lobe thyroid nodule is again noted, better\nassessed on same-day CT of the cervical spine. Included lung parenchyma and\nmediastinum are grossly unremarkable.", "output": "No acute fracture or malalignment of the thoracic spine." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. A rounded sclerotic lesion in the anterior\nL3 vertebral body is likely a bone island. At L3-L4, there is a broad-based\ndisc bulge causing mild spinal canal stenosis and bilateral neural foraminal\nnarrowing. At L4-L5, there is a large disc bulge and ligamentum flavum\nhypertrophy causing moderate spinal canal stenosis and moderate bilateral\nneural foraminal narrowing. At L5-S1, there is a disc bulge causing mild\nspinal canal stenosis and mild right and moderate left neural foraminal\nnarrowing at this level.\n\nLimited views of the paravertebral soft tissues are unremarkable.", "output": "1. No acute fracture or traumatic malalignment of the lumbar spine.\n2. Multilevel degenerative changes as described above, most prominent at\nL4-L5." }, { "input": "Alignment is normal.Chronic appearing anterior compression fracture to the T9\nvertebral body is unchanged from ___. No retropulsion. No evidence of\nacute fractures or alignment abnormality. There is posterior osteophyte at\nthe level of T7-T8 with mild-to-moderate spinal canal narrowing. A posterior\nosteophyte is also seen at the T12-L1 level, leading to moderate spinal canal\nnarrowing. There is no evidence of severe neural foraminal stenosis.There is\nno prevertebral soft tissue swelling.\n\nSmall bilateral pleural effusions are incidentally noted. There is minimal\natelectasis in the lower lobes dependently.\nCoronary artery calcifications are incidentally seen.", "output": "1. No acute subluxation or fractures.\n2. Chronic anterior compression fracture to the T9 vertebral body with no\nretropulsion.\n3. Posterior osteophytosis leading to moderate spinal canal narrowing at the\nT12-L1 level, mild to moderate spinal canal narrowing at the T7-T8 level." }, { "input": "Alignment is normal. No fractures are identified.\n\nMultilevel moderate to severe degenerative changes of the lumbosacral spine,\nmost severe at L2-L3 level with endplate sclerosis, loss of intervertebral\nbody height, and anterior and posterior osteophyte formation. Moderate to\nsevere spinal canal narrowing is most pronounced at the L3-4 and L5-S1 levels\ndue to posterior bulges and ligamentum flavum hypertrophy. There is moderate\nto severe left neural foraminal stenosis at the L2-L3 level. Moderate neural\nforaminal stenosis is also seen bilaterally at L1-2, L2-L3, and left L4-L5\nlevels.\n\nThere is no prevertebral soft tissue swelling. 1.4 x 0.7 cm focal sclerotic\nlesion within the left sacrum is unchanged from ___, likely a bone\nisland. Partially imaged left renal cyst.", "output": "1. No acute subluxation or fractures.\n2. Moderate to severe small lumbar spondylosis including moderate to severe\nspinal canal narrowing at the L3-4 and L5-S1 levels as well as severe\nleft-sided L2-3 neural foraminal stenosis and moderate bilateral neural\nforaminal narrowing at L1-2, L2-L3, and left L4-L5 levels." }, { "input": "The cervical spine alignment is normal. No acute fractures are identified. \nThere is intervertebral disc space narrowing, endplate irregularity, and\nosteophyte formation at multiple levels of the cervical spine, worst at C5-C6\nand C6-C7 there is severe multilevel facet arthropathy. There is no evidence\nof critical spinal canal narrowing. There is moderate left-sided neural\nforaminal narrowing at C3-C4 and C4-C5. There is no prevertebral edema. \nThere is a hypoattenuating nodule in the right lobe of thyroid measuring 1.2\ncm (series 2:64).", "output": "There is no evidence of acute cervical spine fracture or malalignment.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is maintained. No acute fractures are identified. Moderate\ndegenerative changes seen along the cervical spine with loss of intervertebral\ndisc height, subchondral sclerosis, and bridging osteophyte formation.\n\nThere is mild-to-moderate multilevel vertebral canal narrowing due to\nposterior osteophytes and disc bulges with resultant contact upon the thecal\nsac. Multilevel uncovertebral and facet joint hypertrophy is seen causing\nsevere neural foraminal stenosis, particularly at the left C3-C4 and left\nC5-C6 levels. There is no prevertebral soft tissue swelling.\n\nNo focal consolidation is seen in the lung apices. The thyroid gland is\nunremarkable. There is no cervical lymphadenopathy by size criteria. 1 cm\nnodule in the right lobe of the thyroid is unchanged from prior examination.", "output": "1. No acute fractures or traumatic malalignment.\n2. Moderate cervical spondylosis with multilevel mild-to-moderate vertebral\ncanal narrowing and severe neural foraminal stenosis, particularly at the left\nC3-C4 and C5-C6 levels.\n3. 1 cm nodule in the right lobe of the thyroid is unchanged from prior exam.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No acute fractures are identified. There are moderate to\nsevere degenerative changes with anterior vertebral body osteophytosis and\nintervertebral disc height loss, most prominent at L3-L4 and L4-L5. There is\nmild multilevel spinal canal narrowing secondary to ossification of the\nposterior longitudinal ligament at L1-L2 and due to disc bulges at L2-L3,\nL3-L4, and L4-L5. There is moderate right-sided neural foraminal narrowing at\nL4-L5. There is no prevertebral soft tissue swelling.\n\nThere are multiple sclerotic foci in the lumbar spine and sacrum. There is a\n2 mm sclerotic lesion in the L3 vertebral body, unchanged from prior study\ndated ___ (602:50). There is a 3 mm sclerotic focus along the inferior\naspect of the T12 vertebral body, not definitively seen prior study (602:32). \nA sclerotic focus in right sacrum just medial to the right first sacral\nforamen measures 3 mm and was not definitely seen on prior study (2:85). \nAdditional sclerotic foci in the right sacrum (2:82) and left ilium (2:89) are\nunchanged from prior study and likely represent bone islands (2:82).", "output": "1. No acute fracture or malalignment of the lumbar spine.\n2. Moderate to severe degenerative changes, most prominent at L3-L4 and L4-L5,\nlikely contributing to lower back pain.\n3. Multiple sclerotic foci in the lumbar spine and sacrum. Several lesions\nare unchanged from prior study dated ___ and likely represent bone\nislands. New lesions may represent additional bone islands possibly slightly\nless conspicuous on the prior study. However, given history of prostate\ncancer, metastatic disease cannot be definitively excluded. MRI is more\nsensitive in the detection of metastatic lesions." }, { "input": "There is minimal anterolisthesis of C5 on C6, unchanged from prior, likely\nrelated degenerative changes. No fractures are identified.Multilevel\ndegenerative changes are seen, most extensive at C3-4 and notable for\nuncovertebral and facet osteophytes contributing to moderate to severe left\nneural foraminal narrowing. Mild multilevel central canal narrowing is\npresent, most pronounced at C6-C7, without high-grade stenosis.There is no\nprevertebral edema.\n\nThe included lung apices are unremarkable. A tiny 5 mm hypodense nodule seen\nin the right thyroid lobe (3:53). The previously seen 1.0 cm right thyroid\nnodule is not well demonstrated on the current study.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Multilevel degenerative changes are similar to prior." }, { "input": "No evidence of traumatic malalignment. There is minimal anterolisthesis of C5\non C6, unchanged from prior, likely degenerative. No fractures are\nidentified.There are multilevel degenerative changes, most extensive at C3-C4\nwith uncovertebral and facet osteophytosis which results in moderate to severe\nleft neural foraminal narrowing. In addition, there is multilevel canal\nnarrowing, worst at C5-C6 and C6-C7 without high-grade stenosis. No evidence\nof prevertebral edema.\n\nTiny 3 mm hypodense nodule in the right lobe of the thyroid (series 3: Image\n60). Visualized lung apices are unremarkable. Retropharyngeal course of the\ncommon carotid and internal carotid arteries is noted bilaterally.", "output": "No acute fracture or traumatic malalignment. Multilevel degenerative changes\nare similar to prior." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. The partially\nvisualized lungs are unremarkable.. The partially visualized bilateral\nkidneys are unremarkable.", "output": "No fracture or malalignment." }, { "input": "There is minimal anterolisthesis of C3 on C4, mild anterolisthesis of C4 on\nC5, and mild anterolisthesis of C6 on C7, grossly unchanged since ___ and\ndegenerative in etiology. No acute fractures are identified. Multilevel\ndegenerative changes are worst and severe at the C5-6 level. Spinal canal\nnarrowing is worst and mild at the C5-6 level due to hypertrophic endplate\nchanges. No gross neural foraminal narrowing. There is no prevertebral\nedema.\n\nThe imaged thyroid gland is grossly homogeneous.", "output": "No acute fracture or traumatic malalignment. Redemonstrated mild\nanterolisthesis, including C3 and C4-C4 and C5 and C6 on C7, similar to prior." }, { "input": "There is mild anterolisthesis of C7 on T1. No acute fractures are\nidentified.Multilevel degenerative changes are seen, most extensive at C5-6\nand C6-7 and notable for loss of intervertebral disc space, anterior and\nposterior osteophytosis, uncovertebral hypertrophy and facet hypertrophy\ncontributing to mild spinal canal narrowing at C6-7 and moderate bilateral\nneural foraminal narrowing at C5-6 and C6-7.There is no prevertebral edema. \nThere is no cervical lymphadenopathy by size criteria. There is asymmetric\neffacement of the left piriform sinus without evidence of underlying mass\nlesion.\n\nThe thyroid is slightly heterogeneous and enlarged. The included lung apices\nare unremarkable.", "output": "1. No acute fracture.\n2. Mild anterolisthesis C7 on T1 is likely related to degenerative change,\nthough no prior is available for comparison. There is no prevertebral edema\nto suggest acute ligamentous injury. If there is high clinical concern and\nthere are no contraindications, MRI would be more sensitive for ligamentous\ninjury.\n3. Multilevel degenerative changes as described above.\n4. Effacement of the left piriform sinus without definitive underlying mass\nlesion. This could be secondary to swallowing or debris. If there is\nclinical concern for mass lesion, direct visualization is recommended." }, { "input": "There are 5 lumbar-type vertebrae with partial sacralization of L5 on the\nleft. There is L1 vertebral body fracture parallel to the superior endplate\nwith involvement of the anterior and posterosuperior corners, new since the\n___. There is mild linear sclerosis parallel to the superior endplate which\nmay be secondary to acute impaction versus subacute osseous remodeling. There\nis approximately 40% loss of height. Retropulsion of the posterior superior\ncorner measures 4 mm AP on the left, image 7:44, and 2 mm AP on the right,\nimage 7:49. There is mild associated indentation of the ventral thecal sac.\n\nPosterior elements of L1 appear intact. No additional fracture is seen. \nMinimal retrolisthesis of L2 on L3 and L3 on L4 is unchanged.\n\nEvaluation of the spinal canal or neural foramina by CT is limited compared to\nMRI.\n\nT11-T12: No spinal canal narrowing.\n\nT12-L1: Mild disc bulge with partial calcification posteriorly to the right of\nmidline, unchanged since the prior CT. Left greater than right L1 superior\ncorner retropulsion mildly indents the ventral thecal sac, as described above.\n\nL1-L2: Mild disc bulge and right paracentral calcified disc herniation\nextending superiorly above the disc space, similar to the prior\nabdominal/pelvic CT allowing for differences in technique. The ventral thecal\nsac is indented on the right.\n\nL2-L3: Minimal retrolisthesis, disc bulge and facet arthropathy cause mild\nspinal canal narrowing including narrowing of the subarticular zones, moderate\nleft and mild right neural foraminal narrowing, gross similar to the prior CT.\n\nL3-L4: Minimal retrolisthesis, disc bulge, and facet arthropathy cause mild\nspinal canal narrowing including narrowing of the subarticular zones, as well\nas moderate bilateral neural foraminal narrowing, grossly similar to the prior\nCT.\n\nL4-L5: There is a disc bulge, mild right and severe left facet arthropathy,\ncausing at least moderate spinal canal narrowing including narrowing of the\nsubarticular zones, as well as severe right and moderate to severe left neural\nforaminal narrowing. This is grossly similar to the prior CT.\n\nL5-S1: There is a left L5 laminotomy defect. There is a mild disc bulge and\nsevere facet arthropathy. No significant spinal canal narrowing is seen. \nThere is severe left and moderate to severe right neural foraminal narrowing,\ngrossly similar to the prior CT.\n\nCholecystectomy clips are again partially visualized. Mild thickening of the\nleft adrenal apex is unchanged. Aortic calcifications are again noted.", "output": "1. 5 lumbar-type vertebrae with partial sacralization of L5 on the left.\n2. L1 vertebral body fracture parallel to the superior endplate, new since ___, with mild sclerosis along the superior endplate which may\nrepresent acute impaction versus subacute remodeling. Approximately 4% loss\nof height. 4 mm left and 2 mm right superior corner retropulsion, mildly\nindenting the ventral thecal sac.\n3. Multilevel degenerative disease with greatest, at least moderate spinal\ncanal stenosis at L4-L5, and advanced neural foraminal narrowing from L3-L4\nthrough L5-S1, as detailed above." }, { "input": "Alignment is anatomic.Patient is status post anterior fixation at C4 through\nC6 with anterior plate and screws. There is no evidence perihardware fracture\nor lucency. At C3-4, uncovertebral hypertrophy and facet arthropathy results\nin severe narrowing of the right neural foramen and mild narrowing of the\nspinal canal. At C4-5, posterior osteophyte, uncovertebral hypertrophy and\nfacet arthropathy results in mild-to-moderate narrowing of the bilateral\nneural foramina, and mild narrowing of the spinal canal. At C6-7,\nuncovertebral hypertrophy results in moderate narrowing of the bilateral\nneural foramina and mild narrowing of the spinal canal. Otherwise, there is\nno significant neural foraminal or spinal canal narrowing. There is no\nprevertebral soft tissue swelling. Nerve stimulator catheter is seen coiling\nalong the left subcutaneous tissue. The imaged lung apices are unremarkable. \nThe thyroid gland is homogeneous in attenuation without focal nodularity.", "output": "1. No acute fracture or traumatic malalignment.\n2. Status post anterior fixation at C4 through C6 with no evidence of hardware\ncomplications.\n3. Moderate degenerative changes, most notable at C3-4 with severe narrowing\nof the right neural foramen." }, { "input": "There is minimal anterolisthesis of C6 on C7, and T1 on T2 unchanged from\nprior. Elsewhere alignment is normal. There is no fracture. Patient is\nstatus post anterior cervical discectomy and fusion with hardware spanning C4\nthrough C6 without evidence of complication. No fractures are\nidentified.Degenerative changes notable for intervertebral disc height loss,\nposterior osteophytes and uncovertebral joint hypertrophy most notably at C3-4\nwith secondary moderate right foraminal narrowing.There is no prevertebral\nedema.\n\nThe thyroid and included lung apices are unremarkable. A vagal nerve\nstimulator lead is noted on the left.", "output": "No cervical spine fracture or acute malalignment." }, { "input": "Please note evaluation of the C6, C7, T1 level is limited due to artifact.\n\nAlignment is normal. Vertebral body height is maintained. No fractures are\nidentified. There is no significant prevertebral swelling. There are mild\ndegenerative changes with endplate irregularity and anterior osteophyte\nformation noted at several levels. There is loss of normal intervertebral disc\nspace height at C6-C7 and C7-T1.\n\nAt C2-C3, there is bilateral facet arthropathy. There is no significant spinal\ncanal stenosis or neural foraminal narrowing.\n\nAt C3-C4, there is a tiny left paracentral disc protrusion mildly effacing the\nventral CSF space. There is bilateral uncovertebral and facet joint\narthropathy resulting in severe right and moderate left neural foraminal\nnarrowing.\n\nAt C4-C5, there is no disc herniation, spinal canal stenosis, or neural\nforaminal narrowing. There is a small anterior osteophyte noted along\ninferior margin of the C4 vertebral body (series 7, image 39, and series 3,\nimage 54)\n\nAt C5-C6, there is mild disc bulge with resulting mild spinal canal narrowing.\nThere is bilateral uncovertebral and facet joint arthropathy without\nsignificant neural foraminal narrowing.\n\nAt C6-C7, there is mild posterior disc bulge mildly narrowing the spinal\ncanal. There is bilateral uncovertebral and facet joint arthropathy resulting\nin mild right and moderate left neural foraminal narrowing.\n\nAt C7-T1, there is no significant disc herniation or spinal canal stenosis.\n\nThe thyroid gland is unremarkable. There are subcentimeter nonspecific\ncervical lymph nodes throughout the neck.\n\n Within the limits of this noncontrast study there is no evidence of infection\nor neoplasm. There is no prevertebral soft tissue swelling.. The visualized\nportion of the posterior fossa, cervicomedullary junction, paranasal sinuses\nand lung apicesare preserved. Atherosclerotic vascular calcifications are\nnoted of bilateral carotid bifurcations.", "output": "1. Please note evaluation of the C6, C7, and T1 levels is limited due to\nartifact.\n2. No evidence of acute fracture or subluxation.\n3. Mild multilevel degenerative changes as detailed above.\n4. Atherosclerotic calcifications at bilateral carotid bifurcations.\n5. Please note MRI of the cervical spine is more sensitive for the evaluation\nof ligamentous injury." }, { "input": "Cervical alignment is anatomic. No fractures are identified.Multilevel\ndegenerative changes are present. At C3-4 level, posterior osteophytes and a\nparacentral disc protrusion results in moderate spinal canal stenosis and mild\nnarrowing of the right subarticular recess. Disc bulges are also present at\nmultiple other levels without high-grade spinal canal or neural foraminal\nnarrowing. There is no prevertebral soft tissue swelling.\n\nMinimal paraseptal emphysematous changes at the lung apex is identified. No\nsuspicious pulmonary nodules. The left lobe of the thyroid demonstrates a\npossible 1.1 cm hypo attenuating nodule (series 3, image 73). A 5 mm hypo\nattenuating nodule is also noted in the right lobe of the thyroid. . There\nis no cervical lymphadenopathy by size criteria. The major salivary glands\nare unremarkable.\n\nAsymmetric soft tissue density along the left palatine tonsil (series 3, image\n36) is incompletely characterized.", "output": "1. No fracture or traumatic subluxation.\n2. Multilevel degenerative changes as described above, most prominent at C3-C4\nwhere a disc protrusion and intervertebral osteophytes results in moderate\nspinal canal narrowing.\n3. Asymmetric soft tissue density along the left palatine tonsil is\nincompletely characterized. While this may be physiologic, clinical\ncorrelation and direct visualization is recommended.\n4. Interval development of apparent 1.1 cm hypo attenuating nodule in the left\nlobe of the thyroid and 5 mm hypo attenuating nodule in the right lobe of the\nthyroid. These could be further evaluated with thyroid ultrasound as\nclinically indicated." }, { "input": "Alignment is normal. No fractures are identified.Severe multilevel\ndegenerative changes are similar to the recent MRI, and better characterized\non study. There is no prevertebral soft tissue swelling.", "output": "1. No acute fracture or malalignment of the lumbar spine.\n2. Severe multilevel multifactorial degenerative changes are better\ncharacterized by recent MRI." }, { "input": "Alignment is normal. No fractures are identified.There are multilevel\ndegenerative changes of the cervical spine, worst at C4-5 and C5-6. Disc\nosteophyte complexes cause mild spinal canal narrowing at multiple levels. \nUncovertebral and facet hypertrophy cause mild neural foraminal narrowing at\nmultiple levels bilaterally.There is no prevertebral soft tissue swelling.\n\nThere is atelectasis and pulmonary emphysematous changes of the visualized\nlung apices. There is no cervical adenopathy. The thyroid gland is\nunremarkable.", "output": "No acute fracture or dislocation. Multilevel degenerative changes of the\ncervical spine." }, { "input": "Thoracic spine alignment is normal. Vertebral body heights are well\nmaintained. A lucency seen through the right inferolateral aspect of the T8\nvertebral body, which may also represent an acute fracture (2:75). Better\nevaluated on the accompanying CT of the lumbar spine, is a nondisplaced\nfracture of the right T12 lamina. Possible spinous process fracture is also\nnoted at this level. Multilevel degenerative changes including osteophytosis\nand intervertebral disc space narrowing are noted.\n\nThere is a midline disc protrusion, partially calcified, at T5-6. This is\npoorly that visualized on CT but appears likely to indent the spinal cord. If\nfurther evaluation is indicated, an MR study is recommended.\n\nThere is a similar midline disc protrusion at the T ___, also poorly\ncharacterized.\n\nThe prevertebral soft tissues are unremarkable.\n\nLimited evaluation of the chest shows multiple borderline enlarged mediastinal\nlymph nodes.", "output": "1. Fracture of the right T12 lamina as described above.\n\n2. Possible fracture of the the right inferolateral aspect of the T8 vertebral\nbody.\n\nRECOMMENDATION(S): Given these fractures, new further evaluation with MRI can\nbe considered to evaluate for ligamentous injury and other abnormalities not\ndefinitively visualized on CT.\n\nNOTIFICATION: Updated wet read results were discussed with the trauma surgery\nteam at approximately 00:11 on ___.\n\nAt the time that the wet read and recommendation was addended, the patient had\nalready been scheduled for an MRI of the C, T, and L-spine. Per the spine team\nnote, the patient was to be kept on strict flat bedrest in the interim." }, { "input": "Alignment is normal.Again seen are right laminar and spinous process fractures\nat T12. No prevertebral abnormality is noted. Moderate degenerative changes\nare noted, most severe at L4-L5 and L5-S1. At L4-5, intervertebral\nosteophytes and facet osteophytes narrow the spinal canal and markedly narrows\nthe lateral recesses bilaterally. There is also narrowing of the neural\nforamina at the same processes.\n\nAt L5-S1, right-sided osteophyte formation and perhaps calcified or ossified\ndisc protrusion encroaches on the thecal sac, compresses the right S1 nerve\nroot, and fills the right neural foramen with compromise of the exiting right\nL5 nerve root. .\n\nLimited evaluation of the abdomen shows no significant abnormalities.", "output": "1. Fracture of the T12 right lamina and possibly spinous process.\nDegenerative disc disease at L4-5 and L5-S1 with nerve root compromise.\n\nRECOMMENDATION(S): Given type of fracture, MRI a is recommended for further\nevaluation for ligamentous injury and other fractures.\n\nNOTIFICATION: At the time these recommendations were entered, the patient was\nalready scheduled for an MRI of the C, T, and L-spine. I was recommended he\nbe kept under bedrest until the completion of the examination." }, { "input": "Alignment is normal.No acute fracture is identified.There are mild chagnes of\ndegenerative disk disease.\n\nThere is a midline disk protrusion at C3-4. This appears to indent the\nanterior surface of the spinal corrd. Uncovertebral osteophytes narrow the\nright neural foramen.\n\nAt C4-5, a mild disc bulge and intervertebral osteophytes slightly narrow the\nAP diameter of the spinal canal and slightly flatten the anterior surface of\nthe spinal cord. The neural foramina appear normal.\n\nAt C5-6, intervertebral osteophytes mildly narrow the spinal canal and appear\nto contact the spinal cord. The neural foramina appear normal.\n\nAt C6-7, intervertebral osteophytes slightly narrow the spinal canal. At the\noutline of the spinal cord is obscured by artifact. The neural foramina\nappear normal.\n\nThe C7-T1 level appears normal.\n\n There is no prevertebral soft tissue swelling.Within the limitations of this\nnoncontrast exam, there is no evidence of infection or neoplasm.", "output": "Mild changes of degenerative disc disease. No no evidence of fracture,\nmalalignment, or prevertebral soft tissue abnormality." }, { "input": "Study is moderately degraded by motion.\n\nNo definite fracture or traumatic malalignment is noted. Multilevel\ndegenerative changes are seen, most extensive at C4-5, C5-6, and C6-7 and\nnotable for disc height loss, Schmorl's nodes, and small anterior and\nposterior osteophytes. There is no prevertebral edema.\nThe thyroid gland is unremarkable. Note is made of a large left pleural\neffusion. Limited imaging of sinuses demonstrate bilateral maxillary and\nsphenoid sinus mucosal thickening.", "output": "1. Study is moderately degraded by motion.\n2. Within limits of study, no fracture or traumatic malalignment.\n3. Large left pleural effusion.\n4. Paranasal sinus disease as described." }, { "input": "Mild anterolisthesis of C 2 on C3, C3 on C4 and C7 on T1.No fractures are\nidentified. Multilevel degenerative changes are at least moderate and most\nprominent at C3-C4, C5-C6 and C6-C7 with posterior osteophyte and broad-based\ndisc bulging causing mild canal narrowing. There is moderate neural foraminal\nstenosis at C4-5 on the left, severe neural foraminal narrowing at C5-6 and\nC6-7 bilaterally. There is no prevertebral soft tissue swelling.\n\nModerate centrilobular emphysema noted in both apices of the lungs.\nAgain seen is anterior subluxation of the left humerus at the glenohumeral\njoint.", "output": "1. Mild anterolisthesis of C 2 on C3 and C3 on C4, are likely chronic. No\nfractures a sequela of trauma.\n2. Multilevel degenerative changes are at least moderate and worse allowed\nC3-C4, C5-C6 and C6-C7.\n3. Anterior subluxation of the left humeral head." }, { "input": "Alignment is unchanged with mild anterolisthesis of C2 on C3 and C3 on C4 as\nwell as C7 on T1 and T1 on T2.No fractures are identified.Moderate multilevel\ndegenerative changes with intervertebral disc space narrowing, anterior and\nposterior osteophyte formation, and endplate irregularity are most pronounced\nfrom C4-5 through C6-7. Multilevel mild to moderate neural foraminal stenosis\nis most pronounced at C5-6 and C6-7. Additionally, there is severe bilateral\nneural foraminal stenosis at C5-6 and C6-7 due to uncovertebral spurring and\nfacet hypertrophy. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nSevere emphysematous changes with fibrosis noted in both lung apices. Thyroid\ngland is unremarkable. Moderate atherosclerotic calcifications of the carotid\nbifurcations. Opacification of a left inferior mastoid air cell is noted.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate cervical spondylosis with mild to moderate central canal and\nsevere bilateral neural foraminal stenosis at C5-6 and C6-7." }, { "input": "Redemonstration of unchanged 2 mm anterolisthesis of C2 on C3 and C7 on T1 as\nwell as 2 mm retrolisthesis of C5 on C6. No fractures are identified. Bones\nare demineralized with moderate degenerative changes, most prominent at the\nC6-C7 level with narrowing of intervertebral space and osteophytosis. \nMild-to-moderate spinal canal narrowing involving the C4-C5, C5-C6, and C6-C7\nlevels secondary to posterior osteophytosis. Additionally, moderate severe\nbilateral neural foraminal stenosis is noted at the C5-C6 and C6-C7 level\nsecondary to facet degenerative changes. Overall, the appearance is similar\nto ___. No prevertebral soft tissue swelling.\n\nChronic interstitial lung disease is seen in the lung apices. Moderate\natherosclerotic calcifications of the carotid bifurcations noted.", "output": "1. No acute fractures or traumatic subluxation.\n2. Mild-to-moderate cervical spondylosis with mild moderate central canal\nnarrowing and moderate to severe foraminal stenosis secondary to degenerative\nchanges, as detailed above." }, { "input": "The alignment is unremarkable. There are no subluxations. There is no\nevidence of fracture, dislocation or bone destruction. There is no\nprevertebral soft tissue swelling. Mild motion artifact obscures evaluation\nof bony detail from the occipital condyles through the mid portion of C2 but\nthere is no evidence of injury. There is no substantial degenerative change.", "output": "No evidence of fracture or dislocation; a limitation is motion artifact which\nlimits evaluation of bony detail along the skull base through mid C2 level." }, { "input": "There is straightening of the cervical lordosis.No fractures are\nidentified.There are moderate to severe multilevel degenerative changes of the\ncervical spine with loss of intervertebral disc space height, posterior and\nanterior and posterior osteophytosis, and subchondral cystic change. \nMultilevel uncovertebral and facet joint hypertrophy result in moderate to\nsevere left-sided neural foraminal stenosis at C4-C5 and moderate bilateral\nneural foraminal stenosis at C3-C4.1 broad-based disc bulge results in mild to\nmoderate spinal canal stenosis at C4-C5. There is no severe spinal canal\nstenosis.There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm. Nondisplaced fracture is seen involving the left\nangle of the mandible. The thyroid gland is unremarkable. There is an\nincidentally noted 2 mm pulmonary nodule in the right lung apex (___).", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Degenerative disease described above.\n3. Incidentally noted 2 mm pulmonary nodule in the right lung apex. See\nrecommendations below.\n4. Nondisplaced fracture is seen involving the left angle of the mandible.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "There is mild retrolisthesis of C3 on C4, unchanged since the lateral scout\nimage from CT head ___. Alignment is otherwise unremarkable. No fractures\nare identified. There is moderate degenerative change in the cervical spine,\nworst at C5-6 and C6-7 with intervertebral disc space narrowing, endplate\nsclerosis, and anterior and posterior osteophyte formation. There is no\ncritical central canal narrowing. Mild bilateral neural foraminal narrowing\nis seen C5-6 due to uncovertebral spurring and facet hypertrophy. There is no\nprevertebral edema.\n\nThe imaged portion of the thyroid and included lung apices are unremarkable. \nThere is calcification of the carotid bulbs bilaterally, more severe on the\nright.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Mild anterolisthesis of C3 on C4 and C4 on C5 is likely degenerative, however\nthere are no priors for comparison. Otherwise, alignment is normal. No\nfractures are identified.There is no prevertebral soft tissue swelling.\n\nModerate degenerative disc disease at C5-6 and C6-7. There are small\nposterior osteophytes at these levels, but no high-grade spinal canal\nstenosis. There is also multilevel neural foraminal stenosis, most severe at\nC5-6 on the right due to a prominent uncovertebral osteophyte.\n\nMultinodular thyroid with a large predominantly hypodense nodule with\ncalcifications on the right measuring approximately 3.0 x 2.4 cm. No cervical\nlymphadenopathy. Lung apices are clear. Partial opacification of the right\nmastoid air cells. Degenerative changes are seen within the temporomandibular\njoints bilaterally.", "output": "1. Mild anterolisthesis of C3 on C4 and C4 on C5, likely degenerative, however\nthere are no priors for comparison. No fracture.\n2. Degenerative changes with moderate neural foraminal stenosis at C5-6 on the\nright due to a prominent uncovertebral osteophyte.\n3. Multinodular thyroid. Large hypodense nodule on the right measuring up to\n3.0 cm. Thyroid ultrasound is recommended on a nonemergent basis, if not\nalready performed.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "No fracture identified. There is no prevertebral soft tissue swelling. \nAlignment is anatomical. Moderate multilevel degenerative changes are noted,\nincluding anterior osteophytosis with osseous fragments noted at C3-C4 and\nC4-C5, and endplate sclerosis. There is mild canal narrowing noted at C2-C3\nand C3-C4 secondary to mild posterior disc bulge and uncovertebral joint\nhypertrophy. There is mild disc bulge at C5-C6. There is mild left neural\nforaminal narrowing at the C2-C3 and C3-C4 secondary to uncovertebral joint\nosteophytes and facet joint hypertrophy.\n\nThe visualized portion of the lung apices show large bullae secondary to\nemphysema and right-sided apical scarring, which is more fully assessed on CT\ntorso performed on the same day. The thyroid is unremarkable.", "output": "1. No evidence of acute fracture or traumatic malalignment of the cervical\nspine.\n2. The visualized portion of the lung apices show large bullae and right-sided\napical scarring. For full description of intrathoracic findings, please see\ndedicated report from CT torso performed on the same day." }, { "input": "There is irregularity of the anterior superior endplate of C4. Despite the\nlack of prevertebral soft tissue swelling at this level or elsewhere, this\nfinding may represent an acute fracture.\nMild anterolisthesis of C3 on C4 is also noted, but believed to be chronic due\nto adjacent remodeling. Multilevel degenerative changes are also noted.\nVascular calcifications are noted in carotid arteries.\n\nScarring at the left lung apex with a small nodule is present.\nA 5 mm nodule in the left lobe of the thyroid is noted.", "output": "Irregularity of the anterior superior endplate of C4. Despite other findings\nsuggesting acuity, this may still be an acute finding. MRI is recommended for\nfurther evaluation.\n\nNOTE ON ATTENDING REVIEW:\n\nThe finding described above can relate to degenerative changes with adjacent\nsclerosis.\nMultilevel, multifactorial degenerative changes are noted with mild canal\nnarrowing and moderate to severe foraminal narrowing with deformity on the\nnerves.\nNo suspicious lytic or sclerotic lesions are noted.\nRotation of the cervical spine to the right side, can be positional or related\nto scoliosis.\nNo obvious acute fracture noted, within the limitations of extensive\ndegenerative changes.\nCorrelation with MRI if not contraindicated can be considered." }, { "input": "2 mm anterolisthesis of C7 on T1 is re- demonstrated. Anterior fusion\nhardware with interbody spacer is re- demonstrated at C5-C6 without evidence\nof hardware fracture or loosening. Evaluation at this level is limited by\nstreak artifact from hardware. There appears to be small posterior\nosteophytes at this level focally indenting the ventral thecal sac though does\nnot appear to contact the spinal cord itself. Vertebral body heights are\notherwise maintained. Prevertebral soft tissues are unremarkable. No\nfractures are identified. Left C7-T1 neural foramina appear is moderately\nnarrowed by facet and uncovertebral hypertrophy. Neural foramina appear\ngrossly patent at the other imaged levels with areas of only minimal narrowing\nfrom a combination of facet and uncovertebral hypertrophy. Small posterior\ndisc bulges at all imaged levels which appear to contact the anterior cord but\nwithout associated deformation. There is no evidence of infection or\nneoplasm. Vertebral body hemangioma at C7.\n\nHeterogeneous enlargement of bilateral thyroid lobes with focal calcification\nin the left lobe. No discrete measurable nodule. Imaged lung apices are\nclear.", "output": "1. Anterior fusion hardware at C5-C6 without evidence of failure.\n2. Unchanged 2 mm anterolisthesis of C7 on T1.\n3. Mild degenerative changes at other levels with the most prominent finding\nof moderate neural foramina narrowing at the left C7-T1.\n\n4. Posterior disc bulges at all imaged levels focally contacting the ventral\nspinal cord without deformation.\n5. Heterogeneously enlarged thyroid may be further evaluated by dedicated\nultrasound if clinically indicated.\n\nRECOMMENDATION(S): Heterogeneously enlarged thyroid may be further evaluated\nby dedicated ultrasound if clinically indicated." }, { "input": "Bony defect is identified at L4-5 level which appears to be new since previous\nstudy. At this level soft tissue changes are seen posteriorly which may\nindicate postoperative fluid. Although a CT does not provide details of\nintraspinal contents: There is no evidence of high-grade thecal sac\ncompression seen. Pedicle screws are identified at L4 and L5 level without\nevidence of lucency surrounding them. There are no bony destructive process\nidentified. No spondylolysis is seen. The previously seen occlusion at L5\nand S1 level is no longer seen with new pedicle screws at L4 and L5 levels.", "output": "1. Postoperative changes are seen at L4-L5 level. Small amount of fluid is\nseen at the laminectomy site which appears postoperative. No evidence of\nhigh-grade spinal stenosis seen." }, { "input": "The alignment is normal. No acute fracture or traumatic subluxation is seen. \nLumbar levoscoliosis is noted. Endplate sclerosis as well as intervertebral\ndisc space narrowing is seen at L4-L5 and at L5-S1. There is deformity of the\nleft hemi sacrum compatible with healed fracture.\n\nT12-L1: There is no spinal canal or neural foraminal narrowing.\n\nL1-L2: There is no spinal canal or neural foraminal narrowing.\n\nL2-L3: Facet joint arthropathy and ligamentum flavum thickening without\nsignificant canal narrowing. There is mild bilateral foraminal narrowing.\n\nL3-L4: Disc bulge, facet joint arthropathy and ligamentum flavum thickening\nresults in mild spinal canal narrowing. There is also mild bilateral\nforaminal narrowing.\n\nL4-L5: Disc bulge, facet joint arthropathy and ligamentum flavum thickening\nresults in minimal spinal canal narrowing. Facet joint osteophytes contribute\nto moderate right and mild left neural foraminal narrowing.\n\nL5-S1: Left lateral endplate osteophytes contribute to mild left foraminal\nnarrowing no significant right foraminal or canal narrowing.\n\nVisualized loops of the large bowel demonstrates diverticulosis. A cystic\nlesion is seen arising from the midpole of the left kidney measuring 2.3 cm x\n2.1 cm. A 1 cm cystic lesion abutting the sacral nerve roots on the right,\nseries 3, image 64, may be secondary to a Tarlov cyst. Moderate\natherosclerotic calcifications noted within a nondilated abdominal aorta.", "output": "1. No acute fracture or traumatic subluxation.\n2. Lumbar spondylosis, most pronounced at L4-L5 with mild spinal canal\nnarrowing. Moderate right and mild left neural foraminal narrowing is seen at\nthis level. Overall findings have not significantly changed since prior." }, { "input": "Alignment is normal. There are multilevel moderate degenerative changes, most\nprominent from C3-C4 to C6-C7. There is partial fusion of the anterior and\nposterior elements of C3 and C4 vertebra. Bridging anterior osteophytes\nextending from C3 to C5. No fractures are identified.Mild multilevel central\ncanal narrowing due to posterior osteophytes are seen at C4-5, C5-6 and C6-7\nalong with mild bilateral neural foraminal narrowing at these levels due to\nuncovertebral spurring.There is no prevertebral edema.\n\nThe thyroid appears unremarkable. Mild centrilobular emphysema is seen within\nthe visualized lung apices.", "output": "1. No evidence of acute fracture or malalignment of cervical spine.\n2. Moderate multilevel degenerative changes.\n3. Partial fusion of C3 and C4 vertebral bodies." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. There is no significant spinal canal\nstenosis or neural foraminal narrowing.\n\nThe thyroid gland is unremarkable. There is no cervical lymphadenopathy.", "output": "Normal cervical spine CT." }, { "input": "There is no acute fracture or malalignment of the cervical spine. There is\nexaggerated lordosis of the cervical spine, likely due to patient position. \nThe visualized outline of the thecal sac is unremarkable. Mild degenerative\nchanges of the cervical spine are seen, with mild endplate osteophytosis. No\ncritical central or neural foraminal stenosis is seen. No prevertebral edema.\n\nThe aerodigestive tract appears patent. Lung apices are clear. Thyroid gland\nappears normal.", "output": "No acute fracture or malalignment of cervical spine. Mild degenerative\nchanges." }, { "input": "Alignment is normal. No fractures are identified. Moderate degenerative\nchanges of the cervical spine most prominently seen at C4-5 through C6-7 where\nthere is mild central canal and bilateral neural foraminal stenosis. There is\nno evidence of high-grade spinal canal or neural foraminal narrowing. There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Imaged thyroid gland is unremarkable.", "output": "No evidence of acute fracture or subluxation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "No acute fracture or traumatic malalignment." }, { "input": "No fractures identified. Alignment is anatomical.There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThe visualized portion of the lung apices are unremarkable. The thyroid is\nnormal.", "output": "No fracture or malalignment within the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. Mild degenerative changes\nnoted with intervertebral disc height loss, uncovertebral joint osteophytes\nand posterior osteophytes at C5-6 and C6-7. No significant canal or foraminal\nnarrowing. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or malalignment." }, { "input": "There is calcification of the anterior longitudinal ligament, consistent with\nDISH. Mild, multilevel degenerative changes of the visualized thoracic spine.\nLinear lucency through the L1 vertebral body appears similar to prior CT from\n___. Old healed write posterior tenth rib fracture is noted. No\nnew fracture identified. Sclerotic focus within the T4 vertebral body\nmeasuring 0.8 x 0.4 cm (602b:42) is most consistent with a bone island. There\nis no prevertebral soft tissue swelling.\n\nModerate respiratory motion artifact results in suboptimal evaluation of the\nlungs. Given this, visualized portions of the lungs demonstrate extensive\nright-greater-than-left subpleural atelectasis and/or scarring, similar to\nprior exam.\n\nThe visualized heart is moderately enlarged. Severe coronary artery\ncalcification is noted. No definite pericardial effusion. Previously\nidentified pericardial versus duplication cyst appears to measure up to 1.7\ncm.\n\nSmall hiatal hernia is present. A venous catheter in the IVC is partially\nvisualized.", "output": "Re-demonstrated fracture of the L1 vertebral body, similar to prior CT from ___. No new fracture identified." }, { "input": "Linear lucency compatible with fracture through the L1 vertebral body is again\nseen with increased degree of surrounding lucency. Left L1 through L3\ntransverse process fractures are also again noted.\n\nThere is no acute fracture. Lumbar vertebral bodies are well aligned. \nMinimal retrolisthesis of L5 on S1 is again noted. Degenerative changes seen\nat the lumbosacral junction with intervertebral disc height loss, vacuum disc\nphenomenon and endplate sclerosis. There is moderate bilateral foraminal\nnarrowing at these levels. Disc bulges spanning L2-3 through L4-5 contribute\nto mild bilateral foraminal narrowing at these levels.\n\nLucent lesion within the sacrum just the left of midline measures up to 1.3 x\n1.0 cm and has been stable since at least ___, likely benign. Sclerotic foci\nwithin the bilateral iliac alae (601:43, 50) are unchanged and most consistent\nwith bone islands. No new concerning osseous sclerotic or lytic lesions\nidentified.\n\nThe infrarenal abdominal aorta is moderately tortuous with moderate\natherosclerotic calcification. Relatively hyperdense lesion in the upper pole\nof the left-sided kidney is partially visualized, measuring up to 3.1 x 2.4 cm\nwhen seen, better assessed on prior CT from ___ and MRI. Known\npancreatic lesion is not included on this examination. Venous catheter is\nnoted within the IVC.", "output": "L1 vertebral body fracture as seen on prior exam. No acute fracture or new\nmalalignment." }, { "input": "Mild anterolisthesis of C6 on C7 is unchanged, likely degenerative. No\nfractures are identified.Multilevel degenerative changes appears similar to\nprior with loss of joint space and anterior and posterior osteophytes. Disc\nbulges and posterior osteophytes indent the thecal sac at C4-5, C5-6 and C6-7.\nThere is no prevertebral soft tissue swelling. The left upper lobe mass has\nincreased in size now measuring 3.1 x 2.9 cm though incompletely visualized. \nThese thyroid remains enlarged with multiple nodules. There is severe\nnarrowing of the trachea at the thoracic inlet.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Increase size of left upper lobe mass highly suspicious for malignancy.\n3. Multinodular thyroid goiter." }, { "input": "Alignment is normal. No acute fracture is seen.There are multilevel\ndegenerative changes, with loss of disc height at multiple levels, worst at\nC3-C4 and C5-C6 where anterior and posterior osteophytes and small posterior\ndisc bulges result in mild canal narrowing. Facet arthropathy results in up\nto moderate neural foraminal narrowing at multiple levels.There is no\nprevertebral edema. Incidental note is made of calcification of the nuchal\nligament.\n\nThe thyroid is unremarkable. There is mild biapical scarring.", "output": "No acute fracture or traumatic malalignment. Multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.There is a mild multilevel\nspinal canal narrowing, most prominently at C3-C4 (3:27) and C4-C5 due to\nposterior osteophytes. Mild bilateral neural foraminal narrowing is also\nnoted at multiple levels due to facet arthropathy and uncovertebral\nhypertrophy. Facet joint fusion of the C5-C6 bilaterally is noted. There is\nno prevertebral edema.\n\nThe thyroid gland is unremarkable. There is a 3 mm pulmonary nodule in the\nright upper lobe (3:54). Small punctate calcified granuloma in the left upper\nlobe is noted (3:64). A patulous esophagus is noted. Moderate vascular\ncalcifications are visualized.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Multilevel moderate degenerative changes.\n3. 3 mm right upper lobe pulmonary nodule. See recommendations below.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nsmaller than 6 mm, no CT follow-up is recommended in a low-risk patient, and\nan optional CT in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "There is no evidence for acute fracture. No abnormal prevertebral soft tissue\nswelling is identified. Mild retrolisthesis of C3 on C4 is likely due to\ndegenerative changes. Moderate multilevel degenerative changes are seen\nthroughout the cervical spine with intervertebral disc space narrowing,\nendplate sclerosis, and anterior and posterior osteophyte formation, most\nnotable at C2-C3, C3-C4, and C5-C6. Moderate central canal narrowing is noted\nat C3-4 with a disc bulge resulting and moderate central canal narrowing. \nMultilevel neural foraminal narrowing is also demonstrated, appearing severe\non the right at C4-5.\n\nThe visualized lung apices are grossly clear bilaterally. The thyroid is\nhomogeneous in attenuation. There is no evidence of pathologic cervical\nlymphadenopathy.", "output": "1. Moderate multilevel degenerative changes of the cervical spine without\nacute fracture.\n2. Minimal retrolisthesis of C3 on C4 is age-indeterminate but likely\ndegenerative in nature." }, { "input": "Alignment is maintained.No fractures are identified. There is no prevertebral\nsoft tissue swelling. Mild degenerative changes are noted in the cervical\nspine with loss of intervertebral disc space and osteophyte formation. \nMultilevel posterior osteophyte and disc bulges are noted with resultant\nmild-to-moderate vertebral canal narrowing and deformation of the spinal cord.\nMultilevel uncovertebral and facet joint hypertrophy is seen causing severe\nneural foraminal stenosis at the left C4-C5, right C5-C6, and bilateral C6-C7\nvertebral levels. Incidental note is made of prominent cervical lymph nodes\nbilaterally, measuring up to 1.0 cm (series 3: Image ___, likely reactive. \nThere is no evidence of infection or neoplasm. The thyroid is grossly\nunremarkable. The lung apices are grossly clear with mild apical scarring.", "output": "1. No acute fracture or dislocation.\n2. Mild degenerative changes in the cervical spine with multilevel mild to\nmoderate vertebral canal narrowing and multilevel severe neuroforaminal\nstenosis, as above.\n3. Mild prominence of the bilateral cervical lymph nodes is likely reactive." }, { "input": "There is multilevel degenerative disc changes but no evidence of acute\nfracture or subluxation. There are multiple old right rib fractures. Linear\nlucency through C7 is again noted, discussed in the cervical spine CT report.\n\nThere is a 15.9 x 4.2 x 14.2 cm (TV x AP x CC) fat containing mass with\nirregular soft tissue component, in the right upper back, unchanged from ___\n(602b:11).\n\nThere is a chronic left pleural effusion and atelectasis. There is diffuse\nbronchial wall thickening, more prominent in the lower lobes.\n\nA right shoulder joint effusion, unchanged from ___, is also noted.", "output": "1. No acute fracture or subluxation of the thoracic spine.\n2. Complex fatty mass in the right upper back is concerning for a low-grade\nliposarcoma. Further evaluation as an outpatient with MRI is recommended.\n3. Chronic left pleural effusion and atelectasis with evidence of chronic\nbronchitis.\n4. Stable chronic right shoulder joint effusion." }, { "input": "There is no sign of a fracture or abnormal alignment. There are multilevel\ndegenerative changes. The bones are diffusely demineralized. There is no\nprevertebral hematoma. There are no destructive osseous lesions concerning\nfor malignancy. CT is not able to provide intrathecal detail comparable to MRI\nbut the thecal contents are grossly unremarkable.", "output": "No evidence of acute fracture or subluxation. No definitive osseous\nmetastatic disease." }, { "input": "There are linear lucencies in the right transverse process of C4, with\ncortical irregularity, of unknown acuity (2:46). Similarly linear lucencies\nare seen in the C7 vertebral body (601b:36). There are severe compression\nfractures of C2 and C3 and C4, which have significantly progressed from ___\nbut may not be acute. There is 2 mm retropulsion of the posterior aspect of\nC3. There is an equivocal transverse radiolucent fracture line through C7. \nIn addition, there is significant widening of the C2-3 facet joint on the\nright, again new from ___ but of unknown acuity (601b:29). There are severe\nbackground multilevel degenerative changes of the spine. A lipoma is noted in\nthe posterior neck soft tissues.", "output": "1. Potentially acute fractures of the right transverse process of C4 and the\nC7 vertebral body, of unknown chronicity. MRI is recommended for further\nevaluation.\n2. Widening of the right facet joint of C2-3, unknown acuity but new from\n___. The appearance is suggestive of an infectious or inflammatory\narthropathy.\n3. Significant progression of compression fractures of C2, C3, and C4 from\n___." }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture.\nIntervertebral disc space heights are maintained. No acute alignment\nabnormality is identified.\n\nNo prevertebral soft tissue abnormality. Prominent bilateral cervical lymph\nnodes may be reactive. Correlate for signs of infection. The thyroid is\nunremarkable.\nPartially visualized maxillary sinuses demonstrate considerable mucosal\nthickening.", "output": "No cervical spine fracture, acute alignment abnormality, or prevertebral soft\ntissue abnormality.\nMucosal thickening in the partially visualized bilateral maxillary sinuses." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. No significant spinal canal stenosis or\nneural foraminal narrowing is identified.\n\nThe thyroid gland is unremarkable. There is no cervical lymphadenopathy. The\nadenoids are somewhat prominent, likely due to patient's age. Included lung\napices are clear.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "No acute fracture or traumatic malalignment is identified. Vertebral body\nheights and disc spaces are maintained. There is minimal degenerative change\nin the lower thoracic spine with endplate osteophyte formation.\n\nParavertebral soft tissues are grossly unremarkable. There is bibasilar\natelectasis.", "output": "No acute fracture or malalignment of the thoracic spine." }, { "input": "There is no acute fracture or traumatic malalignment. Vertebral body heights\nand disc space are maintained. There is no significant degenerative disease. \nNoncontrast appearance of the paravertebral soft tissues are grossly\nunremarkable.", "output": "Normal lumbar spine CT." }, { "input": "Redemonstration of multilevel posterior thoracolumbar spine fusion, with disc\nspacers, partially imaged.\n\nThere is loosening of the right T10 pedicle screw, with a gap measuring up to\n4 mm between the bone and screw (2:90). Possible early loosening left T10\nscrew distally,. No other areas of hardware loosening, or hardware fracture.\n\nAlignment is unchanged.No acute fractures are identified.Multilevel\ndegenerative changes. Advanced degenerative disc disease T9-T10 level, which\nSchmorl's nodes, likely for maxilla related degenerative change secondary to\nfusion starting just below. Posterior element bone grafting. Multilevel\nforaminal narrowing, most prominent at T10-T11. Chronic L1 compression\nfracture, stable since ___. Posterior paraspinal fluid collection at\nthe thoracolumbar junction, also seen on prior, likely postsurgical.\n\nThere is moderate right and mild left dependent atelectasis in the imaged\nlungs. Bronchial wall thickening, mild bronchiectasis bilaterally.", "output": "1. Loosening right T10 pedicle screw.\n2. Possible early loosening left T10 screw.\n3. Multilevel degenerative changes thoracic spine, worse at T9-T10 level.\n4. Presumed bilateral posterior lung atelectasis, partially seen" }, { "input": "There is mild retrolisthesis of C4 on C5, likely degenerative in etiology. No\nacute fractures are identified.Severe multilevel degenerative changes are\nseen, most extensive at C3-4 and C4-5 and notable for severe disc space\nnarrowing, endplate irregularity, mild retrolisthesis of C4 on C5, and a large\nposterior disc osteophyte complex at C4-C5 causing moderately severe cervical\nstenosis. Severe left-sided neural foraminal narrowing at C4-5 and C5-6 is\npresent as well. There is no prevertebral edema.\n\nThere is a large heterogeneous right thyroid lobe with a dominant 3 cm nodule.\nAn endotracheal tube and enteric tube are partially imaged. There is moderate\ncircumferential calcification of the carotid bulbs bilaterally, without\nsignificant stenosis.\n\nPlease refer to separately dictated CT chest report from the same day for full\ndescription of intrathoracic findings.\n\n Please refer to same day dedicated head CT for full report of cranial\nfindings.", "output": "1. No acute fracture.\n2. Moderate to severe multilevel degenerative changes. Of note, there is\nmoderately severe cervical stenosis at C4-C5 which predisposes the patient to\nspinal cord injury in the setting of minimal trauma. If there is clinical\nconcern for cord injury, MRI may be considered for further evaluation.\n3. C4 on C5 retrolisthesis is likely degenerative in etiology.\n4. Large heterogeneous right thyroid lobe with likely a dominant 3 cm right\nthyroid nodule. Thyroid ultrasound may be considered if not previously\nperformed, as clinically indicated.\n\nRECOMMENDATION(S): Thyroid ultrasound may be considered if not previously\nperformed, as clinically indicated.\n\nNOTIFICATION: The findings were discussed with ___, by ___\n___, M.D. on the telephone on ___ 5 minutes following the discovery\nof the findings." }, { "input": "There is no evidence of acute cervical fracture or subluxation. There is no\nprevertebral soft tissue swelling. There are moderate multilevel degenerative\nchanges with loss of intervertebral disc space height and anterior\nosteophytosis. Additionally, note is made of multiple posterior osteophyte\ncomplexes, most prominent at C5-C6 and C6-C7, causing mild flattening of the\nanterior thecal sac at these levels.\n\nThe thyroid gland is enlarged and note is made of a 12 x 10 mm hypodensity\nwithin the left thyroid lobe. The lung apices are clear.", "output": "1. No evidence of acute fracture or dislocation.\n\n2. Enlarged thyroid gland with a 12 mm hypodensity seen in the left thyroid\nlobe. Further evaluation with a nonemergent thyroid ultrasound is recommended.\n\nNOTIFICATION: Final recommendations were discussed by Dr. ___ with\nDr. ___ on the telephone on ___ at 6:43 ___, 15 minutes after\ndiscovery of the findings." }, { "input": "There is no traumatic malalignment. No fractures are identified. There is\nmoderate degenerative changes of the cervical spine with mild vertebral body\nheight loss, disc space loss and posterior and anterior osteophytosis, worst\nat C3 through 6. There are disc bulges and posterior osteophytes at C3-4,\nC4-5, and C5-6, moderately narrowing the spinal canal and indenting the thecal\nsac, not significantly changed prior. There is diffuse mild narrowing of the\nneural foramina bilaterally. There is no prevertebral soft tissue\nswelling.Again seen is a 1.4 cm hypodensity in the left lobe of the thyroid,\nmildly enlarged from prior. Calcifications are seen at the aortic arch and\nits major branches as well as carotid bulbs bilaterally.", "output": "1. No acute fractures or traumatic malalignment.\n2. Degenerative changes as noted above." }, { "input": "No evidence of acute fracture is seen. There is no dislocation. Multilevel\ndegenerative changes are seen, similar to prior, including disc space\nnarrowing C4 through C7 with endplate irregularities and anterior and\nposterior osteophytes. No prevertebral soft tissue swelling is seen. The\nthyroid gland is not well assessed on this study due to artifact coursing\nthrough this region and was better assessed on the prior study.\nThe partially imaged lung apices are clear.", "output": "No acute fracture of the cervical spine. Re-demonstrated multi-level\ndegenerative changes." }, { "input": "Alignment is normal. No fractures are identified. There is mild\nintervertebral disc space narrowing and osteophyte formation at C5-C6. There\nis no evidence of high-grade spinal canal or neural foraminal stenosis. There\nis no prevertebral soft tissue swelling.\n\nA 2.0 x 1.9 cm hypodense right thyroid nodule is noted (series 3:59), similar\nto the prior chest CTA. Punctate calcification is seen in the left thyroid\ngland along with a 1.4 x 1.1 cm left hypodense thyroid nodule. Visualized\nlung apices are grossly clear.", "output": "1. No fracture or malalignment.\n2. 1.9 cm hypodense nodule in the right lobe of the thyroid, similar to the\nprior chest CTA. Ultrasound follow-up is recommended, if not done previously.\nPlease see recommendations below for further details.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen notable for uncovertebral hypertrophy and posterior\nosteophyte formation resulting in up to mild canal narrowing. There is no\nprevertebral edema.\n\nThe thyroid is unremarkable. Pleural based apical scarring is visualized in\nthe lungs bilaterally.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.At C2-3, intervertebral\nosteophytes and a disc bulge slightly indent the anterior surface of the\nspinal cord. Uncovertebral and facet osteophytes narrow the left neural\nforamen.\nAt the remaining levels of the cervical spine there are mild degenerative\nchanges with no spinal canal narrowing.\nUncovertebral and facet osteophytes produce severe bilateral neural foraminal\nnarrowing at C4-5, moderate narrowing at C5-6 and mild narrowing at C6-7. \nThere is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No evidence of fracture or subluxation.\n2. Multilevel degenerative changes with neural foraminal narrowing" }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges are worse from C3-C6.\n\nThe thyroid and included lung apices are unremarkable. ETT and NG tube are\npartly imaged. Secretions in the nasopharynx may be related to ET tube\nplacement.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.There is no prevertebral soft\ntissue swelling. Mild degenerative changes are noted with disc height loss at\nC5-6 and C6-7 with small posterior osteophytes.\n\n\nKnown nondisplaced right temporal and sphenoid bone fracture better seen on\nconcurrent head CT. Intracranial hemorrhages were also as detailed on\nsubsequent head CT performed at ___.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is no acute fracture or traumatic malalignment. Plates are seen within\nthe mandible, likely related to prior trauma. Vertebral body heights and disc\nspaces are preserved. There is no prevertebral soft tissue swelling. The lung\napices are clear. There is unchanged calcification inferior to the anterior\narch of C1.\n\nThe thyroid is normal. There are multiple enlarged cervical lymph nodes,\nmeasuring up to 1.8 cm (03:29). Additionally, enlarged tonsils are noted. The\nlung apices are clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Enlarged tonsils and cervical adenopathy is likely reactive, suggest\nclinical correlation." }, { "input": "Cervical vertebral bodies are maintained in height and alignment. There is no\nfracture. There is preservation of the normal cervical lordosis. Prevertebral\nsoft tissues are unremarkable. A well corticated ossific body is noted\ninferior to the dens, perhaps related to an old injury.\n\nThe thyroid and included lung apices are unremarkable.\nThere is no evidence of fracture or malalignment.", "output": "No evidence of fracture or malalignment." }, { "input": "Alignment of the thoracic vertebral bodies appears within normal limits. There\nis an anterior wedge compression deformity at the T8 level with approximately\n30% loss of vertebral body height. Additionall at the level of T2, there is a\ncompression deformity with superior end plate depression roughly 25% loss of\nvertebral body height. No evidence of retropulsion or anterior prevertebral\nhematoma. There is evidence of retropulsion. At this level, there is no\nprevertebral hematoma identified.\n\nVisualized portions of the lung bases demonstrate bibasilar atelectasis.\nVisualized portions of the aorta are unremarkable without aneurysmal\ndilatation. Within the limits of a nonenhanced examination, visualized\nportions of the liver, pancreas, spleen, adrenal glands and kidneys are\nunremarkable.", "output": "T2 and T9 superior end plate compression deformities which appear acute,\nthough MR is a more sensitive modality to determine degree of chronicity. No\nevidence of prevertebral hematoma. No evidence of retropulsion.\n\nNOTIFICATION: FIndings communicated to the ED resident Dr. ___ by Dr ___.\n___ via telephone at 10:36 on ___." }, { "input": "Alignment is normal. No fractures are identified.Mild multilevel degenerative\nchanges are seen, most extensive at C6-C7. No high-grade spinal canal or\nneural foraminal stenosis..There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture. No traumatic subluxation." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nParaseptal emphysema noted at the lung apices. Intravenous air is noted\nthroughout the visualized venous structures in the neck.", "output": "No cervical spine fracture or malalignment." }, { "input": "Partially visualized mucosal thickening within the bilateral maxillary sinuses\nnoted. There is no fracture or malalignment within the cervical spine. \nDegenerative changes are noted without critical spinal canal or neural\nforaminal stenosis. There is no prevertebral edema. Degenerative disc\ndisease is most pronounced at C5-6 and C6-7 with mild to moderate disc space\nnarrowing and small endplate osteophytosis. Facet alignment appears preserved\nwithout significant degenerative disease. There is nodular pleuroparenchymal\nscarring at the right lung apex with nodular component measuring 12 x 16 mm. \nThyroid contains a left nodule measuring 10 mm. The base of the dens is\nintact.", "output": "1. No fracture or malalignment in the cervical spine.\n2. Nodular scarring at the right lung apex measuring up to 16 mm which in the\nabsence of priors can be further assessed for short interval stability on a\nthree-month follow-up CT of the chest." }, { "input": "Alignment is normal. No fractures are identified.No substantial degenerative\nchanges. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling.The thyroid and bilateral lung\napices are unremarkable. Opacified paranasal sinuses, better seen on head CT\nfrom today.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No acute fracture or traumatic dislocation.There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Partially imaged\nectopic molar tooth in the left retro maxillary fat with orientation reversed\nrelative to the other maxillary teeth, crown projecting superiorly.", "output": "No acute fracture or traumatic dislocation." }, { "input": "No evidence of traumatic malalignment. There is moderate anterolisthesis of\nC4 on C5, which is unchanged when compared to scout images from prior head CT\nfrom ___. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema. Moderate\ndegenerate changes are seen including uncovertebral hypertrophy with resulting\nmild neural foraminal stenosis at right C3-C4. There is multilevel facet\narthropathy with fusion of the bilateral C2-C3 facet joints.\n\nThe lung apices are unremarkable. There is a 5 mm hypodensity in the left\nlobe of the thyroid lobe compatible with a nodule.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel facet arthropathy with moderate anterolisthesis of C4 on C5 that\nis likely degenerative, and was present on scout images from CT Head from\n___.\n3. 5 mm nodule in the left thyroid lobe. No follow-up is recommended.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is minimal anterolisthesis of C4 on C5 and C7 on T1. Remaining\nvertebral bodies are preserved in alignment and they are preserved in height\nthroughout. There is no fracture. Degenerative changes notable for\nintervertebral disc height loss, anterior and posterior osteophytes and\nuncovertebral joint hypertrophy at C5-6 and C6-7. Facet joint hypertrophy\nspans the cervical spine and there is fusion at the C7-T1 facet joints. . \nMild canal narrowing is noted at these levels results bilateral C6-7 and left\nC5-C6 foraminal narrowing. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Atherosclerotic\ncalcifications within the intracranial ICAs", "output": "No fracture. Anterolisthesis of C4 on C5 and C7 on T1 likely degenerative but\nto be correlated clinically." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Scattered sclerotic bony lesions statistically likely\nrepresent bone islands. There is a 12 mm hypodense left thyroid nodule. \nThere is a 7 mm right upper lobe pulmonary nodule (series 3, image 64).", "output": "1. No acute C-spine fracture or malalignment.\n2. 7 mm right upper lobe pulmonary nodule, a followup chest CT is recommended\nin 3 months.\n3. 12 mm hypodense left thyroid nodule, a nonemergent thyroid ultrasound\nshould be considered.\n\nRECOMMENDATION(S):\n-Follow-up CT chest in 3 months.\n-Thyroid ultrasound, nonemergently." }, { "input": "Alignment is normal. No fractures are identified. Mild degenerative changes\nof the cervical spine. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.Left thyroid\ngland is heterogeneous and enlarged with areas of hypodensity, consistent with\nnodules, largest measuring 1.9 x 1.3 cm (03:59). Calcified scarring in the\nleft upper lobe.", "output": "1. No evidence of malalignment of the cervical spine. No fractures are\nidentified.\n2. Heterogeneous and enlarged thyroid with left thyroid nodules measuring 1.9\ncm. Recommend further evaluation with dedicated thyroid ultrasound if not\nalready performed." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "Normal study." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "No acute fracture or malalignment." }, { "input": "The patient is status post anterior discectomy and cervical fusion of C3\nthrough C7 with fixation screw and plate hardware at C3-4. There is no\nevidence of hardware complication. There is no evidence of fracture. They\nwere are extensive degenerative changes at the articulations of the C1 with\nthe C2 lateral masses bilaterally. There is slight anterior subluxation of C2\non C3, unchanged.\nThere is narrowing of the spinal canal at C2-3 due to ligamentum flavum\nthickening and subluxation. This does not appear to contact the spinal cord. \nUncovertebral and facet osteophytes produce moderate right neural foraminal\nnarrowing. There are prominent erosive changes of the articular surfaces of\nthe right facet joint at this level.\nAt C3-4, intervertebral osteophytes narrow the spinal canal and slightly\nflatten the anterior surface of the spinal cord. Uncovertebral and facet\nosteophytes produce moderate right neural foraminal narrowing.\nAt C4-5, intervertebral osteophytes encroach on the spinal canal and may\ncontact the spinal cord. Uncovertebral and facet osteophytes produce moderate\nright neural foraminal narrowing.\nAt C5-6, intervertebral osteophytes encroach on the midline and left anterior\nside of the spinal canal slightly flattening the spinal cord. The left lamina\nhas been removed at this level. Uncovertebral osteophytes mildly narrow the\nleft neural foramen.\nAt C6-7, a small residual amount of disc material slightly indents the\nanterior surface of the spinal cord. Uncovertebral and facet osteophytes\nproduce moderate bilateral neural foraminal narrowing.\nAt C7-T1, intervertebral osteophytes mildly narrow the spinal canal. Facet\nosteophytes produce mild left and moderate right neural foraminal narrowing. \nAt C7-T1 thickening and calcification of the ligamentum flavum contributes to\nspinal canal narrowing.\nThere is multilevel central spinal canal narrowing, most prominent at C5-C6\nwhere it is moderate secondary to a prominent posterior vertebral body\nosteophyte. There is multilevel neural foraminal narrowing, most prominent at\nC6-C7 on the left where it is moderate secondary to a prominent vertebral body\nosteophyte and facet joint hypertrophy.\n\nThe partially imaged lung apices are clear. The thyroid gland is atrophic\nwithout suspicious nodules.", "output": "1. No evidence fracture or traumatic malalignment of the cervical spine.\n2. Anterior cervical fusion from C3 through C7 with anterior plate and screws\nat C3-4. There is no evidence of hardware complication.\n3. Severe multilevel cervical degenerative disease, grossly unchanged from\nprior study dated ___." }, { "input": "No acute fracture is seen. There is minimal anterolisthesis of C3 on C4 as\nwell as C4 on C5 which is likely degenerative in nature. Multilevel\ndegenerative disc disease is noted most pronounced at C5-6 level. Facet\narthropathy and uncovertebral joint hypertrophy results in mild to moderate\nneural foraminal narrowing most pronounced on the right at C5-6. The outline\nof the thecal sac is unremarkable without signs of significant spinal canal\nnarrowing. Imaged thyroid is unremarkable. Biapical pleuroparenchymal\nscarring noted.", "output": "Degenerative disease without signs of acute fracture. Subtle alignment\nabnormality at C3 and C4 likely chronic. Please correlate clinically." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. Mild multilevel degenerative changes are\npresent, most prominent at C5-C6 with posterior disc osteophyte complex\nindenting on the ventral thecal sac. There is no significant neural foraminal\nnarrowing.\n\nThere are heavy atherosclerotic calcifications of the bilateral carotid bulbs\nas well as the left vertebral artery. The visualized lung apices are clear. \nA calcified right thyroid nodule is again visualized as well as unchanged left\nthyroid nodule.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "There is no evidence for a fracture or prevertebral soft tissue swelling. \nThere is no subluxation. Levoconvex curvature of the cervical spine is noted.\nWithin the limits of CT resolution, there is no evidence for significant\nspinal canal or neural foraminal narrowing.\n\nVisualized lung apices are clear. The thyroid gland is grossly unremarkable.\n\nThere is a small mucous retention cyst in the partially visualized right\nsphenoid sinus. Concurrent head CT is reported separately.", "output": "No fracture or subluxation." }, { "input": "There is very mild retrolisthesis of C C4 on C5, with ossification of the\nposterior longitudinal ligament at this level. No traumatic malalignment\nidentified. No fractures are identified.Degenerative changes of the cervical\nspine are mild, most pronounced at C4-C5, were there is endplate sclerosis and\ndisc space narrowing. No critical spinal canal or neuroforaminal narrowing.\nThere is no prevertebral soft tissue swelling.\n\nA small calcification is noted adjacent to the right thyroid. Re-\ndemonstration of several minimally displaced left occipital fractures,\nextending from the skull base superiorly, as described on the recent CT head\n(2:3, 4). Incidental note of mucosal thickening of the bilateral maxillary\nsinuses.", "output": "1. No acute cervical spinal fracture or traumatic malalignment.\n\n2. Please refer to the CT head report of the same date for further findings,\nincluding occipital fractures and small subdural hemorrhage.\n\nNOTIFICATION: The above findings were communicated in person by Dr. ___\nto Dr. ___ surgery) at 09:45 on ___, 2 min after discovery." }, { "input": "Please note that the T1 vertebral body is incompletely imaged.\n\nThere is straightening of normal cervical lordosis. No fractures are\nidentified.Multilevel degenerative changes are seen, resulting in up to\nmoderate spinal canal narrowing secondary to posterior osteophytes and disc\nbulges at C2-C3, C3-C4, and C4-C5.There is no prevertebral edema.\n\nThe visualized thyroid is mildly heterogeneous.", "output": "No cervical fracture or traumatic malalignment." }, { "input": "Alignment is unchanged.Redemonstration of mildly comminuted fracture noted\nthrough the base of the dens, compatible with a type 2 dens fracture. \nCompared to prior exam, the fracture is slightly more pronounced with slightly\nincreased distraction (series 602, image 32; series 601, image 33). Mild\nprevertebral soft tissue swelling at the level of the C1 into fractures is not\nsubstantially changed in the interval. Additionally, there is fracture\nthrough the right anterior ring and lateral mass of C1, similar prior. \nPartially visualized T2 vertebral body compression fracture with retropulsion\nappears similar compared to prior. No new fracture.\n\nThere is no evidence of critical spinal canal or neural foraminal stenosis. \nVisualized thyroid gland and lung apices are clear.", "output": "1. Redemonstration of type 2 dens fracture. Compared to prior, the fracture\nis slightly more pronounced and distracted.\n2. Redemonstration of right C1 anterior ring and lateral mass fractures,\nsimilar to prior. Partially visualized T2 vertebral body fracture with\nretropulsion, similar to prior.\n3. No new fractures or alignment change." }, { "input": "Evaluation of lower cervical cord is mildly limited due to patient body\nhabitus. Within this limitation, no fracture or traumatic malalignment..There\nis no significant spinal canal stenosis. Mild degenerative changes of the\ncervical spine worst at C4-C5. At C4-C5, uncovertebral hypertrophy results in\nmoderate bilateral neural foraminal stenosis.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No fracture or traumatic malalignment.\n2. Mild degenerative change of the cervical spine with moderate bilateral\nneural foraminal stenosis at C4-C5.." }, { "input": "There is minimal anterolisthesis C4 on C5, likely degenerative. No fractures\nare identified.Multilevel degenerative changes are seen. No prevertebral\nedema. No significant central canal narrowing is evident on CT. There is\nmultilevel mild-to-moderate foraminal narrowing, most prominent at the left\nC3-C4 foramen.\n\nThe thyroid is slightly heterogeneous with several hypodense nodules, benign. \nThere is biapical apical scarring. Otherwise, included lung apices are\nunremarkable.", "output": "No acute fracture or traumatic malalignment.\nDegenerative changes cervical spine." }, { "input": "There is scoliosis of lumbar spine convex to the left side with the apex at L3\nlevel. There is chronic appearing compression with sclerotic changes at the\nsuperior endplate of L1 which appears new since the MRI of ___. At\nL2-3 and L3-4 levels mild to moderate spinal canal stenosis is seen secondary\nto degenerative changes better evaluated on the previous MRI study. At L3-4\nmoderate right foraminal narrowing is seen.\n\nAt L4-5 level, grade 2 spondylolisthesis of L4 over L5 seen with severe facet\ndegenerative changes and severe spinal stenosis. There is also severe\nbilateral foraminal narrowing.\n\nAt L5-S1 level, there is laminectomy visualized. There is no spinal stenosis\nseen. Mild narrowing of the foramina noted.\n\nThe right posterior ilium and the iliac crest demonstrate trabeculated\nappearance which could be secondary to fibrous dysplasia is not fully\nevaluated.", "output": "1. Grade 2 spondylolisthesis of L4 over L5 with severe spinal stenosis and\nforaminal narrowing as on the previous MRI study.\n2. Scoliosis of lumbar spine.\n3. Chronic appearing compression of superior endplate of L1 new since the\nprevious MRI study." }, { "input": "Opacification of the right mastoid air cells without definite fracture\nsuggests ongoing inflammation. Moderate mucosal thickening of the sphenoid\nsinus. Left mastoid air cells are clear. Small amount of cerumen is seen\nwithin the external auditory canal. Degenerative changes of the left\ntemporomandibular joint is present.\n\nNo cervical spine fracture. Vertebral body heights are preserved. Multilevel\nmoderate to severe degenerative changes are noted throughout the cervical\nspine most prominent at C3 through C7 with anterior and posterior osteophytes,\ndisc space narrowing, and subchondral sclerosis. Mild anterolisthesis of C2\non C3, mild retrolisthesis of C5 on C6, mild anterolisthesis of C6 on C7, and\nmild anterolisthesis of C7 on T1 are most likely degenerative in etiology. Pre\nand paravertebral soft tissues are normal. Visualized portions of the\nskullbase show no abnormalities.\n\nLimited assessment of the spinal canal is notable for moderate canal narrowing\nmost prominent at C3-C4, C4-C5, C5-C6 from posterior disc osteophyte\ncomplexes. Visualized portions of the aerodigestive tract are patent. Limited\nassessment of the lung apices are clear.", "output": "1. Opacification of the right mastoid air cells without fracture is most\nlikely inflammatory in nature.\n2. No acute fracture.\n3. Multilevel moderate to severe degenerative changes most prominent at C3\nthrough C7 with moderate canal narrowing most prominent at C3-C4, C4-C5, and\nC5-C6 from posterior disc osteophyte complexes and mild anterolisthesis and\nretrolisthesis as described above." }, { "input": "There is no acute fracture or alignment abnormality within the cervical spine.\nThere is mild narrowing of the central spinal canal due to prominent posterior\nosteophytes at C4 through C7 levels. Thyroid is unremarkable. No\nprevertebral edema.", "output": "No fracture or alignment abnormality. Degenerative changes as stated." }, { "input": "There is no traumatic malalignment of the cervical spine. No fractures are\nidentified. There are multilevel degenerative changes with intervertebral\ndisc space narrowing, vertebral body osteophytosis, and subchondral cystic and\nsclerotic changes, most prominent at C5-C6. There is multilevel canal\nnarrowing, most prominent at C5-C6 where it is moderate (2:49). There is\nmultilevel neural foraminal narrowing, most prominent at C5-C6 where it is\nmoderate bilaterally. There is no prevertebral soft tissue swelling.\n\nThe visualized lung apices are unremarkable. The thyroid appears atrophic. \nThere is no cervical lymphadenopathy based on CT size criteria.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Multilevel cervical spondylosis, most prominent at C5-C6 where there is\nmoderate canal and bilateral neural foraminal narrowing." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. There is mild\ndegenerative change with anterior osteophytosis and multilevel disc space\nnarrowing. The visualized lungs are clear. The thyroid gland is\nunremarkable. There is no cervical lymphadenopathy by CT size criteria. \nVisualized aerodigestive tract is grossly unremarkable.", "output": "No fracture or dislocation. Mild degenerative change." }, { "input": "There is increased kyphosis of the thoracic spine. Loss of vertebral body and\ndisc height is moderate. Anterior and posterior osteophytosis is moderate\nwith multilevel mild canal narrowing. No acute fractures are identified. \nCalcifications of the paraspinal ligaments are extensive. There is no\nevidence of significant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. There is diffuse osteopenia. The visualized lungs are clear.", "output": "1. Moderate degenerative change without evidence of fracture or traumatic\nmalalignment.\n2. Given the degree of osteopenia and ligamentous ossification, if there is\nhigh clinical concern for ligamentous injury, MRI, if there no\ncontraindications would be more sensitive." }, { "input": "There is severe scoliosis of the lumbar spine to the left. . There is a spinal\ncatheter which enters at L3 and extends superiorly on the right, its superior\nextent is not included within the field of view. A second smaller catheter\nseen on the left aspect of the thecal sac entering the canal at approximately\nL2 and extending superiorly on the left. No large fluid collection seen in the\nparaspinal soft tissues.\n\nThere are extensive degenerative sequela including massive anterior\nosteophytes at L4-L5 and small osteophyte at other lumbar levels. There is\nleft-sided facet hypertrophy at L1-L2 and L2-L3. At L1-L2 there is a right\nanterior osteophyte. There is severe spinal canal narrowing at L3-L4 and\nL4-L5. There is moderate canal narrowing at L2-L3. No significant narrowing\nat L5-S1.\n\nThe right kidney is a large compared to the left. Please correlate with\nresults of recent CT abdomen and pelvis .", "output": "Severe degenerative changes and scoliosis.\n\n2 intrathecal catheters the superior extent of which are not visualized on\nthis examination\n\nNo large fluid collection within the posterior soft tissues." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. A slightly expansile\nappearing lucency measuring approximately 3.0 x 1.1 cm centered at the T1\nspinous process extending into the bilateral lamina. No evidence of\nunderlying fracture. There is no prevertebral soft tissue swelling. There is\nno evidence of infection or neoplasm.", "output": "1. No cervical spine fracture or malalignment.\n2. Expansile lucent lesion centered in the T1 spinous process for which\nnonurgent MRI is suggested." }, { "input": "Alignment is normal. No fractures are identified. There is chronic mild\nsuperior endplate deformity of L3. Multilevel mild degenerative changes are\nseen, most extensive at L2-3 and L3-4 and notable for posterior disc bulge,\nligamentum flavum thickening and facet joint arthropathy causing mild neural\nforaminal and spinal canal narrowing. Degenerative changes are seen of\nbilateral SI joints.There is no prevertebral edema.\n\nCholecystectomy clips are noted, otherwise visualized portions of the abdomen\nare unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild degenerative changes in the lumbar spine." }, { "input": "Alignment is normal. No acute cervical spine fracture is identified.There is\nmild multilevel degenerative changes, which is most severe at C4-5 where disc\nbulge and posterior osteophyte causes mild central canal narrowing. There is\nno significant neural foraminal narrowing.There is no prevertebral soft tissue\nswelling.\n\nA linear left temporal bone fracture extending into the external auditory\ncanal is again seen (2:7), as seen on CT head from the same date. Fluid fills\nthe external auditory canal, possibly blood products. The otic capsule\nappears intact, as do the ossicles.", "output": "1. No evidence of fracture or traumatic subluxation.\n2. Mild multilevel degenerative changes.\n3. Left temporal bone fracture as described on CT head from the same date." }, { "input": "Alignment is normal. No fractures are identified. Degenerative changes seen\nat C5-C6 with posterior disc bulge and endplate osteophytes resulting in\neffacement of the ventral CSF as seen on prior MRI. There is no prevertebral\nsoft tissue swelling.\n\nThe thyroid and lung apices are unremarkable.", "output": "No acute fracture or malalignment of the cervical spine." }, { "input": "There is no evidence for a fracture. Vertebral body heights are preserved.\nMinimal anterolisthesis of C7 on T1 is again seen, unchanged. There is no\nevidence for prevertebral edema.\n\nMultilevel degenerative disease is again seen, as detailed below. There is\ndisk space narrowing at C5-6 and C6-7, and to a lesser extent at C3-4 and\nC4-5. Evaluation of spinal canal detail by CT is limited.\n\nAt C2-3, there are bilateral uncovertebral and facet osteophytes with mild\nbilateral neural foraminal narrowing, unchanged. No significant spinal canal\nnarrowing is seen, allowing for streak artifact from dental amalgam.\n\nAt C3-4, there is moderate to severe left neural foraminal narrowing by\nuncovertebral and facet osteophytes, similar to the prior CT. No significant\nspinal canal narrowing is seen.\n\nAt C4-5, there is a small right paracentral endplate osteophytes indenting the\nventral thecal sac and approaching the ventral spinal cord. The spinal canal\ndoes not appear significantly narrowed. There is right greater than left facet\narthropathy, but no significant neural foraminal narrowing. These findings are\nunchanged.\n\nAt C5-6, a broad-based disc osteophyte complex mildly indents the ventral\nthecal sac. The ventral spinal cord is not sufficiently assessed. There is\nmoderate bilateral neural foraminal narrowing by uncovertebral and facet\nosteophytes. These findings are not significantly changed.\n\nAt C6-7, a broad-based disc osteophyte complex mildly indents the ventral\nthecal sac. The ventral spinal cord is not sufficiently assessed. There is\nmoderate, left greater than right neural foraminal narrowing by uncovertebral\nosteophytes. These findings are not significantly changed.\n\nAt C7-T1, no spinal canal narrowing or significant neural foraminal narrowing\nis seen, though severe right facet arthropathy is present.\n\nMiddle ear cavities, mastoid air cells, partially visualized pneumatized\npetrous apices, and partially visualized sphenoid sinuses are clear. This exam\nis not technically optimized for evaluation of the visualized intracranial\ncontents. There is calcified plaque in bilateral intracranial vertebral\narteries. There is mild calcified plaque at bilateral common carotid artery\nbifurcations, as well as in the visualized aortic arch and proximal great\nvessels. There is mild dependent atelectasis in the visualized upper lungs.", "output": "Multilevel degenerative disease appears similar to ___, within the\nlimits of CT resolution, as detailed above." }, { "input": "Minimal retrolisthesis L1-L2, similar. Advanced degenerative changes lumbar\nspine,. Egenerative disc disease, disc space narrowing at L1-L 2, L3-L4,\nL4-5, L5-S1 levels. Endplate hypertrophic changes. Lumbar facet arthritis. \nSpine stimulator in place. Prominent laterally directed osteophytes right\nL3-L4, L4-5 level. Degenerative changes bilateral sacroiliac joints.\n\nAt L1-L2 level central canal is patent. Moderate bilateral foraminal\nnarrowing, stable.\n\nAt L2-L3 level central canal is patent,, patent foramina.\n\nAt L3-L4 level there is mild central canal narrowing, similar. Moderate\nbilateral foraminal narrowing, similar. Interval worsening of degenerative\ndisc disease\n\nAt L4-5 level there is mild central canal narrowing. Severe right foraminal\nnarrowing, stable. Mild left foraminal narrowing.\n\nAt L5-S1 level there is patent central canal. Severe bilateral foraminal\nnarrowing, stable.\n\nPartially seen is right adrenal nodule, also present in ___, consistent with\nbenign adenoma. Benign simple cyst left kidney", "output": "1. Advanced degenerative changes lumbar spine, similar.\n2. Mild central canal narrowing.\n3. Multilevel significant foraminal narrowing, as above." }, { "input": "Numbering of the cervical spine is provided on series 602, image 44.\n\nSince the prior study performed on ___, there has been interval\nposterior spinal fusion with hardware extending from C3 through T1. C3\nthrough C7 laminectomies are also noted. There is no acute fracture or\nevidence of hardware loosening. There is 2 mm retrolisthesis of C4 on C5,\nwhich is new from the preoperative study. Approximately 2 mm anterolisthesis\nof C7 on T1 is not significantly changed.\n\nMultilevel degenerative changes with anterior/posterior osteophytes, mild loss\nof intervertebral disc space height and uncovertebral hypertrophy are most\npronounced at C5-C6 and C6-C7. There is also multilevel neural foraminal\nstenosis, most pronounced at C3-C4 bilaterally, C5-C6 bilaterally, and at\nC6-C7 on the left, findings which are better assessed on the prior dedicated\nMRI performed ___.\n\nThyroid is unremarkable. Imaged lung apices are clear.\n\nEvaluation of the soft tissues reveals overlying skin thickening and\nsubcutaneous fat stranding, consistent with postsurgical change.", "output": "Postsurgical changes from interval posterior fusion with hardware extending\nfrom C3 through T1. No acute fracture or hardware complication based on CT." }, { "input": "Alignment is normal. No fractures are identified.Multilevel disc osteophyte\ncomplexes. Posterior element degenerative changes most prominent at the left\nC7-T1 facet joint. Disc space narrowing C3-C4 and C5-C6. A combination of\ncongenitally narrow spinal canal, disc osteophyte complexes results in severe\nspinal canal narrowing, worst at C3-C4, better assessed on the cervical spine\nMRI obtained 2 days prior. Moderate to severe multilevel foraminal narrowing,\nworse at C3-C4 bilateral foramina, C5-C6 left foramen, and C6-C7 left foramen.\nIncidental note is made of an arcuate foramen on the right at C1. Incidental\npalatine tonsilliths.", "output": "Multilevel degenerative changes in the setting of congenitally narrow spinal\ncanal results in multilevel severe central canal, foraminal narrowing." }, { "input": "Alignment is normal. No fractures are identified. Vertebral body heights and\nintervertebral disc spaces are maintained without significant degenerative\nchanges. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling.\n\nThyroid gland is normal. Lung apices are clear. Incidental note is made of a\nright-sided tracheal diverticulum (02:59).", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is a burst fracture of the L1 vertebral body with approximately 7 mm of\nretropulsion of the posterosuperior margin of the vertebral body into the\nspinal canal. There is focal kyphosis at this level. The fracture extends\nthrough the lamina just to the right of the spinous process. There is a\nsagittal component to the burst fracture in the midline. The fracture\ninvolves the pedicles bilaterally, the left superior facet and the right\nsuperior facet. There is a transverse fracture extending through the T12\nspinous process. This spinous process fracture has sclerotic margins\nsuggesting that it is not acute. There is a vacuum phenomenon in the T12-L1\nintervertebral disc and in the L1 vertebral body. There is no subluxation or\nrotation at this level.\nNo other fractures are identified. There is calcification of the L5-S1\nintervertebral disc.\nAxial imaging from T10 through T12 demonstrates facet osteophyte formation and\nossification of the ligamentum flavum with no spinal canal or neural foraminal\nencroachment.\nAt L1, the retropulsed osseous fragment causes substantial spinal canal\nnarrowing. CT cannot determine the severity of spinal cord or cauda equina\ncompression.\nAt L1-2 there is no significant spinal canal or neural foraminal narrowing.\nAt L2-3, there is mild bulging of the disc without spinal canal or neural\nforaminal narrowing.\nAt L3-4, there is bulging of the disc that, along with ligamentum flavum\nthickening and facet osteophytes produces mild spinal canal narrowing.\nAt L4-5, there is a bulge of the disc that encroaches on the spinal canal and\nalong with facet osteophytes and ligamentum flavum thickening mildly narrows\nthe spinal canal.\nThere is a disc bulge at L5-S1 that contacts the traversing S1 nerve roots\nbilaterally, but there is no spinal canal compromise and the neural foramina\nappear normal.\nThere are mild degenerative changes of the sacroiliac joints bilaterally, more\nprominent on the left than right.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "1. Burst fracture of the L1 vertebral body with bone retropulsed into the\nspinal canal, sagittal fracture through the lamina and involvement of the\nsuperior facets bilaterally.\n2. Horizontal fracture through the T12 spinous process perhaps subacute.\n3. No prior imaging studies available for comparison. Thus, I cannot\ndetermine whether these changes have progressed since the prior examination.\n\nNOTIFICATION: The finding of an L1 burst fracture with substantial\nretropulsed bone a involvement of the posterior elements was discussed by\ntelephone by Dr. ___ with ___ of Neurosurgery at 1:50pm\n___, immediately upon reviewing the images. The patient has a follow\nup appointment with Dr. ___ 2:15 pm on the same day." }, { "input": "Mild anterolisthesis of L4 on L5 is chronic, likely degenerative in nature. \nNo acute traumatic malalignment.No fractures are identified.There are anterior\nposterior osteophytes throughout the cervical spine, most severe at C5-6 and\nC6-7. There is mild loss of disc heights at C5-6 and C6-7. Otherwise the\nvertebral body and disc heights are preserved. Uncovertebral and facet\nosteophytes cause mild right neural foraminal narrowing at C4-5 and mild left\nneural foraminal narrowing at C6-7. No spinal canal stenosis.There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. The thyroid and bilateral lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine, most severe at C5-6\nand C6-7 levels." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm. There is no soft tissue swelling. Severe emphysema is noted at\nbilateral lung apices.", "output": "1. No acute fracture or malalignment.\n2. No soft tissue swelling." }, { "input": "As on the MR study, the lumbar vertebrae are normal in height and alignment,\nand the normal lordosis is maintained. Allowing for technique, there is no\nabnormality of the paraspinal or limited included retroperitoneal soft\ntissues. As before the T12-L1 through L4-5 disc space height is maintained,\nwith only mild bulging at the L4-5 level, but no canal or foraminal stenosis.\n\nThere is degeneration of the L5-S1 disc with mild bulging, slightly eccentric\nto the left, which contacts and slightly deforms the traversing left S1 nerve\nroot sleeve in the subarticular zone, as before. There is also mild call\nneural foraminal narrowing, left more than right, but no definite exiting\nneural impingement, concordant with the previous study. Of note, there is no\nfinding to suggest spondylolysis at the L5 level.", "output": "1. L5-S1: Isolated disc degeneration with mild bulging, eccentric to the left,\nslightly displacing and deforming the traversing left S1 nerve root, as on the\nMR study of ___.\n\n2. No finding to suggest L5 spondylolysis." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Visualized intrathoracic and intra-abdominal structures are\nunremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. Schmorl's node at the\nsuperior endplate of L3 is noted. There is no evidence of spinal canal or\nneural foraminal stenosis. There is no prevertebral soft tissue\nswelling.Visualized intra-abdominal intrapelvic structures are unremarkable.", "output": "No acute fracture." }, { "input": "There is mild anterolisthesis of C3 on C4 and C4 on C5, most likely\ndegenerative in etiology. Alignment is otherwise unremarkable. No acute\nfractures are identified.Moderate degenerative changes are seen with\nintervertebral disc space narrowing, calcified discs, and small posterior disc\nbulges. Marked degenerative changes are also noted on the right at C1-2 with\nsubchondral sclerosis and cyst formation. Additionally, facet hypertrophy and\nuncovertebral spurring results in mild to moderate multilevel bilateral neural\nforaminal narrowing, worse at C4-5. No critical central canal stenosis is\nseen.There is no prevertebral edema.\n\nThere is minimal scarring at the lung apices. An 8 mm nodule is seen within\nthe left lobe of the thyroid, which does not meet the ACR criteria for\nfollow-up.", "output": "1. No fractures.\n2. Moderate cervical spondylosis with mild to moderate bilateral neural\nforaminal narrowing, worse at C4-5. Mild anterolisthesis of C3 on C4 and C4\non C5, most likely degenerative in etiology." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges are present with anterior and posterior bridging osteophytes, causing\nspinal canal narrowing at multiple levels. There is no evidence of infection\nor neoplasm. Respiratory motion limits assessment of the lung apices, however\nseptal thickening is consistent with pulmonary edema.", "output": "1. No acute fracture or traumatic malalignment. Multilevel degenerative\nchanges.\n2. Septal thickening in the lung apices is consistent with pulmonary edema." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges including anterior and posterior bridging osteophytes with partial\ncalcification of the anterior longitudinal ligament and posterior longitudinal\nligament causing mild multilevel spinal canal stenosis are unchanged from the\nprior study. The lung apices are clear. The thyroid is normal.", "output": "1. No acute fracture or malalignment.\n2. Stable appearance of multilevel degenerative changes." }, { "input": "Alignment is essentially anatomic. No fractures are identified. There is\npartial ossification of the anterior and posterior longitudinal ligaments. \nThere are multilevel, multifactorial degenerative changes of the cervical\nspine, worse at C2-3 where ossification of the posterior longitudinal ligament\ncauses mild to moderate canal narrowing. There is also mild to moderate canal\nnarrowing at C5-6 and C6-7 due to posterior longitudinal ligament\nossification. Moderate bilateral neural foraminal narrowing is most\npronounced at C5-6. There is no prevertebral soft tissue swelling. There is\nno evidence of infection or neoplasm.\nVisualized thyroid gland and lung apices are unremarkable.", "output": "1. No acute fracture or traumatic subluxation is identified.\n2. Multilevel moderate degenerative changes with up to moderate canal\nnarrowing at C2-3, C5-6, and C6-7." }, { "input": "Alignment is normal. No fractures are identified.\n\nThere is intervertebral disc space narrowing, osteophyte formation, and\nendplate irregularity at multiple levels of the cervical spine.\nAt C2-3 ossification posterior ligaments severely narrows the spinal canal and\nencroaches on the spinal cord. The neural foramina are mildly narrowed by\nuncovertebral and facet osteophytes.\nOssification of the posterior longitudinal ligament and continues along the\nposterior margin of the C3 vertebral body narrowing the spinal canal and\nindenting the spinal cord.\nAt C3-4, intervertebral osteophytes narrow the spinal canal and flatten the\nanterior surface of the spinal cord. Uncovertebral and facet osteophytes\nproduce bilateral neural foraminal narrowing.\nAt C4-5, intervertebral osteophytes and bulging of the disc mildly narrow the\nspinal canal and contact the spinal cord. There is severe narrowing of the\nright neural foramen due to uncovertebral and facet osteophytes.\nAt C 5 6 intervertebral osteophytes narrow the spinal canal prominently in the\nmidline and encroach on the spinal canal flattening the spinal cord. \nOssification of the posterior longitudinal ligament contributes to suggest\nsevere midline spinal canal narrowing. There is severe bilateral\nuncovertebral joint osteophyte formation and neural foraminal narrowing.\nOssification of the posterior longitudinal ligament continues along the\nposterior margin of the C6 vertebral body causing severe narrowing of the\nspinal canal. At the C6-7 level, ossification of the posterior longitudinal\nligament and intervertebral osteophytes severely narrow the spinal canal. The\nleft neural foramina is moderately narrowed on the right neural foramen\nseverely narrowed by uncovertebral osteophytes.\nOssification of the posterior longitudinal ligament posterior to the C7 body\nencroaches on the spinal canal.\nThe C7-T1 and included portions of the upper thoracic spine levels demonstrate\nno spinal canal or neural foraminal compromise.\nThere is no prevertebral edema. Vascular calcifications are noted. The\nthyroid appears heterogeneous.", "output": "1. No evidence of fracture or dislocation.\n2. Ossification of the posterior longitudinal ligament and severe degenerative\ndisc disease produce spinal canal and neural foraminal narrowing at multiple\nlevels." }, { "input": "There is no evidence of fracture or malalignment. There is no prevertebral\nsoft tissue swelling.\n\nNo significant degenerative changes are seen. The thyroid is normal. There is\nno cervical lymphadenopathy. The visualized apices of lungs are clear.", "output": "No acute cervical spine fractures identified." }, { "input": "Alignment is normal. No fractures are identified.There is no severe canal or\nforaminal narrowing.There is no prevertebral edema. The thyroid and included\nlung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "No fractures or malalignment. There are multilevel degenerative changes,\nincluding disc space narrowing, endplate sclerosis and osteophytosis. There is\nno critical canal narrowing.\n\nThere are endotracheal and enteric tubes. The enteric tube is partially\ncoiled in the pharynx. But traverses inferiorly off the field of view within\nthe esophagus.\n\nThyroid is unremarkable. Surgical clips seen at the inferior margin of the\nleft lobe of the thyroid. There is consolidation in the bilateral lung\napices. Some areas of calcification posteriorly suggest scarring. Please see\nseparately dictated CT chest for further evaluation.", "output": "No fracture or malalignment." }, { "input": "No acute cervical spine fracture is identified. There is no prevertebral soft\ntissue swelling. Severe, multilevel degenerative changes are again noted\nthroughout the cervical spine, with loss of disc height and facet and\nuncovertebral joint hypertrophy, most severe at C4 through C6 levels, with\nassociated bilateral neural foraminal narrowing. Moderate to severe central\ncanal narrowing is also most pronounced at C4-5 and C5-6. Spondylolisthesis at\nmultiple levels is unchanged, including mild retrolisthesis of C4 on C5, C5 on\nC6, and C6 on C7 an mild anterolisthesis of C7 on T1. There is no evidence of\nosseous infection or neoplasm. A tiny 3 mm left apical ground glass nodule is\nincidentally noted. Heterogeneity of the thyroid gland is re- demonstrated.", "output": "1. No cervical spine fracture or traumatic malalignment.\n2. Severe multilevel degenerative changes with moderate to severe central\ncanal narrowing at C4-5 and C5-6. This places the patient at increased risk\nfor spinal cord injury with minimal trauma, and if there are neurologic\nsymptoms referable to these levels, an MRI can be obtained for further\nassessment.\n3. Tiny 3 mm left apical ground glass pulmonary nodule, for which no follow up\nimaging is necessary in the absence of risk factors for malignancy such as\nsmoking. If such risk factors exist, follow up CT could be obtained in ___\nyear." }, { "input": "There is no evidence of cervical spine fracture. There is no prevertebral\nsoft tissue swelling. Moderate multilevel degenerative changes are present\nmost pronounced at C4/5 and C5/6. There is minimal anterior joint space\nwidening at C5/6 with maintained facet alignment, this is likely degenerative\nin nature. Mild anterolisthesis of C7/ T1, also likely degenerative. There\nis no evidence of critical spinal canal or neural foraminal narrowing. There\nis no evidence of infection or neoplasm. Known left humeral fracture\npartially imaged on scout view. The lung apices are clear. The thyroid is\nunremarkable.", "output": "1. No evidence of cervical spine fracture.\n2. Moderate multilevel degenerative changes.\n3. Partially image left humeral fracture." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling\n\nPartially imaged is a 4.5 x 2.8 cm low-density lesion to the cerebellum on the\nleft measuring simple fluid density, likely chronic.\n\nThe thyroid is unremarkable. Bilateral lung apices are notable for probable\nscarring in the right lung apex.", "output": "No acute fracture or traumatic malalignment.\nLow-density, cystic structure in the posterior fossa on the left, incompletely\nimaged." }, { "input": "Alignment is preserved. There is a mildly displaced fracture through the\nanterior superior endplate of the L1 vertebral body. There is no\nretropulsion. There is trace prevertebral hematoma (series 3, image 122). \nLucencies through the posterior inferior endplate of the L2 vertebral body\n(series 602, image 49) appear chronic. No retropulsion is demonstrated.\n\nA lucency through the anterior aspect of the T12 vertebral body likely\nrepresents a fractured osteophyte. There is mild surrounding stranding and a\npossible trace component of prevertebral edema (series 3, image 114).\n\nThere is diffuse osteopenia with multilevel degenerative change throughout the\nlumbar spine. There is irregularity seen at the left superior articular\nsurface the T11 pars articularis (series 2, image 91), however this appears\nchronic. Degenerative changes including posterior osteophytes and thickening\nof the ligamentum flavum result in up to moderate canal narrowing at L2-3\nthrough L4-5.\n\nThere is focal ectasia of the infrarenal abdominal aorta just above the\nbifurcation measuring up to 2.9 cm. There is diffuse atherosclerosis\nthroughout the visualized aorta. Moderate bilateral foraminal narrowing seen\nbilaterally at L3-4 through L5-S1 and on the left at L2-3.\n\nSubcentimeter left thyroid nodule is noted. Visualized lungs are clear. The\nvisualized airway is patent. No large pleural effusion. Intra-abdominal\nimages demonstrate partial visualization of a prior cholecystectomy. \nCalcifications in renal pelves are likely vascular. There are prominent\nbilateral peripelvic cysts. The bladder is substantially distended. There is\nno evidence of bowel obstruction.", "output": "1. Compression fracture of the L1 vertebral body without retropulsion. There\nis mild prevertebral edema and a trace component of hematoma.\n2. There is extension of the fracture into an anterior osteophyte off of the\ninferior endplate of T12. No additional fracture plane is demonstrated\nthrough the T12 vertebral body.\n3. No high level spinal canal narrowing within the limits of modality. \nMultilevel moderate canal narrowing in the lumbar spine below the level of the\nfracture.\n4. Focal abdominal ectasia of the heavily calcified abdominal aorta just above\nthe bifurcation measuring up to 2.9 cm." }, { "input": "The exam remain slightly motion limited even though some of the images were\nrepeated.\n\nThere is no evidence for a fracture or prevertebral edema. 3 mm\nanterolisthesis of C6 on C7 is present, without disc space widening or\nsplaying of the spinous processes. To the contrary, there is severe disc\nspace narrowing at this level, as well as at C4-5 and C5-6. At C3-4, there is\na large disc osteophyte complex indenting the ventral spinal cord. Smaller\ndisc osteophyte complexes indent the ventral spinal cord at C4-5, C5-6, and\nC6-7. There is multilevel neural foraminal narrowing by uncovertebral and\nfacet osteophytes.\n\nThis exam is not technically optimized for evaluation of the partially\nvisualized intracranial contents.\n\nVisualized lung apices are clear. Just caudal to the thoracic inlet, there is\nan indeterminate soft tissue density contiguous with the right lateral wall of\nthe esophagus, which indents the left posterior trachea. On image 3:57, it\ncan be measured separately from the esophageal lumen, and it measures 1.7 x\n1.7 cm. It appears slightly larger on slightly more cranial images, but there\nthe esophagus is collapsed, and the lesion cannot be measured separately from\nthe esophagus.", "output": "1. Motion limited exam without evidence for a fracture.\n2. 3 mm anterolisthesis of C6 on C7, chronicity indeterminate in the absence\nof prior studies, but most likely degenerative.\n3. Incompletely characterized soft tissue lesion contiguous with the right\ndysphagia wall just caudal to the thoracic inlet, indenting the left posterior\ntrachea. Diagnostic considerations include a duplication cyst or a\nmesenchymal neoplasm.\n\nRECOMMENDATION(S): If the right upper paraesophageal lesion, has not been\nworked up previously, then gastroenterology and/ or thoracic surgery\nconsultation could be considered, if clinically warranted. Contrast enhanced\nneck CT performed with the patient drinking water or radiopaque contrast, or\nneck MRI, could potentially be helpful if desired by a consulting specialist. \nA barium esophagram could be considered, but this lesion appears extraluminal." }, { "input": "Mild anterolisthesis of C4 on C5, C5 on C6, and C6 on C7 is likely\ndegenerative, however there are no priors for comparison. No fractures are\nidentified. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nDegenerative disc disease throughout the cervical spine, most severe at C5-6. \nSmall posterior intervertebral osteophytes, but no high-grade spinal canal\nstenosis. There is also multilevel moderate neural foraminal stenosis due to\nuncovertebral and facet osteophytes.\n\nThe lung apices are clear. No cervical lymphadenopathy. No thyroid nodules.", "output": "1. Mild anterolisthesis of C4 on C5, C5 on C6, and C6 on C7 is likely\ndegenerative, however there are no priors for comparison.\n2. No evidence of fracture. No prevertebral soft tissue swelling.\n3. Multilevel multifactorial degenerative changes, as described above." }, { "input": "There is no acute fracture or traumatic malalignment.There is no high-grade\nspinal canal or neural foraminal narrowing.There is no prevertebral edema. \nRe-identified is asymmetric widening of the left occipitomastoid suture, felt\nlikely to be congenital rather than traumatic diastasis as there is no\nassociated soft tissue hematoma or stranding.\n\nThe thyroid and included lung apices are unremarkable. No cervical\nlymphadenopathy by size criteria. The visualized aerodigestive tract is\nunremarkable, noting left retropharyngeal course of the internal carotid\nartery.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Re-identified is symmetric widening of the left occipitomastoid suture,\nfelt likely to be congenital rather than traumatic diastasis as there is no\nassociated soft tissue hematoma or stranding. Clinical correlation is\nrecommended." }, { "input": "Postoperative changes with anterior fusion of the C4-C6 vertebral bodies with\nexpected prevertebral swelling and subcutaneous emphysema. There is no\nevidence of hardware failure, fracture or loosening.\n\nAlignment is maintained.No acute fractures are identified. Multilevel\nmoderate degenerative changes are seen throughout the cervical and visualized\nportions of the thoracic spine. Multilevel intervertebral osteophytes are\nseen at the C4-C5, C5-C6, and C6-C7 vertebral levels with mild indentation of\nthecal sac.", "output": "1. Postoperative changes with anterior fusion of the C4 through C6 vertebral\nbodies with expected prevertebral swelling and subcutaneous emphysema.\n\n2. No evidence of hardware failure, fracture, or loosening." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. Multilevel, multifactorial degenerative\nchanges are identified with endplate osteophyte formation and disc space\nnarrowing. There is degenerative disc disease at C4-C5 causing mild\nindentation on the ventral thecal sac. Uncovertebral and facet hypertrophy\nare noted at multiple levels causing moderate right neural foraminal narrowing\nat C4-C5. Incidental note is made of a retropharyngeal course of the right\ninternal carotid artery.\n\nThe thyroid gland is unremarkable. The included lung apices are clear. The\nesophagus appears patulous. There is no cervical lymphadenopathy. Fluid is\nnoted in the right mastoid tip.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel, multifactorial degenerative changes as described above, worst\nat C4-C5." }, { "input": "Alignment is normal. No fracture or traumatic malalignment are identified.\nThere is no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.Multiple prominent, morphologically normal\ncervical lymph nodes are seen. No pathologically enlarged lymph nodes are\nseen. Partially imaged upper lung apices are grossly clear.", "output": "1. No acute fracture or traumatic malalignment." }, { "input": "There is no acute fracture or dislocation. There is mild reversal of the\nnormal cervical lordosis. There is no prevertebral soft tissue swelling. \nLimited, non-contrast appearance of the included soft tissues is unremarkable.\nMinimal degenerative change is seen at C5/C6.", "output": "No acute fracture or dislocation seen." }, { "input": "There is no acute fracture or dislocation in the cervical spine. Mild to\nmoderate degenerative changes of the cervical spine, with facet joint\nhypertrophy and uncovertebral joint osteophytosis. Multilevel posterior\nosteophytes and smaller anterior osteophytes are seen. Mild central canal\nnarrowing is seen at C5/C6 due to posterior disc osteophytes. No prevertebral\nedema.\n\nThyroid gland appears homogeneous. There is no cervical lymphadenopathy.", "output": "No acute fracture or dislocation of the cervical spine. Mild to moderate\ndegenerative changes, as described above, including mild central canal\nnarrowing at C5/C6 due to posterior disc osteophyte." }, { "input": "Mild loss of the cervical lordosis.No fractures are identified. Mild\ndegenerative demineralization. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.", "output": "No fractures or malalignment a sequela of trauma." }, { "input": "Minimal anterolisthesis of C4 on C5 is likely degenerative. Moderate to\nsevere degenerative changes from C5-C7 include loss of intervertebral disc\nspace, subchondral sclerosis, subchondral cyst formation, and osteophyte\nformation. There is no critical spinal canal or neural foraminal stenosis. No\nfractures are identified. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.", "output": "1. No fracture.\n2. Minimal anterolisthesis of C4 on C5, likely degenerative.\n3. Moderate to severe multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Prominent bilateral\ncervical lymph nodes are nonspecific, likely reactive.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "There is fracture of C1 vertebra identified with corticated margins indicative\nof healing. No definite cleft identified in the anterior arch of C1. Mild\noverlapping of both lateral masses of C1 on C2 identified. The prevertebral\nsoft tissue thickness is normal. There is normal vertebral body alignment\nseen. The occipital C1 relationship is maintained. The facet joints show\nnormal alignment.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Findings indicative of healing at the C1 fracture. No significant spinal\nstenosis at craniocervical junction." }, { "input": "No acute fracture is identified. Moderate, multilevel degenerative changes of\nthe visualized cervical spine, with disc height loss, disc bulge,\nuncovertebral osteophytosis, subchondral cystic change, endplate sclerosis and\nosteophyte formation, most notable at C6-C7. Disc bulge and posterior\nosteophyte at C5-C6 result in mild spinal canal narrowing. There is mild\nbilateral neural foraminal narrowing at C5-C6 and C6-C7 levels. There is no\nprevertebral edema.\n\nNo concerning thyroid nodules identified. No cervical lymphadenopathy by CT\nsize criteria. Mild atherosclerotic calcification of the carotid arteries\nbilaterally. Lung apices are remarkable for moderate centrilobular and\nparaseptal emphysema, as well as mild right apical fibrosis. Bilateral\ntonsilliths are incidentally noted.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Moderate, multilevel degenerative changes, as described above. Disc bulge\nand posterior osteophytes at C5-C6 result in mild spinal canal narrowing at\nthat level. Mild bilateral neuroforaminal narrowing at C5-C6 and C6-C7." }, { "input": "No acute fracture identified. Alignment is anatomic. Patient is status post\nleft L5 hemilaminectomy. Moderate, multilevel degenerative changes of the\nlumbar spine, with disc height loss, disc bulge, vacuum disc phenomenon, facet\njoint hypertrophy, and osteophyte formation, most notable at L4-L5. Disc\nbulge at L4-L5 results in mild spinal canal narrowing at this level and\nmoderate-to-severe left neural foraminal stenosis, better assessed on prior MR\n___ from ___. Left L5 spondylolysis.\n\nIll-defined sclerotic focus within the inferior right ilium (601:42) stable\nsince the prior study from ___ and may represent a bone island..\n\nMultiple hypoattenuating lesions are noted within the partially visualized\nbilateral kidneys, the largest within the right upper pole, better assessed on\nprior MR ___, consistent with simple renal cysts. Multiple punctate\ncalculi within the left renal pelvis, better assessed on prior CTU from ___, consistent with nonobstructing stones.\n\nModerate-to-severe atherosclerotic calcification of the abdominal aorta. Mild\naneurysmal dilatation of the bilateral common iliac arteries. Chronic\ndissection of the distal abdominal aorta with moderate intimal calcification\nis unchanged.", "output": "1. No acute fracture or traumatic malalignment of lumbar spine.\n2. Moderate, multilevel degenerative changes, as described above and better\nassessed on prior MR ___.\n3. Multiple bilateral renal hypoattenuating lesions are partially visualized,\nthe largest arising from the right upper pole, better assessed on prior MR\n___, consistent with simple renal cysts.\n4. Multiple nonobstructing left renal stones, better assessed on prior CTU.\n5. Mild aneurysmal dilatation of the bilateral common iliac arteries. \nUnchanged focal chronic dissection of the distal abdominal aorta." }, { "input": "No definite acute fracture is identified.Alignment is normal. No prevertebral\nsoft tissue swelling is present.\n\nMultilevel moderate degenerative changes are seen in the cervical spine, worse\nat C4-C5, where there is intervertebral disc space height loss, anterior and\nposterior osteophyte formation, endplate sclerosis, and uncovertebral\nhypertrophy. A moderate sized disc bulge at C3-4 results in moderate central\ncanal narrowing. Mild narrowing of the spinal canal and the bilateral neural\nforamina, worse on the right than on the left, is present at multiple levels,\nmost pronounced at C4-5. Sclerosis, likely degenerative, is noted at the\ntip of the dens.\n\nThe imaged thyroid gland and visualized lung apices are unremarkable.", "output": "Moderate spondylosis without acute fracture or subluxation." }, { "input": "Partial sacralization of the L5 vertebral body. There is minimal grade 1\nanterolisthesis of L3 on L4 and L4 on L5, likely degenerative in etiology. No\ndefinite fractures are identified. Minimal apparent anterior compression\ndeformity of the superior endplate of the L5 vertebra is likely degenerative. \nSpinal canal narrowing is worst and moderate at the L3-4 level due to\ncircumferential disc bulge and facet hypertrophy. There is no gross neural\nforaminal stenosis. There is no prevertebral soft tissue swelling. There is\nno evidence of infection or neoplasm. There is mild to moderate\natherosclerotic calcifications of of the aorta and iliac arteries. Minimal\nnodularity of the left adrenal, unchanged.", "output": "1. No acute fracture.\n2. Mild-to-moderate lumbar spondylosis. Age-indeterminate minimal\nanterolisthesis of L3 on L4 and L4 on L5, likely degenerative in etiology.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "There is no evidence of fracture or traumatic malalignment. No prevertebral\nsoft tissue abnormality is detected. Intervertebral discs heights are grossly\nmaintained. The lung apices are clear.", "output": "No evidence of fracture or traumatic malalignment." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. Mild degenerative changes of the cervical\nspine are noted, most prominent at C5-C6. There is mild right neural\nforaminal narrowing at this level secondary to uncovertebral hypertrophy. A\nright paracentral posterior disc protrusion is also noted at this level\ncausing mild spinal canal stenosis.\n\nAgain seen is a 3.5 x 2.5 cm soft tissue mass is again identified inferior to\nthe lower pole of the left thyroid gland. Just superiorly there is a second\n1.6 x 1.1 cm nodule. These are grossly unchanged since ___ and may represent\nenlarged lymph nodes or parathyroid lesions. The included lung apices are\nclear.", "output": "1. No acute fracture or traumatic malalignment.\n2. 3.5 and 1.6 cm soft tissue nodules inferior to the left lobe of the\nthyroid, unchanged since prior study. These may represent enlarged lymph\nnodes or parathyroid lesions. Correlation with parathyroid hormone and\nnon-emergent ultrasound is recommended for further evaluation if not\npreviously performed.\n\nRECOMMENDATION(S): Non emergent neck ultrasound is recommended." }, { "input": "Alignment is normal. No cervical spine fractures are identified.There is no\nsignificant canal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.\n\nNondisplaced left posterior second rib fracture is noted.", "output": "No cervical spine fracture or malalignment.\nAcute nondisplaced left posterior second rib fracture." }, { "input": "Alignment is normal. No fractures are identified.Moderate multilevel\ndegenerative changes with intervertebral disc space narrowing, endplate\nsclerosis and irregularity, anterior and posterior osteophyte formation are\nmost pronounced at C5-6 and C6-7. Mild central canal narrowing is also noted\nat C5-6 and C6-7 due to the presence of the posterior osteophytes. Moderate\nneural foraminal narrowing due to uncovertebral spurring is most severe\nbilaterally at C5-6.There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nImaged thyroid gland is unremarkable. Lung apices are clear.", "output": "1. No acute fracture or malalignment.\n2. Moderate cervical spondylosis." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Mild degenerative\nchanges are noted in the cervical spine spanning C3 through T1 with mild loss\nof disc space and small endplate osteophytes. No prevertebral edema. The\naerodigestive tract appears patent. Lung apices are clear. Thyroid gland\nappears normal. Endotracheal and nasogastric tubes in place.", "output": "No fracture or malalignment." }, { "input": "Mild anterolisthesis of C3 on C4, and retrolisthesis of C5 on C6, similar in\nappearance to radiographs of the C-spine from ___. No acute\nfractures are identified. There are moderate to severe degenerative changes\nof the cervical spine including loss of intervertebral disc height, anterior\nand posterior osteophyte formation, endplate irregularity, and intervertebral\ndisc vacuum phenomenon, most severe at the C4 to the C6 level, and resulting\nin up to moderate spinal canal stenosis worst at the C4-C5 level. Mild\nbilateral neural foraminal narrowing is most pronounced at C5-6. There is no\nhigh-grade foraminal narrowing. No prevertebral edema.\n\nA sclerotic focus is seen in the right lateral mass of C2 is noted.\n\nThe thyroid contains a 1.2 cm hypodense nodule. The included lung apices are\ngrossly unremarkable.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n2. Moderate to severe cervical spondylosis with unchanged C3 on C4\nanterolisthesis and C5 on C6 retrolisthesis.\n3. Sclerotic focus in the right lateral mass likely represents a bone island,\nhowever please correlate with any history of malignancy consider bone scan for\nfurther assessment.\n4. 1.2 cm thyroid nodule is incidentally noted, but does not require dedicated\nimaging follow-up per ACR criteria.\n\nRECOMMENDATION(S): Absent suspicious imaging features, unless there is\nadditional clinical concern, ___ College of Radiology guidelines do not\nrecommend further evaluation for incidental thyroid nodules less than 1.0 cm\nin patients under age ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Diffuse osteopenia and extensive multilevel degenerative changes of the imaged\nspine with significant loss of intervertebral disc height throughout the\nthoracic spine and also noted in the imaged cervical spine at C5-C6 and C6-C7.\nSignificant kyphosis is demonstrated, which appears slightly increased\ncompared to the prior chest CT, associated with chronic compression fractures\ninvolving the vertebral bodies of T5 and T7, where there is high-density\nmaterial consistent with prior kyphoplasty.\nThe complex segment within T5 extends posteriorly along the left pedicle,\nsimilar to the CT from ___.\nLoss of vertebral body heights are also noted at T8, T9, T10, and T12, similar\nto the prior study. Compared to the reference study from ___ there\nis slight decrease in height of the T4 vertebral body associated with mild\nendplate sclerosis, probably reflecting a compression deformity of unknown\nchronicity.\nMild spinal canal narrowing associated the compression at T7 is noted.\nNo severe neural foraminal narrowing is noted, within the limitations of the\nstudy.\nThere is no prevertebral soft tissue swelling. A moderate hiatal hernia is\nnoted.", "output": "1. Slight decrease in height of the T4 vertebral body associated with mild\nendplate sclerosis, probably reflecting a compression deformity of unknown\nchronicity but new since ___. If concern for ligamentous injury, MR\nmay be considered.\n2. Diffuse osteopenia with extensive multilevel degenerative changes, chronic\ncompression deformities of several vertebral bodies, and sequela of\nkyphoplasties at T5 and T7." }, { "input": "Patient positioning and dental amalgam streak artifact limits study.\n\nGrade 1 anterolisthesis of C3 on C4 is unchanged and likely degenerative. \nVertebral body heights are preserved. The visualized osseous structures are\nosteopenic. No definite acute fractures are identified. Nonspecific cystic\nchanges are again noted within the dens, progressed compared to ___ prior\ncervical spine CT, and allowing for differences in technique, grossly similar\nto ___ prior cervical spine MRI.\n\nThere are extensive degenerative changes, most pronounced at the\ncraniocervical junction and at C5-6 and C6-7 where there is loss of\nintervertebral disc space height, endplate sclerosis, subchondral cystic\nchange and anterior posterior osteophytes. Multilevel moderate to severe\ncanal and neural foraminal narrowing is better appreciated on the previous MRI\n___ dated ___.\n\nThere is no prevertebral soft tissue swelling.\n\nLimited imaging of the lungs suggest emphysematous changes.", "output": "1. Patient positioning, dental amalgam streak artifact and diffuse osteopenia\nlimits study.\n2. Within limits of study, no definite acute fracture or traumatic\nmalalignment.\n3. Patient's known severe vertebral canal narrowing at C3-4 increases risk of\ntraumatic cord injury at this level. If concern for spinal cord or\nligamentous injury, consider cervical spine MRI for further evaluation.\n4. Grossly stable extensive multilevel degenerative changes with unchanged\ngrade 1 anterolisthesis of C3 on C4, better demonstrated on ___ MRI dated\n___.\n5. Allowing for difference in technique, grossly stable nonspecific cystic\nchanges of dens. While findings may be degenerative in nature, myelomatous\nlesion is not excluded on the basis of this examination." }, { "input": "Evaluation is markedly limited due to patient positioning.\n\nAllowing for this, alignment is preserved. Mild anterolisthesis of C3 on C4\nis stable, likely degenerative. Diffuse osteopenia is again seen. Vertebral\nbody heights are preserved. No definite acute fracture. Nonspecific cystic\nchanges are again seen within the dens, overall similar to the prior CT, but\nprogressed since ___. There is a corticated lucency extending from the\ncystic region anteriorly to the cortex, similar to prior.\n\nExtensive degenerative changes, most pronounced at the craniocervical\njunction, and at C5-6 and C6-7 appear overall similar and were better\ndescribed on the prior CT. Allowing for patient positioning and comparison\nusing sagittal images, multilevel moderate to severe canal and neural\nforaminal narrowing appears grossly similar and was better appreciated on the\nMRI from ___. No definite prevertebral soft tissue swelling is seen.\nEmphysematous changes are again seen in the bilateral lung apices.", "output": "1. Limited study due to diffuse osteopenia and patient positioning. Within\nthis limitation, no definite acute fracture or traumatic malalignment.\n2. Known severe vertebral canal narrowing at C3-4 appears grossly similar on\nsagittal images, but is not well assessed on axial images due to positioning.\n3. Grossly stable extensive multilevel degenerative changes with stable mild\nanterolisthesis of C3 on C4.\n4. Nonspecific cystic change of the dens appears grossly similar. While this\nmay be degenerative in nature, myelomatous lesion still cannot be excluded, as\nwith prior." }, { "input": "No acute cervical spine fracture is identified. There are multilevel,\nmultifactorial degenerative changes, most severe at the C5-C6 level with disc\nspace narrowing, vertebral body osteophytes, and subchondral sclerosis. There\nis also grade 1 anterolisthesis of C4 on C5, which appears unchanged compared\nto prior study. There is also uncovertebral and facet hypertrophy resulting in\nmoderate right neural foraminal narrowing at C3-C4 and moderate left neural\nforaminal narrowing at C4-C5 and C5-C6.\n\nThere is asymmetric enlargement of the left thyroid gland with a 3.1 x 4.4 cm\nhypodense lesion with calcification arising from the lower pole. Another 1.3 x\n1.0 cm hypodense lesion is also identified in the left mid thyroid. Another\nnodule with calcifications is also seen within the right thyroid measuring\napproximately 1.4 cm. There is no cervical lymphadenopathy. The visualized\nlung apices are clear.", "output": "1. No evidence of fracture or traumatic malalignment. Multilevel degenerative\nchanges as described above.\n\n2. Multiple thyroid nodules identified with the largest measuring 3.1 x 4.4\ncm in the left lower pole. A non-emergent thyroid ultrasound may be obtained\nfor further evaluation if clinically indicated." }, { "input": "This study is slightly degraded by patient motion artifact. Alignment is\nnormal. There is no thickening of the prevertebral soft tissues. No fractures\nare identified. Multilevel, multifactorial degenerative changes are again\nseen, most severe at the level of C5-6, where there is disc space narrowing,\nvertebral body osteophytosis, and subchondral sclerosis.\nThere is asymmetric enlargement of the left lobe of the thyroid gland, with\nmultiple thyroid nodules identified. The largest of which measures 3.2 x 4.1\ncm, appears hypodense, with some calcifications, and is located in the lower\nlobe of the thyroid gland. The lung apices are clear.", "output": "1. No the evidence of fracture or malalignment.\n\n2. Multiple stable appearing thyroid nodules." }, { "input": "Alignment is normal.There is mild loss of vertebral body height at L5, chronic\nin appearance, with no fracture identified. There are mild multilevel\ndegenerative changes in the lumbar spine were Schmorl's nodes at the L2 and L3\nlevels. A posterior disc bulge at the level of L4-L5 causes moderate canal\nstenosis (602b:45, 2:70). Additional posterior disc bulge at L5-S1 causes\nmild canal narrowing. There is no neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nLimited views of the abdomen show a 1.3 x 0.9 cm simple left renal cyst.", "output": "1. Mild loss of vertebral body height at L5, chronic in appearance, with no\nacute fracture.\n2. Posterior disc bulge at L4-L5 causes moderate canal stenosis.\n3. Posterior disc bulge at L5-S1 causes mild canal narrowing." }, { "input": "Alignment of the cervical vertebral bodies is normal without subluxation. No\nfractures are identified. There is no evidence of spinal canal or neural\nforaminal narrowing. No prevertebral soft tissue swelling is present. The\nvisualized soft tissues are unremarkable. Visualized lung apices are clear.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Severe fragmentation and arthritis at the right TMJ is noted. Partially\nvisualized opacification of the left sphenoid sinus noted. There is no\nfracture or malalignment in the cervical spine. No prevertebral edema. Lung\napices are clear. A right thyroid nodule is present measuring up to 1.4 cm in\ndiameter. No lymphadenopathy. Degenerative disc disease from C4 through C7\nnoted with mild to moderate loss of disc space.", "output": "1. No cervical spine fracture or malalignment.\n2. Degenerative disc disease from C4 through C7, mild to moderate.\n3. Severe right TMJ arthritis.\n4. Right thyroid nodule measuring 1.4 cm for which nonemergent ultrasound is\nrecommended to further assess." }, { "input": "No acute fracture or malalignment is identified. There is no prevertebral\nsoft tissue swelling. There is mild intervertebral disc height loss at C4-5\nand C5-C6 which are also notable for uncovertebral joint hypertrophy and small\ndisc protrusions which partially efface the ventral CSF.\n\nThere is a 6 mm hypodensity in the right lobe of the thyroid. Thyroid is\notherwise unremarkable.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality of\nthe cervical spine." }, { "input": "No acute fracture or alignment abnormality is seen within the cervical spine. \nThere is anterior cervical fusion spanning C4 through C6 with anterior plate\nand vertebral body screws at C4 and C6. No signs of hardware failure. No\nprevertebral edema. Multilevel degenerative changes including facet and disc\ndisease noted with prominent disc osteophyte complex noted posteriorly at C3-4\nlevel. Neural foraminal stenosis due to uncovertebral and facet joint\nhypertrophic changes is pronounced at C3-4 bilaterally. The base of the dens\nis intact. At the lung apices, emphysema is present. Thyroid gland is\nunremarkable.", "output": "No acute fracture or traumatic alignment abnormality. Postsurgical changes\nwith anterior spinal fusion at C4 through C6. Degenerative changes as stated." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. Only mild spurring is seen within the mid cervical\nspine with mild loss of disc space at C5-6 level. There is nuchal ligament\ncalcification noted. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. Thyroid gland appears normal.", "output": "No fracture or malalignment. Mild degenerative changes as stated." }, { "input": "Evaluation is slightly limited by motion in the lower cervical spine. \nAlignment is normal. No fractures are identified. Multilevel moderate\ndegenerative changes and congenitally short pedicles cause multilevel\nmild-to-moderate canal stenosis, most pronounced at C3-C4 due to a posterior\nosteophyte. Mild multilevel bilateral neural foraminal stenosis is most\npronounced at C3-4 and C5-6. Assessment for prevertebral soft tissue swelling\nis limited by motion though known is definitively seen.\n\nVisualized thyroid gland is unremarkable. Ground-glass opacification in the\nlung apices may be due to motion.", "output": "1. No fracture or traumatic malalignment identified on moderately motion\nlimited examination.\n2. Multilevel spinal canal narrowing with moderate canal narrowing at C3-C4." }, { "input": "No fractures are identified. Alignment is normal. There is no prevertebral\nedema.\n\nThere is disc space narrowing, uncovertebral and posterior osteophytes which\nis most severe at the C4-C5 through C6-C7 levels and mild canal space\nnarrowing which is most prominent at the level of the C5 vertebral body. \nThere is focal ossification of the posterior longitudinal ligament at the\nlevel of C5-C6 and severe narrowing of the left neural foramen at C5-C6.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Degenerative changes without fracture or subluxation." }, { "input": "Alignment is normal.No acute fracture is seen.Mild degenerative changes\ninclude disc space narrowing at C6/C7 where there are also small anterior\nposterior osteophytes and slight endplate degenerative irregularity.There is\nno prevertebral soft tissue swelling.Partially imaged endotracheal and enteric\ntubes are seen, with associated fluid/aerosolized secretions in the\nnasopharynx. Thyroid gland is grossly homogeneous. The partially imaged lung\napices demonstrate paraseptal pulmonary emphysema.", "output": "1. No acute fracture or dislocation of the cervical spine.\n2. Partially imaged lung apices demonstrate paraseptal emphysema." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes are\nnotable for intervertebral disc height loss spanning C4-5 through C6-7 with\nassociated posterior osteophytes. There is ossification of posterior\nlongitudinal ligament spanning C5-6 through C6-7 resulting in mild-to-moderate\ncanal narrowing. Uncovertebral joint osteophytes contribute to moderate\nsevere foraminal narrowing, left worse than the right at C4-5, on the right at\nC5-6 is.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. A 1.9 cm sebaceous\ncyst is seen posteriorly at the lower neck on the right.", "output": "Degenerative changes without cervical spine fracture or malalignment." }, { "input": "Very minimal anterolisthesis of C4 over C5 is of indeterminate age, but may be\ndegenerative.No acute fractures are identified.Anterior and posterior\nosteophytes are seen from C5-C7. The vertebral body heights are preserved. \nThere is mild loss of disc heights at C5-6 and C6-7 and C7/T1.. No high-grade\nspinal canal stenosis. Uncovertebral facet osteophytes cause mild right\nneural foraminal narrowing at C3-4, mild left neural foraminal narrowing at\nC4-5, mild left and moderate right neural foraminal narrowing at C5-6, and\nmild right neural foraminal narrowing at C6-7. is chronic nonunion of the\nposterior arch of C1. There is no prevertebral soft tissue swelling.The\nthyroid is unremarkable. The visualized bilateral lung apices are\nunremarkable.", "output": "1. No acute fracture. Very minimal anterolisthesis of C4 over C5 is of\nindeterminate age, but may be degenerative.\n2. Multilevel degenerative changes of the cervical spine as described in the\nbody of the report." }, { "input": "Alignment is normal. No fractures are identified. Note is made of congenital\nlack of fusion of the posterior elements of C1. Degenerative changes are\nnoted with disc height loss at C5-6 and C6-7. Associated uncovertebral joint\nosteophytes seen at C6-C7. There is a disc protrusion at the C3-C4 which\ncontacts and flattens the ventral aspect of the cord. There is no critical\ncanal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment.\nDegenerative changes including disc protrusion at C3-C4 which contacts and\nremodels the ventral aspect of the cord." }, { "input": "Alignment is normal. No fractures are identified. There is no critical spinal\ncanal stenosis. There is no prevertebral soft tissue swelling.", "output": "No fracture." }, { "input": "There is no acute fracture or malalignment. Intervertebral disc height loss\nis noted at L4-5 and L5-S1 with significant sclerosis of the adjacent\nendplates which is new since ___. Right L4 hemilaminotomy is also new since\nprior. Moderate to severe bilateral foraminal narrowing is seen at L5-S1 as\nwas seen on prior MR.\n\n___ paraspinal retroperitoneal soft tissues are unremarkable.", "output": "Degenerative changes without acute fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling.\n\nMultilevel degenerative changes including intervertebral disc height loss and\nposterior osteophyte formation are seen. These changes are most extensive at\nC4-C5 where there is mild to moderate canal narrowing. Facet joint\nhypertrophy is sternal is worse on the left most severe at C2-3 and C5-6. \nModerate to severe left foraminal narrowing is noted at C4-5.\n\nThere is deformity of the proximal left humerus based on the scout view which\nis apparently chronic but not particularly well assessed.\n\nThere is a 1.7 cm cc right thyroid nodule. Lung apices are clear. \nAtherosclerotic calcifications are noted at the carotid bulbs.", "output": "1. Degenerative changes without acute fracture or malalignment.\n2. 1.7 cm right thyroid nodule.\n\nRECOMMENDATION(S): Dedicated thyroid ultrasound suggested on a nonurgent\nbasis." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. Multilevel, multifactorial degenerative\nchanges are noted with disc space narrowing, subchondral sclerosis, and\nmarginal osteophyte formation. There is also uncovertebral and facet\nhypertrophy causing mild bilateral neural foraminal narrowing at C4-C5 and\nC5-C7.\n\nThe thyroid gland is massively enlarged with a dominant heterogeneous lesion\nmeasuring 3.4 x 3.1 cm in the left lobe. There is no cervical\nlymphadenopathy. Visualized lung apices are clear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel, multifactorial degenerative changes as described above.\n3. Massively enlarged and heterogeneous thyroid gland for which clinical\ncorrelation advised." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. The thyroid gland is homogeneous. The partially imaged lung\napices are clear.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "There is loss of height of the T2 and T3 vertebral bodies. These findings are\nnew since the cervical spine CT of ___. However, they appear\nchronic. There is no evidence of soft tissue swelling associated with this and\nno fracture lines are detected. There is no other evidence of fracture.\n\nThere is no prevertebral soft tissue swelling. The cervical vertebral body\nheights are preserved. There are multi-level multifactorial degenerative\nchanges of the cervical spine, overall similar to ___ with anterior\nbridging osteophytes from C3- C6. There is disk bulging and thickening of the\nligamentum flavum at C2-3 with canal narrowing. Disk bulges and osteophytes\nat C3-4, ___ and ___ narrow the spinal canal, but likely do not produce cord\ncompression. The thyroid gland is unremarkable. The lung apices are clear. \nThere is no gross evidence of infection or neoplasm on this noncontrast study.", "output": "Compression fracture of the T2 and T3 vertebral bodies. They appears chronic\nbut new since ___. There is no other evidence of fracture. There is\nno evidence of subluxation. No evidence of fracture.\n\nNOTIFICATION: The finding of chronic- appearing T2 and T3 compression\nfractures was discussed by telephone by Dr. ___ with the ___ QA nurse at\n11:40 am on ___, immediately upon noting it." }, { "input": "There is exaggeration of the thoracic kyphosis. Otherwise, alignment is\ngrossly preserved. No fractures are identified. There are unchanged chronic\ncompression deformities of the T2 and T3 vertebral bodies. There are moderate\nmultilevel degenerative changes of the cervical spine, not substantially\nchanged compared to prior, with loss of intervertebral disc space height and\nbridging osteophytosis spanning C3-C6. There is mild spinal canal stenosis\npredominately affecting C3-C6 due to posterior disc bulge and osteophytosis. \nThere is no high-grade spinal canal stenosis. There is no prevertebral edema.\n\nThe thyroid is unremarkable. Ill-defined 4 mm left apical nodule is unchanged\ndating back to ___. Enlarged 1.8 x 1.2 cm right supraclavicular lymph node,\npreviously 1.1 by 0.9 cm.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes of the cervical spine.\n3. Enlarging right supraclavicular lymph node." }, { "input": "Alignment is normal without spondylolisthesis. Multi-level degenerative\nchanges are mild and most pronounced that C5 through C7. Tiny, well\ncorticated ossific fragments just below the inferior anterior aspect of the C5\nand C6 vertebral bodies are likely degenerative, although acute ligamentous\ninjury cannot be excluded in the setting of trauma. At C4-C5, there is a\nbroad-based disc bulge, greater on the right indenting the anterior right\naspect of the spinal canal and may touch the spinal cord. There is associated\nnarrowing of the right lateral recess but the neural foramina is patent. The\nspinal canal is otherwise patent at all levels. No significant neural\nforaminal narrowing. No prevertebral soft tissue swelling. No osseous\nlesions concerning for malignancy or infection. The paraspinous muscles are\nnormal. There is bilateral incomplete fusion/nonunion of the hyoid bone, a\ncongenital variant.\n\nNonspecific tiny calcifications in the right palatine tonsil may suggest\nchronic inflammation (series 3, image 27).", "output": "1. Normal alignment and no evidence of acute cervical spine fracture.\n\n2. Mild degenerative changes most prominent at C5-C7 with tiny\nwell-corticated ossific fragments at the anterior inferior aspect of C5 and C6\nwhich are likely degenerative osteophytes rather than ligamentous avulsions. \nCorrelate clinically.\n\n3. Mild broad-based disc bulge, more on the right at C4-C5 indenting the\nright anterior spinal canal and lateral recess and may touch but does not\ncompress the spinal cord at this level." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C5-C6 and notable for uncovertebral\nhypertrophy and osteophytes causing moderate bilateral neural foraminal\nstenosis without significant spinal canal narrowing.There is no prevertebral\nedema.\n\nThere is moderate calcification of the aortic arch. The lung apices\ndemonstrate right apical scarring as well as diffuse ground-glass opacities\nbilaterally, right worse than left which may reflect infectious/inflammatory\nprocess or underlying asymmetric pulmonary edema. There is a moderate right\npleural effusion, partially imaged.", "output": "1. No evidence of fracture or malalignment of the cervical spine.\n2. Bilateral diffuse ground-glass opacities may represent\ninfectious/inflammatory process. Partially imaged moderate right pleural\neffusion.\n3. Multilevel degenerative changes as described above." }, { "input": "Note that the T1 vertebral body and a portion of the T2 vertebral body are not\nimaged. There is a moderate to severe pathologic burst fracture of the T4\nvertebral body, as noted on the same-day MR with up to roughly 5 mm of\nretropulsion causing at least moderate canal stenosis, with cord impingement\nseen on the prior MR. ___ areas of hypodensity are seen within the T4\nvertebral body, compatible with myelomatous involvement. Posterior cortical\nmargin is nearly entirely eroded. The remainder of the thoracic vertebral\nbody heights are preserved without additional fracture. There is diffuse\nheterogeneity of the visualized bones, with several scattered areas of\nhypodensity, corresponding to diffuse bone marrow replacement as seen on the\nMR. ___ are moderate multilevel degenerative changes. Alignment is\npreserved.\n\nThere is mild left-greater-than-right bibasilar atelectasis. A punctate\ncalcified granuloma is noted in the right lower lobe. The imaged portion of\nthe lungs are otherwise clear. Visualized portion of the heart demonstrates\naortic annular and severe coronary artery calcification. The visualized\nportion of the upper abdomen is grossly unremarkable.", "output": "1. Moderate to severe pathologic fracture of the T4 vertebral body with 5 mm\nretropulsion, as seen on same-day MR.\n2. Diffuse heterogeneity of the visualized bones, consistent with myelomatous\ninvolvement." }, { "input": "Alignment is normal. No acute fractures are identified. There is no evidence\nof spinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.The thyroid is normal. Partially visualized lung apices are\nunremarkable.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture. \nIntervertebral disc space heights are maintained. No acute alignment\nabnormality is identified. Approximately 3 mm of anterolisthesis of C3 on C4\nis noted, likely degenerative in nature. There is no prevertebral soft tissue\nabnormality.\n\nModerate-severe, multilevel, multifactorial degenerative change is seen\npredominantly involving the levels of C3-C4, through C6-C7 with intervertebral\ndisc height loss, uncovertebral joint hypertrophy, and anterior osteophyte\nformation. The left C2-C3 facet is fused. Degenerative changes are noted at\nthe left C3-C4 without. There is no critical spinal canal stenosis by CT\nexamination.\n\nThe thyroid is grossly unremarkable in appearance. No lymphadenopathy is\npresent by CT size criteria. The visualized lung apices are clear.", "output": "1. No evidence of acute fracture.\n2. Anterolisthesis of C3 on C4 which may be degenerative but clinical\ncorrelation suggested.\n3. Moderate-severe, multilevel degenerative changes of the cervical spine.\n\nNOTIFICATION: Updated WET READ discussed by Dr. ___ with Dr. ___ at\n20:10 on ___." }, { "input": "No evidence of traumatic cervical malalignment or acute fracture. Tiny well\ncorticated osseous fragment about the anterior superior endplate of the C5\nvertebral body, likely representing a limbus vertebra (602:32), normal variant\nanatomy. There is no evidence of severe spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. Visualized lung\napices are unremarkable.", "output": "No evidence of traumatic cervical malalignment or acute fracture." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. Multiple tonsilliths are noted on the right (03:14). There\nis minimal biapical pleural-parenchymal scarring.", "output": "No acute cervical spine fracture or acute malalignment." }, { "input": "There is no evidence of acute fracture or traumatic malalignment. Minimal\nanterolisthesis of C7 on T1 is likely degenerative. No prevertebral soft\ntissue swelling is identified. The paraspinal soft tissues are unremarkable.\nModerate-to-severe degenerative disc disease is most prominent from C4-C5\nthrough C6-C7 with loss of intervertebral disc height, anterior and posterior\nspondylophytic changes and facet joint arthropathy resulting in multilevel\nneural foraminal narrowing. CT is not able to provide intrathecal detail\ncompared to MRI, but the visualized outline of the thecal sac appears\n\nThe visualized aerodigestive tract is unremarkable. No lymphadenopathy is\npresent by CT size criteria. The lung apices are clear.", "output": "1. No fracture or malalignment.\n\n2. Moderate to severe degenerative changes of the cervical spine.\n\n3. Extensive atherosclerotic calcification of the bifurcation of the carotid\narteries as well as the bilateral vertebral arteries." }, { "input": "No acute fracture is identified. Minimal anterolisthesis of the C7 on T1\nvertebral bodies is likely degenerative and unchanged compared to ___. There is moderate to severe spinal canal narrowing at the C3-4 level,\nrelated to disc bulge, ligamentum flavum hypertrophy, and osteophytosis. \nThere is moderate spinal canal narrowing at the C4-5 level, related to disc\nbulging. Right greater than left neural foraminal narrowing is at least\nmoderate from the C3-4, C4-5, and ___ levels. There is no prevertebral soft\ntissue swelling.", "output": "1. No acute fracture, malalignment, or prevertebral soft tissue swelling.\n2. Moderate to severe spinal canal narrowing at the C3-4 level." }, { "input": "Alignment is normal. No fractures are identified.Ossification of the posterior\nlongitudinal ligament at the C4-5 disc interspace. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm.\n\nLung apices are clear. Numerous hypo and hyperenhancing thyroid nodules are\nseen bilaterally. No cervical lymphadenopathy.", "output": "1. No fracture or traumatic malalignment.\n2. Multinodular thyroid gland." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Mild disc space narrowing at T1-T2 is incidentally noted.\n\nVisualized lung apices and thyroid are unremarkable.", "output": "No evidence of fracture or malalignment.\n\nNOTIFICATION: The above findings were communicated in person by Dr. ___\nto Dr. ___ team) at 07:51 on ___, immediately after\ndiscovery." }, { "input": "The patient is status post anterior fusion from C3-C7, and no evidence or\nhardware failure is seen. Anterolisthesis of C7-T1 is likely degenerative in\nnature. No acute fracture is seen.\n\nThere are multilevel degenerative changes. Posterior disc osteophyte complex\ncause moderate spinal canal narrowing, most notable at C3-C4. Uncovertebral\nhypertrophy causes multilevel neural foraminal narrowing, most severe on the\nright at C3-C4", "output": "1. Satisfactory appearance of cervical spine anterior fusion.\n2. Multilevel degenerative changes as described above causing moderate spinal\ncanal narrowing and neural foraminal narrowing, most severe at C3-C4." }, { "input": "No evidence of traumatic malalignment. There is no prevertebral edema.\n\nEvaluation is significantly limited in the lower cervical spine due to motion,\nhowever there appears to be a smooth rounded density extruding posteriorly\nfrom C5-C6. There are also calcifications extending posteriorly from C6-C7,\nwhich could represent disc osteophyte complex. Irregularity is seen along the\nposterior aspect of the C6 vertebral body. Extremely limited evaluation for\nfracture given motion, however recommend correlation clinically for focal\npain.\n\nThe thyroid is unremarkable. Few small bullae are noted at the lung apices.", "output": "1. Study is moderately degraded by motion artifact; in the context of these\nlimitations;\n2. No evidence of traumatic malalignment.\n3. Evaluation of the lower cervical spine is extremely limited due to motion,\nhowever there appears to be a smooth rounded density extruding posteriorly\nfrom C5-C6. There are also calcifications extending posteriorly from C6-C7,\nwhich could represent a disc osteophyte complex. Extremely limited evaluation\nfor fracture given motion, there does appear to be irregularity along the\nposterior margin of the C6 vertebral body. If there is continued clinical\nconcern for acute fracture, MRI cervical spine may be obtained.\n\nRECOMMENDATION(S): MRI of the cervical spine may be helpful for further\nevaluation.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 3:51 pm, 10 minutes after\ndiscovery of the findings." }, { "input": "There is a stenosis at C7-T1 which caused delay in contrast transits to the\nupper cervical spine. Therefore, and delayed images were obtained through the\ncervical spine after contrast redistribution.\n\nThe patient is status post C5 through C7 anterior fusion. There is grade 1, 3\nmm, anterolisthesis of C7 with respect to T1. Cervical spine alignment is\notherwise preserved. There is no evidence for hardware fracture or failure.\nThere is no acute cervical spine fracture.\n\nC2-C3: No significant spinal canal or neural foraminal narrowing is present.\n\nC3-C4: There is a shallow disc protrusion which mildly effaces the ventral\nsubarachnoid space. The neural foramen are patent.\n\nC4-C5: There is a disc osteophyte complex and thickening of the ligamentum\nflavum causing moderate narrowing of the spinal canal and remodeling of the\ncervical cord. Mild bilateral neural foraminal narrowing is secondary to\nuncovertebral and facet osteophytes.\n\nC5-C6 and C6-C7: The patient is status post anterior fusion at these levels\nand there is no disc protrusions or significant canal narrowing. Moderate to\nsevere bilateral neural foraminal narrowing is secondary to uncovertebral and\nfacet osteophytes.\n\nC7-T1: In addition to the anterolisthesis at this level, there is a disc\nprotrusion and facet degenerative change which contribute to severe narrowing\nof the spinal canal with complete effacement of the cerebral spinal fluid\nsurrounding the cervical cord, and remodeling of the cord. Severe bilateral\nneural foraminal narrowing is secondary to the anterolisthesis and\nuncovertebral and facet osteophytes.\n\nT1-T2, T2-T3, T3-T4 and T4-T5: No significant spinal canal or neural foraminal\nnarrowing is present. Please see the separately dictated thoracic and lumbar\nspine report for details of the lower thoracic spine.", "output": "1. Status post anterior fusion of C5 through C7. There is no evidence for\nhardware failure.\n2. Multilevel cervical spine degenerative changes worst at C7-T1 where there\nis severe spinal canal narrowing with near complete effacement of the cerebral\nspinal fluid surrounding the cord and remodeling of the cervical cord." }, { "input": "No fractures identified. There is no prevertebral soft tissue swelling. No\nevidence of infection or neoplasm. Mild anterolisthesis of C7 on T1, and\nminimal anterolisthesis of C4 on C5 and C5 on C6, all appear unchanged from\nprior study and likely secondary to degenerative change.\n\nModerate multilevel degenerative change is noted, including anterior and\nposterior osteophytosis, endplate spondylosis, and moderate disc space\nnarrowing most prominent at C7-T1 and C5-C6. There is ossification of the\ntransverse ligament. There is mild canal narrowing at C7-T1 secondary to\nanterolisthesis, mild posterior disc bulge, and facet joint hypertrophy. \nThere is moderate to severe neural foraminal narrowing on the left side at\nC3-C4 and moderate neural foraminal narrowing on the left at C4-C5 and C5-C6,\nsecondary to uncovertebral osteophytes and facet arthropathy.\n\nThe visualized portion of the bilateral lung apices are unremarkable. A\nhypodense nodule in the inferior pole of the left lobe of the thyroid measures\n2.1 x 1.9 cm, which is unchanged in size from dedicated thyroid ultrasound in\n___.", "output": "1. No evidence of acute fracture of the cervical spine. No change in\nalignment.\n2. Moderate multilevel degenerative changes are most prominent at C7-T1 and\nC5-C6, as described above.\n3. Stable appearance of a thyroid nodule in the left inferior pole, measuring\n2.1 cm and unchanged in size from dedicated thyroid ultrasound in ___." }, { "input": "Grossly stable minimal C7 on T1 anterolisthesis is again noted.\n\n The visualized osseous structures are osteopenic. There is no definite\nevidence of fracture.\n\nMultilevel degenerative changes are seen, most extensive at C4-C5 through\nC7-T1 notable for intervertebral disc height loss, posterior osteophytosis,\nand uncovertebral hypertrophy which results in mild canal narrowing at C7-T1,\nas well as severe left neural foraminal narrowing at C3-C4, and mild to\nmoderate left neural foraminal narrowing of C4-C5 and C5-C6. Likely\ndegenerative pannus at the C1-2 junction is again noted, resulting in at least\nmild vertebral canal narrowing. There is no prevertebral edema.\n\nGround-glass opacities and scarring are visualized at the right lung apex. \nThere are bilateral large pleural effusions that extend to the lung apices. A\nleft lobe thyroid nodule measures up to 1.8 x 1.7 cm on this examination and\nis grossly unchanged from thyroid ultrasound of ___ given differences\nin technique. Atherosclerotic vascular calcifications are seen in bilateral\ncarotid bifurcations. Scattered subcentimeter nonspecific lymph nodes are\nnoted throughout the neck bilaterally, without definite enlargement by CT size\ncriteria.", "output": "1. Diffuse osteopenia limits evaluation for acute fractures.\n2. No definite evidence of acute fracture.\n3. Multilevel degenerative changes as described above, most notable for mild\ncanal narrowing at C7-T1. If clinically indicated, consider cervical spine\nMRI for further evaluation.\n4. Limited imaging lungs demonstrate bilateral pleural effusions and\nnonspecific patchy opacities. If clinically indicated, consider correlation\nwith dedicated chest imaging.\n5. Left 1.8 x 1.7 cm thyroid nodule, grossly unchanged compared to prior\ncervical spine CT, better visualized on ___ thyroid ultrasound.\n6. Nonspecific subcentimeter lymph nodes as described." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. An unchanged, small posterior disc bulge at C3-C4 causes\nmild canal narrowing and partially effaces the ventral CSF. There is no\nforaminal narrowing. Incidental note is made of a congenitally unfused\nposterior arch of C1.\n\nImaged portion of the thyroid is unremarkable. Imaged portions of the lung\napices are unremarkable.", "output": "1. No acute cervical spine fracture.\n2. Stable, small posterior disc bulge at C3-C4 partially effaces the ventral\nCSF." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is moderate degenerative\nchanges along the cervical spine. There is no prevertebral soft tissue\nswelling.", "output": "1. No evidence of acute fracture or dislocation." }, { "input": "There is mild retrolisthesis of C3 on C4. There is minimal anterolisthesis of\nC7 on T1.No acute fracture is detected.Degenerative changes of the cervical\nspine are moderate to severe, most pronounced at C3-C4 and C6-C7, where there\nis severe loss of disc height and osteophytosis. There is mild spinal canal\nnarrowing at these levels. Loss of height of the superior endplate of C4 with\nendplate irregularities most consistent with degenerative change. At C5-C6,\nthere is mild right neural foraminal narrowing. There is no prevertebral soft\ntissue swelling.", "output": "1. No acute cervical spine fracture.\n\n2. Moderate to severe degenerative changes, as above." }, { "input": "Alignment is normal. No fractures are identified. No evidence for\nprevertebral edema. A small disc protrusion minimally indents the ventral\nthecal sac at C5-C6. No significant neural foraminal narrowing is seen.\n\nThere is extensive subcutaneous emphysema within and between left suboccipital\nand left greater than right posterior paravertebral muscles. There is a skin\ndefect just to the right of midline at the level of C2-C3, image 3:44, likely\ncorresponding to the entry point of the stab wound. No radiopaque foreign\nbody is seen.\n\nThe thyroid is unremarkable. Small pocket of air along the right posterior\ntrachea at the thoracic inlet, image 3:84, is in a classic location for a\ntracheal diverticulum, though the connection to the trachea is not visualized,\nlikely due to slice thickness. Included lung apices are clear.", "output": "1. No fracture or subluxation.\n2. Extensive subcutaneous emphysema within and between left suboccipital and\nleft greater than right posterior paravertebral muscles. No evidence for a\nradiopaque foreign body." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. The thyroid\nis unremarkable. The partially visualized lung apices are unremarkable. \nSeveral dental caries are incidentally noted within the imaged aspect of the\nteeth. Partially imaged is mucosal thickening in the maxillary, sphenoid, and\nethmoid sinuses.", "output": "No fracture or malalignment." }, { "input": "There is mild compression of the L3 vertebral body inferiorly, of\nindeterminate age. There may be a small paravertebral hematoma at this level.\nMultilevel degenerative changes are seen, including vacuum phenomenon at L3\nthrough S1. There is disc space narrowing, worst at L5/S1 where there is also\nmarginal sclerosis and small and osteophytes. Broad based disc bulge and\nhypertrophy of the ligamentum flavum at L3/L4 causes moderate to severe\nnarrowing of the central canal CT this level. There is also severe narrowing\nof the central canal at L4/L5 with disc bulge seen. .\n\nSoft tissues demonstrate bibasilar atelectasis. There is a partially imaged\nsmall hiatal hernia. There is a 2.9 x 2.7 cm heterogeneously hypodense\nstructure arising from the lateral midpole of the right kidney, which measures\nHounsfield units greater than that typically seen for a simple cyst, however,\nis not well assessed on this study. Additionally, there is a 1.9 cm exophytic\nrounded lesion arising from the anterior lower pole of the right kidney. \nFindings can be further characterized on nonurgent renal ultrasound. Aortic\nand other arterial calcifications are seen.", "output": "1. Mild compression of the L3 vertebral body inferiorly, of indeterminate\nage, but concern for acute component. Possible small paravertebral hematoma\nat this level.\n\n2. Two right renal lesions measuring ___ greater than that typically seen for\nsimple cyst.\n\nRECOMMENDATION(S): Nonurgent renal ultrasound for further assessment of the\nright renal lesions." }, { "input": "Evaluation is slightly limited due to streak artifact from the dental amalgam.\nAlignment is normal. No fractures are identified.Degenerative changes of the\ncervical spine are moderate, denoted by disc space narrowing and osteophytosis\nmost pronounced at C5-C6 and C6-C7, were there is mild spinal canal narrowing.\nThere is no prevertebral soft tissue swelling.\n\nThe esophagus is patulous. Punctate calcification is identified in the left\nthyroid lobe (image 51, series 2), measuring 3.2 mm in transverse dimension,\nthe lung apices are unremarkable.", "output": "There is no evidence of cervical spinal fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.Calcifications\nare noted within the right lobe of the thyroid. The left vertebral foramina\nat C3 and C4 level are prominent likely due to somewhat tortuous vertebral\nartery", "output": "No evidence of traumatic malalignment, acute fracture or prevertebral edema." }, { "input": "Alignment is normal. No fractures are identified. There are multilevel\ndegenerative changes of the cervical spine noting osteophytosis and\nuncovertebral joint hypertrophy. There is no high-grade spinal canal or\nneural foraminal narrowing. There is no prevertebral edema.\n\nSurgical clips are seen in the soft tissues of the neck bilaterally in this\npatient with history of prior ENT surgery. The thyroid gland is unremarkable.\nThere is a subpleural 6 mm lung nodule in the right upper lobe, not seen on\nprior imaging.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. New 6 mm lung nodule in the right upper lobe. Attention on follow-up\nimaging is recommended." }, { "input": "Alignment is normal. No fractures are identified. Multilevel degenerative\nchanges of the cervical spine, including anterior and posterior osteophyte\nformation and intervertebral disc height narrowing, are most prominent at\nC5-C7. Mild spinal canal narrowing is most pronounced at C7-T1, due to a\nposterior disc bulge. There is no evidence of significant neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm. The imaged lung apices are unremarkable. \nThyroidectomy clips are seen.\n\nHyperdense and partly calcified round lesion compatible with a meningioma is\nseen in the right posterior fossa.", "output": "1. No acute cervical spine fracture. Normal alignment.\n2. Mild, multilevel degenerative changes of the cervical spine, including mild\nspinal canal narrowing at C7-T1." }, { "input": "There is a two-column burst fracture of the L4 vertebral body with\napproximately 6 mm of retropulsion of bony fragments into the central spinal\ncanal (601b:39). There is mild loss of vertebral body height. The remaining\nvertebral bodies are normal in height and alignment. There are moderate\nmultilevel degenerative changes, particularly facet arthropathy, though there\nare anterior osteophytes inferiorly. Prominent disc osteophyte complex at L2-3\nalso causes mild spinal canal stenosis. Numerous cystic lesions in the right\nkidney are incompletely imaged. Most have the appearance of simple cysts. \nThe largest measures approximately 6.5 x 4.4 cm (3:38). These are stable when\ncompared to CT torso on ___. Smaller cysts are noted in the left\nkidney and are unchanged. The abdominal aorta is normal caliber, though there\nare dense atherosclerotic calcifications.", "output": "1. Unstable 2 -column burst fracture of the L4 vertebral body with 6 mm of\nretropulsion. Moderate multilevel degenerative changes.\n2. Multi-cystic right kidney, incompletely imaged. When compared to CT torso\nof ___, these are unchanged." }, { "input": "There is no fracture or traumatic malalignment the thoracic spine. Mild to\nmoderate multilevel degenerative changes include confluent anterior\nosteophytes compatible with DISH.\n\nThe thoracic vertebral bodies are normal in height and alignment. To the\nextent that the contents of the spinal canal can be evaluated, no high-grade\ncanal stenosis is seen.\n\nThe heart is moderately enlarged with coronary artery and aortic annular\ncalcifications. There is also a trace pericardial effusion. Nonhemorrhagic\nbilateral pleural effusions are small the right and trace on the left. Note is\nalso made of a peripheral nodule in the right lower lobe measuring 7 x 5 mm\n(601:10). This is not seen on prior CT torso in ___, but there was a pleural\neffusion and atelectasis at the time.", "output": "1. No fracture traumatic or malalignment of the thoracic spine.\n2. 7 mm peripheral nodular density in the right lower lobe, possibly scarring\nfrom prior infection. Followup chest CT is recommended in three months to\nensure stability.\n3. Trace to small nonhemorrhagic bilateral pleural effusions.\n4. Moderate cardiomegaly and trace pericardial effusion." }, { "input": "Alignment is normal. No fractures are identified. Multilevel mild\ndegenerative changes are seen throughout the C-spine with anterior osteophyte\nformation and disc space height loss, most prominent at C6-7. There is no\nprevertebral edema. A well corticated defect within the left post for lateral\narch of C1 is likely a chronic or congenital defect.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or vertebral malalignment." }, { "input": "Alignment is normal. No fractures are identified.Well-corticated defect in the\nleft posterolateral arch of C1 is stable from ___. Mild multilevel\ndegenerative changes are again seen with intervertebral disc space narrowing,\nanterior and posterior osteophyte formation and endplate irregularity, most\nprominent at the C6-C7 level, with a posterior disc osteophyte complex at this\nlevel resulting in severe spinal canal narrowing, unchanged no significant\nneural foraminal stenosis..There is no prevertebral soft tissue swelling.\nThere is no evidence of infection or neoplasm within the limits of this\nnoncontrast enhanced study.\n\nVisualized lung apices and thyroid gland are within normal limits.", "output": "No evidence of traumatic subluxation or acute fracture." }, { "input": "Thoracic spine:\nAlignment is normal.Subtle lucency through the left anterior first rib is not\nseen on same day cervical spine CT (02:13) and is likely to be artifactual. \nOtherwise, no acute fractures are identified. Vertebral body heights are\nmaintained. Mild multilevel degenerative changes are seen, most prominent at\nT9-T10 with bridging anterior osteophytes and mild intervertebral disc space\nnarrowing. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling\n\nLumbar spine:\nAlignment is normal. No fractures are identified.Mild multilevel degenerative\nchanges are seen, most prominent L3-4 with anterior osteophytes and mild disc\nbulging causing mild central canal stenosis. Moderate facet arthropathy at\nL4-L5, L5-S1 and L5-S1 result in mild to moderate bilateral neural foraminal\nnarrowing. There is no prevertebral soft tissue swelling. There is mild\ndegenerative changes to the sacroiliac joints, right greater than left.\n\nOtherwise, there is no evidence of infection or neoplasm within the limits of\nthis noncontrast enhanced study. Mild calcified atherosclerotic disease of the\nabdominal aorta. Visualized lung parenchyma and pleura are unremarkable. \nVisualized intra-abdominal organs are otherwise unremarkable. Incidental\nnoting of partial anomalous pulmonary venous return, with a vessel seen\nextending from the left brachiocephalic to region of the pulmonary veins.", "output": "1. Subtle nondisplaced lucency through the left anterior first rib is not seen\non same day cervical spine CT, likely artifactual, but please correlate with\nany tenderness on physical exam.\n2. Otherwise, no evidence of acute traumatic fracture or subluxation within\nthe thoracic or lumbar spine." }, { "input": "Alignment is normal. No fractures are identified.Mild to moderate degenerative\nchanges of the cervical spine are present, with osteophytosis and disc space\nnarrowing most pronounced at C6-C7 and C7-T1. There is no prevertebral soft\ntissue swelling.\n\nIncluded thyroid demonstrates a small punctate calcification in the right lobe\n(03:50). Visualized lung bases are clear.", "output": "No acute cervical spinal fracture or traumatic malalignment." }, { "input": "Trace, millimetric grade 1 anterolisthesis of C4 on C5 is most likely\ndegenerative in etiology. No acute fractures are identified. Multilevel\ndegenerative changes are seen, most extensive at C4-5 and notable for mild\nintervertebral disc disease, and mild right neural foraminal narrowing\nsecondary to facet arthropathy. There is no prevertebral edema.\n\nPartially imaged lung apices demonstrate minimal right apical paraseptal\nemphysema, coronal series 601, image 28. No cervical lymphadenopathy is seen.\nThyroid gland may be mildly diffusely enlarged.", "output": "1. Minimal, millimetric grade 1 anterolisthesis of C4 on C5 is most likely\ndegenerative in etiology.\n2. No acute fracture.\n3. Possible mild diffuse enlargement of the thyroid gland. Consider outpatient\ncorrelation with thyroid function tests." }, { "input": "There are 12 rib-bearing and 5 non rib-bearing vertebrae with partial\nsacralization of L5.\n\nTHORACIC SPINE:\nThere is complete fragmentation and destruction of T10 vertebral body. There\nis also severe loss of height of T9 vertebral body with anterior wedging and\nfragmentation, and severe loss of height of T11 vertebral body with posterior\nwedging and fragmentation. There is a kyphotic deformity centered at T9-T10\nwith multiple bone fragments retropulsed into the spinal canal from mid T9\nthrough mid T11 levels. Associated epidural phlegmon/abscess and associated\nspinal canal narrowing better demonstrated on the same-day MRI. Associated\nbilateral paraspinal phlegmon and abscesses are also better assessed on the\npreceding MRI, but also visible on CT images 301: 81-100. Left paraspinal 2.6\nx 1.7 cm collection on image 301:81 demonstrates peripheral calcifications\nwhich may be secondary to underlying chronic sequestrum. Mild hyperdensity\nalong the periphery of the 3.7 x 2.2 cm right paraspinal collection on image\n301:93 may represent contrast enhancement from the preceding MRI.\n\nThere is a well corticated lucency involving the left pedicle and superior\nfacet of T9, extending to the left T8-T9 facet joint, images 2:62-78,\n602:56-60. Left T8-T9 and bilateral T9-T10 facet joints are perched. \nBilateral T10 pedicles are fragmented. There is well corticated irregularity\nof the right T10-T11 facet joint, images 602:47, 2:92.\n\nLUMBAR SPINE:\nVertebral body heights are preserved. Alignment is normal. L1-L2 through\nL4-L5 disc space heights are preserved. L5-S1 disc is underdeveloped due to\npartial sacralization of L5. No evidence for significant spinal canal or\nneural foraminal narrowing.\n\nOTHER:\nEvaluation of the visualized posterior abdomen pelvis is limited due to\nabsence of intravenous contrast and paucity of fat. Multiple calcified celiac\naxis, other mesenteric, and retroperitoneal lymph nodes appear present. There\nis excreted contrast within bilateral renal collecting systems from the\npreceding MRI.", "output": "1. 12 rib-bearing vertebrae and 5 non-rib-bearing vertebrae with partial\nsacralization of L5.\n2. Discitis/osteomyelitis involving T9 through T11 are again demonstrated. \nComplete fragmentation and destruction of T10 vertebral body and bilateral\npedicles. Severe loss of height of T9 and T11. Kyphotic angulation at T9-T10\nwith multiple bone fragments dorsal to T9-T11. Associated epidural\nphlegmon/abscess and spinal canal narrowing are better assessed on the\npreceding MRI.\n3. Well corticated lucency extending into the left T9 posterior elements and\nto the left T8-T9 facet joint, likely sequela of the osteomyelitis. Well\ncorticated irregularity of the right T10-T11 facet joint, unclear whether\nsecondary to infection or secondary degenerative change.\n4. Left T8-T9 and bilateral T9-T10 facet joints are perched.\n5. Bilateral paraspinal collection at T9 through T11. A left paraspinal\ncollection demonstrates peripheral calcifications which may be secondary to\nunderlying sequestrum or underlying calcified lymph node, given the presence\nof other calcified lymph nodes in the visualized abdomen.\n6. Multiple calcified mesenteric and retroperitoneal lymph nodes in the\npartially imaged abdomen, suggesting granulomatous disease.\nCOMMENT:\nTB should be considered given involvement of 3 vertebral levels and calcified\nintra-abdominal lymph nodes.\n\nNOTIFICATION: The preliminary report was discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 6:26 am, 10\nminutes after discovery of the findings.\n\n The final interpretation and the comment regarding TB testing were discussed\nwith ___, M.D. by ___, M.D. on the telephone on ___ at\n10:08 am, 5 minutes after discovery of the findings." }, { "input": "Alignment is normal.There are healing fractures of the right C6 inferior\narticular facet and of the right C7 lateral mass and superior facet. Slight\nanterior subluxation of the C6 facet on C7 appears similar to the prior study.\nNo new fractures are identified.\nAt C2-3 there is a minimal bulge of the disc with no encroachment on the\nspinal canal or neural foramina.\nAt C3-4 there is a minimal bulge of the disc with no encroachment on the\nspinal canal or neural foramina.\nAt C4-5 there is an unchanged tiny midline protrusion that contacts the\nanterior surface of the spinal cord.\nAt C5-6 there is a broad bulge of the disc that flattens the anterior surface\nof the spinal cord. Facet and uncovertebral osteophytes produce mild\nbilateral neural foraminal narrowing.\nAt C6-7, intervertebral osteophytes and a midline and left-sided disc\nprotrusion encroach on the spinal canal and flatten the left anterior aspect\nof the spinal cord. There is mild right and no left neural foraminal\nnarrowing.\nImaging at C7-T1 and the included portions of the upper thoracic spine\ndemonstrate no spinal canal or neural foraminal compromise.\n\nThere is no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "1. Healing C6 and C7 fractures with no change in near anatomic position.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "Alignment is normal.\n\nHealing fractures of the right C6 inferior articular facet and right C7\nlateral mass and superior facet are re-identified. There has been slight\nprogression of healing involving the right C7 lateral mass fracture. Subtle\nanterior subluxation of the right C6 facet on C7 facet persists with similar\nassociated narrowing of the right neural foramen. Previously seen right\nanterolateral T1 fracture has nearly completely healed. No new fractures are\nidentified. Atlantodens interval is preserved. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nC2-3: Disc desiccation and minimal central disc protrusion are re-identified\nalong with uncovertebral spurring. There is no significant central stenosis\nor foraminal narrowing.\n\nC3-4: Disc desiccation and minimal central disc protrusion are re-identified\nalong with uncovertebral spurring. There is no significant central stenosis or\nforaminal narrowing.\n\nC4-5: Disc desiccation and minimal central disc protrusion are re-identified\nalong with uncovertebral spurring. There is no significant central stenosis or\nforaminal narrowing.\n\nC5-6: Minimal disc bulge is seen with uncovertebral spurring. No significant\ncentral canal stenosis seen. Mild bilateral foraminal narrowing is similar.\n\nC6-7: Left foraminal disc bulge uncal spurring are present. Subtle anterior\nsubluxation of the C6 facet relative to C7 contributes right foraminal\nnarrowing. There is mild central stenosis, mild to moderate right and mild\nleft foraminal narrowing, similar to the prior study.\n\nC7-T1: No significant central stenosis or foraminal narrowing.", "output": "1. Right C6 inferior articulating facet, right C7 superior facet and right C7\nlateral mass fractures with slight progression in healing of the C7 lateral\nmass fracture. Nearly completely healed small right anterolateral T1\nfracture.\n2. Subtle anterior subluxation of the right C6 facet relative to C7 with\ncorresponding mild to moderate right foraminal narrowing.\n3. Cervical spondylosis with mild to moderate foraminal narrowing and mild\ncentral stenosis detailed above.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):___\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "No acute fractures are identified.There is no prevertebral soft tissue\nswelling.Multilevel degenerative changes most prominent at L3-L4 and L5-S1 are\nnot significantly changed from CT performed in ___. At L5-S1, bilateral\npars defects and grade 1 anterolisthesis are again seen. Schmorl's nodes\ninvolve the superior endplate of S1 and inferior endplate of L3. Multilevel\ndisc bulges cause mild spinal canal narrowing and at least moderate bilateral\nneural foraminal narrowing at L5-S1. No severe spinal canal narrowing.\n\nA sclerotic focus in the spinal process of L3 suggests a bone island. \nExtensive atherosclerotic calcifications in the abdominal aorta, superior\nmesenteric artery, and bilateral renal arteries again noted.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes in the lumbar spine, as described.\n3. Bilateral pars defects and grade 1 anterolisthesis at L5-S1.\n4. At least moderate bilateral neuroforaminal narrowing at L5-S1." }, { "input": "There is no evidence of fracture. There is minimal cervical kyphosis at C5-6.\nAlignment is otherwise normal. . Mild to moderate, multilevel degenerative\nchanges are seen within the cervical spine, worst at C5-6 and C6-7, where\nthere is disc height loss, anterior and posterior osteophyte formation, and\nslight anterior angulation of C5 on C6.\nThere is widening of the space between the spinous processes at C5-6 and\nslight subluxation of the facet joints bilaterally. These findings all appear\nto be chronic and may be due to degenerative disease, prior chronic injury, or\nboth. However, in the setting of trauma, the possibility of superimposed\nacute injury cannot be excluded. If there are clinical findings suggesting\nacute cervical spine injury, correlation with cervical spine MR may be\nhelpful. Intervertebral osteophytes at C5-6 moderately encroach on the\nspinal canal.\n\nThe prevertebral soft tissues are unremarkable. The thyroid gland is normal. \nThe lung apices are clear.", "output": "No acute fracture or traumatic malalignment.\n\nNOTIFICATION: The revised report of possible chronic injury at C5-6 was\nadmitted through the ED QA email system" }, { "input": "No traumatic malalignment or fractures are identified.Again seen are\nmultilevel degenerative changes throughout the cervical spine, worst at C3-C4\nwith disc space narrowing, endplate sclerosis, osteophytosis and facet and\nuncovertebral hypertrophy. There is mild spinal canal narrowing at multiple\nlevels. There is no prevertebral edema.\n\nThe thyroid is unremarkable. There is a large right pleural effusion. The\nleft lung apex is unremarkable.", "output": "1. No traumatic malalignment or fractures are identified.\n2. Large right pleural effusion." }, { "input": "Mild reversal of cervical lordosis is noted. Alignment is otherwise\nnormal.Mild degenerative changes of the cervical spine with anterior\nosteophytes and disc space narrowing. No fractures are identified. There is\nno evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nMild mucosal thickening of the left sphenoid sinus and left maxillary sinus\nare noted. Heterogeneously enlarged right thyroid lobe measures 2.5 x 1.7 cm.", "output": "1. No acute fracture or acute malalignment.\n2. Mild multilevel degenerative changes of cervical spine with anterior\nosteophytes and disc space narrowing.\n3. 2.5 cm heterogeneously enlarged right thyroid lobe.\n\nRECOMMENDATION(S): If clinically indicated and not previously assessed\nconsider dedicated thyroid ultrasound for further evaluation." }, { "input": "There is further loss of height of L2 vertebra since the previous study with\nnow apparent vertical cleft through the ___ the vertebral body. Mild\nsclerosis is seen involving both anterior and posterior fragments. No\nsignificant retropulsion is identified. No paraspinal hematoma is identified.\n\nMinimal disc bulging is seen in the lumbar region without spinal stenosis or\nforaminal narrowing. Abdominal vascular calcifications are again seen.", "output": "1. Chronic appearing compression of L2 vertebra demonstrates further decrease\nin height and increased visualization of the fracture cleft. Sclerosis is\nseen at the vertebral fracture fragments but no retropulsion is identified. \nNo paraspinal hematoma is seen." }, { "input": "Prior cervical and thoracic spine MRI demonstrates 12 rib-bearing vertebrae\nwith small ribs at T12. 5 lumbar-type vertebrae are again visualized caudal\nto T12.\n\nBurst fracture of L2 vertebral body is again demonstrated, with a central gap\nand mild sclerosis of the fracture fragments, unchanged compared to ___. The degree of moderate loss of vertebral body height is also\nunchanged. No significant retropulsion is seen, though there may be unchanged\nminimal retrolisthesis of L2 on L3. Minimal levoconvex curvature of the\nlumbar spine is again noted.\n\nNo new fracture is seen. T12, L1, and L3 through L5 vertebral body heights\nare preserved. Mild disc bulges are again seen throughout the lumbar spine\nwithout evidence for significant spinal canal narrowing. Disc bulges and\nfacet osteophytes cause mild to moderate neural foraminal narrowing throughout\nthe lumbar spine, most advanced at L3-L4 and L4-L5.\n\nThere is vacuum phenomenon and mild degenerative changes in the included\nportions of the sacroiliac joints.\n\nVisualized medial lung bases are unremarkable. There is calcified plaque in\nthe abdominal aorta and visualized iliac arteries.", "output": "Unchanged appearance of L2 vertebral body fracture compared to ___, as detailed above." }, { "input": "There is exaggeration of normal cervical lordosis. Minimal retrolisthesis of\nC3-C4 as well as minimal anterolisthesis C5-C6 and C6-C7 is likely\ndegenerative in etiology.No acute fractures are identified.Degenerative\nchanges along the cervical spine are moderate with intervertebral disc space\nnarrowing, subchondral sclerosis and cystic formation, and osteophytes.There\nis no prevertebral soft tissue swelling. Uncovertebral and facet joint\narthropathy results in multilevel mild to moderate vertebral canal narrowing\nwith contact upon the spinal cord at C3-C4, and moderate to severe neural\nforaminal stenoses, most severe at right C4-C5 level.\n\n There is no evidence of infection or neoplasm. Nonspecific ground-glass\nopacities are seen in the lung apices, possibly of infectious or inflammatory\netiology. A tracheostomy is partially seen. The thyroid gland is\nunremarkable. Atherosclerotic calcifications are mild in the carotid\nbifurcations, left greater than right.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate cervical spondylosis with multilevel mild-to-moderate vertebral\ncanal narrowing and moderate to severe neural foraminal stenoses, as detailed\nabove." }, { "input": "Alignment is normal. No fractures are identified. There are mild multilevel\ndegenerative changes with mild intervertebral disc height loss, and anterior\nosteophytes with small posterior disc osteophyte complexes. No significant\ncentral canal narrowing. Mild neural foraminal narrowing is noted on the left\nat C3-4 and on the right at C4-5 due to facet arthropathy and uncovertebral\nspurring. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or traumatic malalignment." }, { "input": "There is mild anterolisthesis of C2 on C3 and C7 on T1. There is mild\nretrolisthesis of C3 on C4 and C4 on C5. No acute cervical spine fractures\nare identified.Multilevel degenerative changes are seen, most extensive at\nC3-4 and C4-5 and notable for loss of intervertebral disc height,\nosteophytosis, uncovertebral hypertrophy, and endplate sclerosis causing mild\nto moderate spinal canal narrowing and moderate neural foraminal\nnarrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No evidence of acute cervical spine fracture.\n2. Multilevel degenerative changes of the cervical spine as described above.\n3. Multiple levels of mild alignment abnormality, likely secondary to\ndegenerative change, however in the setting of trauma acute injury cannot be\ncompletely excluded. If clinically indicated an MRI C-spine can be considered\nfor further evaluation of the ligamentous complexes." }, { "input": "There is 3 mm of anterolisthesis of C7 on T1, likely degenerative. No\nfractures are identified.Multilevel degenerative changes are seen, most\nextensive at C4-5 through C6-7 and notable for loss of intervertebral disc\nheight, endplate sclerosis, anterior and posterior osteophytosis,\nuncovertebral hypertrophy and facet joint hypertrophy causing mild neural\nforaminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Extensive\natherosclerotic calcifications noted at the carotid bulbs. Extensively\ntortuous thoracic aorta noted on the scout view.", "output": "1. No acute fracture.\n2. 3 mm of anterolisthesis of C7 on T1 is likely degenerative.\n3. Multilevel degenerative changes of the cervical spine, most extensive at\nC5-6." }, { "input": "There is minimal reversal of the normal cervical lordosis. There is grade 1\nanterolisthesis of C6 on C7. There is no traumatic malalignment.No fractures\nare identified. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm within the limits of a noncontrast exam. \nThere is bilateral, left greater than right, mucosal thickening of the\nbilateral maxillary sinuses.\n\n\nThere are mild multilevel degenerative changes, evidenced by disc space\nnarrowing, endplate sclerosis, and uncovertebral and facet hypertrophy. No\nevidence of significant spinal canal or neural foraminal narrowing.\n\nVisualized lung apices are unremarkable. Visualized thyroid is unremarkable.", "output": "1. No traumatic malalignment or fractures are identified." }, { "input": "Severe multilevel degenerative changes are present worse from C3 through C6. \nMild 2 mm of anterolisthesis of C3 on C4 and C5 on C6 is likely\ndegenerative.No fractures are identified. There is moderate to severe spinal\ncanal stenosis at C3-C4. No evidence of severe spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.Severe\nbiapical scarring and with calcifications. Pulmonary fibrotic changes are\npartially visualized", "output": "1. No fracture.\n2. Mild anterolisthesis of C3 on C4 and C5 on C6, likely degenerative. Given\nabsence of priors, chronicity is difficult to establish.\n3. Multilevel degenerative changes." }, { "input": "Anterior-posterior alignment is preserved. There is severe pronounced\ndextroscoliosis of the thoracic ___ about T7-8. No fractures are\nidentified. There is no evidence of spinal canal stenosis. There is no\nprevertebral soft tissue swelling.\n\nRedemonstration of bilateral apical fibrotic changes as well as pleural\nthickening and calcification. No pericardial effusion. No pleural effusion. \nThere is a right perihepatic calcified granuloma. There is a large hiatal\nhernia on the left containing a partial loop of stomach (series 601, image\n22).", "output": "1. No acute fractures or traumatic subluxation.\n2. Severe dextroscoliosis of the lumbar ___ about T7-8.\n3. Large hiatal hernia containing a significant portion of the stomach." }, { "input": "Anterior-posterior alignment is preserved. There is severe levoscoliosis of\nthe lumbar ___ about L2. There is a linear lucency and cortical\nstep-off through S5, which is concerning for a nondisplaced fracture (series\n602, image 39).There is no evidence of high-grade spinal canal stenosis.There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nRedemonstration of a right hepatic lobe calcification, likely of the capsule. \nMultiple simple renal cortical cysts are demonstrated bilaterally, measuring\nup to 1.9 cm. No bowel obstruction. Ascites. Significant atherosclerotic\ncalcification of the abdominal aorta is demonstrated. There is a 6.1 cm left\nadnexal cyst, previously measured 5.0 cm on prior ultrasound from ___.", "output": "1. Nondisplaced fracture through the S5 level.\n2. No traumatic subluxation.\n3. Severe levoscoliosis of the lumbar ___ about L2.\n4. A 6.1 cm left adnexal cyst, previously measured 5.0 mm in ___. Recommend\nnonurgent follow-up with dedicated pelvic ultrasonography if deemed clinically\nappropriate.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:11 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "No fractures are identified. Diffuse moderate-severe degenerative changes\nincluding unchanged retrolisthesis of C3 on C4 and anterolisthesis of C5 over\nC6. No high-grade spinal canal stenosis. There is mild-to-moderate\nmultilevel neural foraminal narrowing, which is most pronounced at the C4-5\nlevel on the right. There is mild widening of the intervertebral disc space\nat C7/T1, likely secondary to degenerative process including mild height loss\nof C7, which is unchanged from ___. There is no prevertebral edema.\n\nThere is bilateral apical scarring with pleural thickening and calcification. \nThe thyroid is normal.", "output": "No acute fracture or traumatic subluxation." }, { "input": "Severe levoscoliosis of the lumbar ___ about the L2 vertebra with\nmultilevel moderate to severe degenerative changes are redemonstrated. \nAnteroposterior alignment is preserved. No acute fracture is seen. Chronic\nappearing nondisplaced fracture through S5 (602:50) appears unchanged in\nalignment. No evidence of high-grade spinal canal narrowing.\n\nRedemonstration of right hepatic lobe calcification, likely a capsular\ncalcification or intrahepatic calcified granuloma. Simple cysts in the\nbilateral kidneys measure up to 2.5 cm, unchanged. No evidence of bowel\nobstruction. Significant atherosclerotic calcifications of the abdominal\naorta are again seen. There is no ascites. 5.3 cm left adnexal cyst appears\nsimple, previously 6.1 cm.", "output": "1. Within the limitations of extensive degenerative changes and severe\nlevoscoliosis of the lumbar spine, no acute fractures or traumatic\nmalalignment.\n2. Redemonstration of simple left adnexal cyst now measuring 5.3 cm. If not\npreviously evaluated with pelvic ultrasound, non urgent follow-up with\ndedicated pelvic ultrasound may be obtained as clinically appropriate.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "Minimal retrolisthesis of C3 on C4 and mild anterolisthesis of C5 on C6 is\nunchanged. There is an oblique minimally displaced fracture through the\nanterior inferior endplate of the T1 vertebra (601:35). The posterior\nelements are intact without widening. There is severe multilevel degenerative\nchanges, worst about the C3-C7 levels where there is loss of intervertebral\ndisc space, pronounced marginal osteophytosis, and extensive subchondral\nsclerosis and endplate irregularity. Spinal canal narrowing is worst and mild\nat the C3-4 level due to hypertrophic endplate changes. Multilevel mild\nbilateral neural foraminal narrowing, most pronounced C4-5, without severe\nneural foraminal narrowing. There is trace prevertebral soft tissue swelling\nat the site of acute fracture.\n\nSevere biapical partially calcified pleuroparenchymal scarring. The thyroid\nis unremarkable.", "output": "1. Acute, minimally displaced fracture through the anterior inferior endplate\nof the T1 vertebra.\n2. No traumatic malalignment." }, { "input": "No evidence of traumatic cervical malalignment. Minimal retrolisthesis of C3\non C4 is unchanged compared to the prior exam. Minimal anterolisthesis of C5\non C6 is also unchanged. Compression deformity of the inferior endplate of\nthe T1 vertebra likely reflects sequelae of remote injury from prior fracture\nas seen on the examination of ___. Superior endplate height loss\nat T3 was also present on prior. No acute fracture or dislocation is\nidentified. Multilevel degenerative changes of the cervical spine are\nmoderate to severe including osteophytosis, facet hypertrophy, and disc space\nnarrowing. This results in multilevel neural foraminal narrowing, worse\nspanning C3-C7.\n\nNo prevertebral soft tissue swelling.\n\nThe visualized thyroid is unremarkable.\n\nScarring is noted at the lung apices bilaterally, unchanged compared to the\nprior exam.", "output": "1. No evidence of traumatic cervical malalignment or acute fracture.\n2. Moderate degenerative changes of the cervical spine, as detailed above." }, { "input": "Alignment is normal. No fractures are identified. A large bridging anterior\nosteophyte is seen at C5-6. Posterior osteophytes and mild disc bulge at C6-7\nresults in mild spinal canal narrowing. There is no neural foraminal\nnarrowing. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nThere is a 4 mm hypodense lesion in the inferior right thyroid lobe.\nAn azygos lobe is incidentally noted.", "output": "1. No evidence of acute hemorrhage or traumatic malalignment.\n2. Mild degenerative changes with disc osteophyte complex at C6-7 resulting in\nmild spinal canal narrowing." }, { "input": "Multilevel degenerative changes are seen including multilevel disc space\nnarrowing, worst C3 through C7. There is minimal retrolisthesis C3 over C4\nand mild anterolisthesis of C7 over T1, of indeterminate age, given lack of\npriors for comparison, but most likely degenerative. The facet joints are in\ngood alignment. No acute fracture is seen. There is no prevertebral edema.\n\nPartially imaged fractures of the bilateral maxilla and pterygoid plates,\nbetter seen on dedicated maxillofacial CT.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No acute fracture cervical spine seen.\n2. Multilevel degenerative changes. Minimal retrolisthesis of C3 over C4 and\nmild anterolisthesis of C7 over T1, of indeterminate age given lack of priors\nfor comparison, but most likely degenerative. Facet joints are in good\nalignment bilaterally.\n3. Partially imaged maxillofacial fractures are described in the dedicated\nmaxillofacial CT report." }, { "input": "There is minimal retrolisthesis of C5 over C6 for there is also disc space\nnarrowing and and mild endplate sclerosis. There also small anterior and\nposterior osteophytes at this level. No frank dislocation is seen.No acute\nfracture is identified.Facet arthropathy is noted, worst at C2 through the C4.\nThere is no prevertebral soft tissue swelling. Partially imaged thyroid gland\nappears mildly prominent but not fully imaged or well assessed on this study. \nNo discrete thyroid nodule is identified. Mild apical pleural thickening is\nseen although not much of the lung apices are included on the images. Carotid\nartery calcifications are seen.", "output": "1. No acute fracture. Minimal retrolisthesis of C5 over C6 is of\nindeterminate age, but likely degenerative. Degenerative changes.Partially\nimaged thyroid gland appears mildly prominent but not fully imaged or well\nassessed on this study, correlate with thyroid function tests non urgently. \nNo discrete thyroid nodule is identified" }, { "input": "Vertebral body heights are maintained and there is no evidence of fracture.\nIntervertebral disc space heights are maintained. There are however disk\nbulges at C4-C5 and C5-C6, which at the former level may contact the ventral\naspect of the cord. No acute alignment abnormality is identified.\n\nNo prevertebral soft tissue abnormality. No lymphadenopathy is present by CT\nsize criteria. The thyroid is unremarkable. The visualized lung apices are\nclear. Mild mucosal thickening is seen in the right sphenoid sinus.", "output": "No cervical spine fracture, acute alignment abnormality, or prevertebral soft\ntissue abnormality. Disc bulges at C4-C5 and C5-C6." }, { "input": "Alignment is normal. No fractures are identified.Moderate multilevel\ndegenerative changes are noted with loss of disc space, osteophyte formation,\nand uncovertebral hypertrophy. There is mild left C5-C6 neural foraminal\nnarrowing and mild to moderate bilateral C6-C7 neural foraminal\nnarrowing.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Scattered bilateral ground-glass opacities in\nthe upper lung apices is consistent with pulmonary edema noted on chest\nradiograph performed on the same day.", "output": "Minimal degenerative disc disease. Otherwise normal study of the cervical\nspine.\nPulmonary edema noted on limited imaging of the chest.." }, { "input": "Vertebral body heights and alignment are maintained. There is no evidence of\ncervical spine fracture. A well circumscribed lytic lesion at the C6\nvertebral body is unchanged from ___, as is a sclerotic focus in the C4\nvertebral body, both of uncertain clinical significance. Overall the\nvisualized osseous structures are mildly osteopenic. With numerous\nnonspecific, grossly stable lucent lesions seen throughout the cervical spine.\nThere is no prevertebral soft tissue swelling.\n\nThere is no evidence of critical bony spinal canal or neural foraminal\nnarrowing.\n\nThere are mild multilevel degenerative changes, not significantly changed from\n___, again noted to be most pronounced at the C6-7 and C7-T1 levels.\n\nWithin limits of this noncontrast exam there is no evidence of infection or\nneoplasm. Calcified scarring at the right lung apex is unchanged. The thyroid\nis unremarkable. There are dense calcification at the carotid bifurcations\nbilaterally.", "output": "1. No evidence of cervical spine fracture.\n2. Limited imaging of the lung apices again demonstrates nonspecific right\nlung apical calcified scarring. Recommend clinical correlation. If clinically\nindicated, recommend correlation with dedicated chest imaging.\n3. Grossly stable C6 vertebral body lytic lesion and C4 vertebral body\nsclerotic lesion, compared to ___ prior CT cervical spine study.\nAdditional nonspecific lucent lesions throughout cervical spine are also\ngrossly stable, and may represent focal osteopenia, degenerative change, or\npossible additional lesions. Recommend clinical correlation. If clinically\nindicated, further evaluation may be obtained via bone scan.\n4. Dense atherosclerotic calcifications of bilateral carotid bifurcations.\n5. Please see concurrently obtained head CT study with accession ___ for\ndescription of cranial structures.\n\nRECOMMENDATION(S): RE 2: Recommend clinical correlation. If clinically\nindicated, recommend correlation with dedicated chest imaging.\n\n RE 3: Recommend clinical correlation. If clinically indicated, further\nevaluation may be obtained via bone scan.\n\n RE 4: Recommend clinical correlation." }, { "input": "Alignment is similar to the previous examination with rotation of C1 on C2\nresulting with in anterior subluxation of the left lateral mass and posterior\nsubluxation of the right lateral mass relative to C2, unchanged.No fractures\nare identified. Overall, the visualized osseous structures are mildly\nosteopenic with numerous nonspecific lucent lesions seen throughout the\ncervical spine. Mild to moderate degenerative changes are seen in the cervical\nspine with loss of intervertebral disc height, subchondral sclerosis, and\nosteophyte formation.\n\nThere is multilevel mild-to-moderate vertebral canal narrowing due to\nposterior osteophyte formation and posterior disc bulges, notably at the C3-C4\nvertebral level with flattening of the spinal cord (series 3: Image 31). \nThere is severe neural foraminal stenosis at the right C3-C4 level due to\nuncovertebral and facet joint arthropathy.\n\nA well-circumscribed lytic lesion within the C4 and C6 vertebral bodies are\nunchanged since the prior study in ___. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. There is\npartial opacification of the right mastoid air cells. Pleural calcifications\nare re-demonstrated within the right apex. Atherosclerotic calcifications of\nthe carotid bifurcations are re-demonstrated.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Mild-to-moderate degenerative changes in the cervical spine with multilevel\nmild-to-moderate vertebral canal narrowing and severe right neural foraminal\nstenosis, notably at the C3-C4 vertebral level.\n3. Mild osteopenia with numerous nonspecific, lucent lesions seen throughout\nthe cervical spine, unchanged since ___." }, { "input": "There is straightening of the usual cervical lordosis with minimal focal\nkyphosis about the C6-7 level. Alignment is otherwise unremarkable. Apparent\nill-defined appearance of the superior endplate of the T1 vertebra is likely\ndue to a combination of demineralization and/or artifact. No fractures are\nidentified. There is no significant spinal canal narrowing. Neural foraminal\nnarrowing is worst and mild at the left C6-7 level due to uncovertebral and\nfacet hypertrophy. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nExtensive vascular calcifications are noted including calcification of the\nvertebral arteries. Thyroid and lung apices are unremarkable.", "output": "1. No acute fracture or acute malalignment.\n2. Extensive vascular calcifications can be seen in a patient with history of\ndiabetes. Correlation with clinical history is recommended." }, { "input": "There is minimal anterolisthesis of C3 on C4, C4 on C5 and C7 on T1.No\nfractures are identified.There are mild-to-moderate multilevel degenerative\nchanges including intervertebral disc height loss, osteophyte formation, and\nfusion of the C7-T1 facets bilaterally. There is no prevertebral soft tissue\nswelling.\nNew mild disc bulge at C2-3 does not contact the spinal cord. Facet and\nuncovertebral osteophytes produce mild left neural foraminal narrowing.\nAt C3-4, there is severe right and moderate left neural foraminal narrowing\ndue to uncovertebral and facet joints. Intervertebral osteophytes narrow the\nspinal canal but do not contact the spinal cord.\nCord at C4-5, disc bulge mildly narrows the spinal canal and slightly flattens\nthe anterior surface of the spinal cord. There is severe bilateral neural\nforaminal narrowing due to uncovertebral and facet osteophytes.\nC5-6, intervertebral osteophytes narrow the spinal canal and slightly flatten\nthe anterior surface of the spinal cord. Uncovertebral osteophytes produce\nsevere bilateral neural foraminal narrowing.\nC6-7, intervertebral osteophytes narrow the spinal canal and flatten the\nanterior surface of the spinal cord. There is moderate left and severe right\nneural foraminal narrowing due to uncovertebral osteophytes.\nAt C7-T1, subluxation minimally narrows the spinal canal. The left neural\nforamen is mildly narrowed.\nThe included portions of the upper thoracic spine demonstrate no spinal canal\nor neural foraminal narrowing.\nThere is no evidence of infection or neoplasm. The thyroid gland is\nmultinodular with individual nodules measuring up to approximately 1.3 cm.", "output": "1. No evidence of fracture.\n2. Mild degenerative subluxations at multiple levels.\n3. Multinodular thyroid gland with nodules measuring up to 1.3 cm. Per ACR\nrecommendations, no follow-up imaging is recommended." }, { "input": "Re-demonstrated is a burst fracture of the T12 vertebral body without evidence\nof retropulsion, which is grossly unchanged as compared to MRI ___, allowing for differences in technique between studies. There is\nfracture extension into the right facet(2:11) and a nondisplaced component\ninvolving the left lamina (2:12). There is a transversely oriented sclerotic\nline in the L1 vertebral body (602:47) compatible with a fracture, and\nminimally changed in morphology as compared to MRI ___. There is\na nondisplaced fracture of the spinous process and lamina of the T11 vertebral\nbody (2:5), not definitely visualized on MRI ___. There are\nnondisplaced fractures of both transverse processes of L1 (2:26 and 27), not\ndefinitely visualized on ___. Previously characterized posterior\nepidural hematoma is poorly evaluated on the CT scan.\n\nThere are acute mildly displaced fractures of the posterior aspect of the left\nseventh and eighth ribs (301:50 and 64), not included in the field of view on\n___.\n\nThere is grade 1 retrolisthesis L2 on L3 and grade 1 retrolisthesis of L3 on\nL4, unchanged from ___. There are severe degenerative changes at\nmultiple levels in lumbar spine including severe intervertebral disc space\nnarrowing, osteophyte formation, endplate irregularity, and facet arthropathy.\nThere is moderate spinal canal narrowing and neural foraminal stenosis at\nmultiple levels of the lumbar spine, better characterized on ___. \nThere is mild-to-moderate intervertebral disc space narrowing of the thoracic\nfindings.\n\nRe-demonstrated is a subtle cortically based mass in the left kidney (301:29)\nbetter characterized on ___. There is severe emphysema. There\nare small left and trace right bilateral pleural effusions with associated\natelectasis. There is severe background atherosclerotic disease. Within the\nlimitations of motion degradation, mitral annular, aortic valvular, and\ncoronary arterial calcifications are severe.", "output": "1. There are mildly displaced fractures of the posterior left seventh and\neighth ribs. These fractures were not included in the field of view on MRI ___.\n2. T12 burst fracture with extension into the right facet and left lamina is\ngrossly unchanged as compared to ___. No retropulsion.\n3. Transversely oriented fracture of the L1 vertebral body is grossly\nunchanged in morphology as compared to ___.\n4. Non-displaced fracture of the spinous process and bilateral lamina of T11\nand non-displaced fractures of both transverse processes of the L1 vertebral\nbody were not definitely visualized on ___.\n5. Previously characterized posterior epidural hematoma is poorly evaluated on\nthe CT scan. MRI can be considered for further characterization for\nevaluation of an epidural collection.\n6. Re-demonstration of a subtle cortically based mass in the left kidney,\nbetter characterized on ___, for which nonurgent MRI is\nrecommended for further characterization." }, { "input": "Re-demonstrated is a burst fracture of the T12 vertebral body without evidence\nof retropulsion, which is grossly unchanged as compared to MRI ___, allowing for differences in technique between studies. There is\nfracture extension into the right facet(2:11) and a nondisplaced component\ninvolving the left lamina (2:12). There is a transversely oriented sclerotic\nline in the L1 vertebral body (602:47) compatible with a fracture, and\nminimally changed in morphology as compared to MRI ___. There is\na nondisplaced fracture of the spinous process and lamina of the T11 vertebral\nbody (2:5), not definitely visualized on MRI ___. There are\nnondisplaced fractures of both transverse processes of L1 (2:26 and 27), not\ndefinitely visualized on ___. Previously characterized posterior\nepidural hematoma is poorly evaluated on the CT scan.\n\nThere are acute mildly displaced fractures of the posterior aspect of the left\nseventh and eighth ribs (301:50 and 64), not included in the field of view on\n___.\n\nThere is grade 1 retrolisthesis L2 on L3 and grade 1 retrolisthesis of L3 on\nL4, unchanged from ___. There are severe degenerative changes at\nmultiple levels in lumbar spine including severe intervertebral disc space\nnarrowing, osteophyte formation, endplate irregularity, and facet arthropathy.\nThere is moderate spinal canal narrowing and neural foraminal stenosis at\nmultiple levels of the lumbar spine, better characterized on ___. \nThere is mild-to-moderate intervertebral disc space narrowing of the thoracic\nfindings.\n\nRe-demonstrated is a subtle cortically based mass in the left kidney (301:29)\nbetter characterized on ___. There is severe emphysema. There\nare small left and trace right bilateral pleural effusions with associated\natelectasis. There is severe background atherosclerotic disease. Within the\nlimitations of motion degradation, mitral annular, aortic valvular, and\ncoronary arterial calcifications are severe.", "output": "1. There are mildly displaced fractures of the posterior left seventh and\neighth ribs. These fractures were not included in the field of view on MRI ___.\n2. T12 burst fracture with extension into the right facet and left lamina is\ngrossly unchanged as compared to ___. No retropulsion.\n3. Transversely oriented fracture of the L1 vertebral body is grossly\nunchanged in morphology as compared to ___.\n4. Non-displaced fracture of the spinous process and bilateral lamina of T11\nand non-displaced fractures of both transverse processes of the L1 vertebral\nbody were not definitely visualized on ___.\n5. Previously characterized posterior epidural hematoma is poorly evaluated on\nthe CT scan. MRI can be considered for further characterization for\nevaluation of an epidural collection.\n6. Re-demonstration of a subtle cortically based mass in the left kidney,\nbetter characterized on ___, for which nonurgent MRI is\nrecommended for further characterization." }, { "input": "THORACIC:\nA healing fracture line of the pedicles and spinous process of T11 is seen.\n\nA healing chronic burst fracture of T12 is seen, with sclerosis along the\nfracture line. There is anterior wedge deformity with approximately 30% loss\nof the vertebral height. No retropulsion is seen. Additionally, there are\nhealing fracture lines along the right transverse process of T12 and left T12\npedicle (2:87). There is moderate to severe spinal canal narrowing at T12-L1\ndue to posterior and bilateral facet osteophytes and thickening of the\nligamentum flavum.\n\nThere is dextroconvex curvature of the thoracic spine, with the apex at\nT12-L1. The alignment is normal.\n\nLUMBAR:\nA healing fracture line is seen across the L1 vertebral body with less than 5%\nloss of body height.\n\nThere is levoconvex curvature of the lumbar spine, with the apex at L4. There\nare mild retrolistheses of L2-3 and L3-4. Multilevel degenerative changes of\nthe lumbar spine are seen, resulting in moderate spinal canal narrowing at\nL1-2, L2-3, L3-4 and L4-5.\n\nOTHER:\nOld left seventh and eighth rib fractures are seen. A new 1.9 cm x 2.7 cm\nmass is seen in the right upper lobe (02:59). Coronary artery calcifications\nare seen. Bibasilar pulmonary scarring is seen. A 2 cm mass is\nre-demonstrated in the left kidney. Calcified atherosclerotic changes of the\nabdominal aorta and a arteries are seen. There is a 1.9 cm aneurysm of the\nright common iliac artery and a 2.1 cm aneurysm of the left common iliac\nartery. The posterior soft tissues demonstrate two oval-shaped nodular\nlesions measuring approximately 24 x 11 and 26 x 12 mm in sagittal projection\n(series 6, image 65), unchanged since the prior MRI examination in ___, probably consistent with sebaceous cysts.", "output": "1. Healing fractures of the T11 posterior elements, T12 vertebral body,\ntransverse process and pedicle and L1 vertebral body.\n2. Anterior wedge compression deformity of T12 with approximately 30% loss of\nthe vertebral body height.\n3. New 1.9 x 2.7 cm mass in the right upper lobe. This may be neoplastic in\netiology or infectious. Further evaluation with a chest CT with contrast is\nrecommended.\n4. Unchanged 2 cm left renal mass.\n5. Degenerative changes of the lower thoracic and lumbar spine with moderate\nto severe spinal canal narrowing at T12-L1, L1-2, L2-3, L3-4 and L4-5." }, { "input": "There is no evidence of acute fracture. There is fusion of the anterior\nT10/T11 vertebral bodies with kyphosis at this level, chronic in nature. \nSmall multilevel Schmorl's nodes are seen. There is no prevertebral soft\ntissue swelling. There is minimal bibasilar atelectasis. Included soft\ntissues are otherwise unremarkable.", "output": "1. No acute fracture.\n2. Fusion of the anterior endplates of the T11/10 vertebral bodies with\nkyphosis centered at this level. Multilevel small Schmorl's nodes." }, { "input": "The visualized intra-abdominal organs are unremarkable.\n\nThere is a limbus vertebra at L4. There are multiple Schmorl's nodes most\npronounced at L5, L4 and L2. There is no definite acute fracture seen. There\nis no prevertebral soft tissue swelling. Vertebral body alignment is\nmaintained.", "output": "1. No acute fracture seen.\n2. Schmorl's nodes at multiple levels with a limbus vertebra at L4." }, { "input": "There is a slight irregularity of the spinous process of C6 of indeterminate\nage. There is no fracture line seen. There is no additional evidence of acute\ncervical spine fracture or dislocation. Vertebral body heights are maintained.\nThere is no prevertebral soft tissue swelling. There are no significant\ndegenerative changes. The lung apices are clear. The thyroid is homogeneous.", "output": "1. Slight irregularity of the spinous process of C6 without clear fracture\nline seen, is age indeterminate, correlate with site of pain.\n2. No evidence of acute fracture seen elsewhere. No dislocation." }, { "input": "There is no evidence of acute fracture or traumatic malalignment. Diffuse\nsclerotic metastases are again seen throughout the cervical spine in an\noverall similar distribution compared MRI the cervical spine on ___ are comparison is difficult to differences in technique. Sclerotic\nlesions are also seen in the clivus and skullbase. Vertebral heights are\nmaintained. CT is not able to provide intrathecal detail compared to MRI, but\nthe visualized outline of the thecal sac appears unremarkable. No\nlymphadenopathy is present by CT size criteria. The lung apices are clear. \nThe thyroid is heterogeneous and mildly enlarged.", "output": "1. No acute fracture or traumatic malalignment\n2. Diffuse sclerotic metastases - no pathological fracture." }, { "input": "The bones appear demineralized. No acute displaced fracture is seen. \nVertebral body heights are preserved. There is mild anterolisthesis of C4 on\nC5. There is no evidence for prevertebral edema or disc space widening.\nCalcified pannus at the atlantoaxial joint, suggestive of CPPD arthropathy,\ndoes not cause significant spinal canal narrowing. There are disc protrusions\nand endplate osteophytes from C2-C3 through C5-C6 with moderate spinal canal\nnarrowing at C2-C3. There is multilevel neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nThere are multiple pulmonary nodules in the included apical upper lobes,\nmeasuring up to 3 mm, series 2, images 61, 62, 63, 65, 66, unchanged compared\nto the prior chest CT. There are thyroid nodules measuring up to 6 mm on the\nleft on image 3:62.", "output": "1. No fracture or traumatic malalignment.\n2. Minimal 2 mm of anterolisthesis C4 on C5 is likely degenerative.\n3. Multiple pulmonary nodules in the included apical upper lobes, measuring up\nto 3 mm are unchanged compared to the ___ chest CT. Please note that a\nfollow up chest CT in 12 months was recommended in the ___ chest CT\nreport.\n4. Subcentimeter thyroid nodules. The ___ College of Radiology guidelines\nsuggest that in the absence of specific personal risk factors for thyroid\ncancer, no further evaluation is recommended for nodules smaller than 15 mm in\nthis age group." }, { "input": "There is an age indeterminate anterior wedge deformity in of C7, with minimal\nretropulsion and apparent pressure lucencies through the superior endplate. .\nThere is no significance spinal canal narrowing. There is no prevertebral\nsoft tissue swelling. There is mild multilevel anterolisthesis, measuring up\nto to 2 mm with small multilevel degenerate osteophytes as well as facet\ndegenerative changes and ankylosis at multiple levels. The thyroid is\nunremarkable.", "output": "1. Age-indeterminate anterior C7 wedge deformity, with suggestion of a linear\nfracture lucency through the superior endplate, but potentially subacute. No\nspinal canal stenosis or prevertebral soft tissue swelling.\n2. Multilevel degenerative changes.\n\nRECOMMENDATION(S): If clinically indicated an MRI may be obtained, if there\nare no contraindications.\n\nNOTIFICATION: The findings were discussed by Dr. ___ with Dr. ___ on\nthe telephone on ___ at 5:38 ___, 5 minutes after discovery of the\nfindings." }, { "input": "No fractures or malalignment identified. There is no prevertebral soft tissue\nswelling. There is no significant evidence of spinal canal or neural\nforaminal narrowing. The lung apices are clear. The thyroid is normal. Small\ncystic structure anterior to the trachea at the level of the thyroid measuring\n7 mm is noted. This may be a nodule in the pyramidal lobe.", "output": "No evidence of fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. There is dependent atelectasis, otherwise, the lungs\nare clear. The visualized abdomen is normal.", "output": "No fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing.", "output": "No fracture or malalignment." }, { "input": "No traumatic malalignment is identified.No fractures are identified.There is\nno prevertebral soft tissue swelling.\nMild posterior narrowing of disc space at C3-4 and C4-5 are likely\ndegenerative. Severe degenerative changes of the cervical spine is notable for\nendplate and uncovertebral joint osteophytes causing severe neural foraminal\nnarrowing on the right side at C5-6.", "output": "No fracture is identified." }, { "input": "Motion artifact limits assessment. There is minimal retrolisthesis of C5 on\nC6, and C6 on C7, with loss of cervical lordosis.\n\nThere is a small fragmented/fractured osteophyte with respect to the left\nsuperior articular process of C4 about the left C3/C4 facet joint (602:44,\n2:36), age indeterminate but likely not acute given sclerotic remodeling, and\na lack of adjacent soft tissue changes. There is no involvement of the\nforamen transversarium.\n\nThere are multilevel degenerative anterior and posterior disc osseous complex,\nuncovertebral and facet arthrosis, most severe between C5/C6, C6/C7, causing\nup to moderate narrowing of the neural foramina, and mild-to-moderate\nnarrowing of the central canal.\n\n3.9 x 3.4 cm hypodense partially calcified left thyroid nodule (3:60),\ndisplacing the trachea to the right. Bubble of gas within the left subclavian\nvein, likely related to IV/line placement (image 67, series 3). Few\nbenign-appearing jugulodigastric and level 2 lymph nodes.\n\nLeft maxillary sinus Findings described on dedicated CT facial bone report.", "output": "1. Fragmented/fractured osteophyte with respect of the left superior articular\nprocess of C4, age indeterminate, but likely not acute. No acute fractures\notherwise.\n2. 3.9 cm left thyroid nodule. Further evaluation with dedicated thyroid\nultrasound is recommended.\n3. Multilevel degenerative changes, most pronounced at C5/C6 and C6/C7,\ncausing up to moderate narrowing of the neural foramina, and mild-to-moderate\nnarrowing of the central canal." }, { "input": "The patient is status post L5-S1 posterior fixation with bilateral pedicle\nscrews and an interbody spacer. There is no evidence of hardware failure or\nloosening. Alignment is normal. Moderate degenerative changes at L5-S1 include\nsubchondral sclerosis and endplate irregularity. Facet arthropathy and a\nposterior disc bulge cause mild spinal canal and moderate neural foraminal\nstenosis bilaterally at L4-L5. Please note that MR is more sensitive for\nspinal canal and neural foraminal stenoses.\n\nThe fractures of the the right L3 transverse process and the right eleventh\nand twelfth ribs are unchanged from prior studies. No new fractures are\nidentified. The fluid collection in the posterior subcutaneous tissues has\ndecreased compared with the immediate prior study. A splenic artery\nembolization plug is incidentally noted (07:52).", "output": "1. Moderate degenerative changes at L5-S1 with no evidence of hardware\nloosening or failure.\n2. Mild spinal canal and moderate neural foraminal stenoses at L4-L5.\n3. Unchanged right L3 transverse process, right eleventh rib, and right\ntwelfth rib fractures. No new fracture is identified." }, { "input": "Alignment is normal. No acute fractures are identified. There is\nintervertebral disc space narrowing, endplate irregularity, and osteophyte\nformation at multiple levels of the cervical spine, most severe at C5-C6,\nconsistent with degenerative change. There is uncovertebral hypertrophy and\nfacet arthropathy at C5-C6. There is no prevertebral soft tissue swelling. \nThe partially visualized lung apices are unremarkable.", "output": "No acute fracture or malalignment. Degenerative changes." }, { "input": "Motion artifact related to the air digestive tract mildly limits evaluation\nfrom C3 through C6. Streak artifact from dental amalgam mildly limits\nevaluation at C2.\n\nThere is no evidence for a fracture or prevertebral soft tissue swelling. No\nsubluxation allowing for motion artifact. There is a levoconvex curvature of\nthe cervical spine and an incompletely imaged dextroconvex curvature of the\nupper thoracic spine. Disc protrusions mildly indent the ventral thecal sac\nat C2-C3 and C3-C4. No high-grade spinal canal stenosis is seen within the\nlimits of CT.\n\nThere is minimal scarring at the left lung apex. The thyroid is grossly\nunremarkable. No lymphadenopathy by CT criteria. 2 mm right submandibular\ngland sialolith is noted, image 3:35. Concurrent head CT is reported\nseparately.", "output": "1. Motion limited exam. No evidence for a fracture or subluxation.\n2. 2 mm right submandibular gland sialolith." }, { "input": "There is reversal of normal cervical lordosis, likely related to collar. No\nfractures are identified.No significant degenerative changes are noted. There\nis no evidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.The imaged thyroid gland and lung apices are\nunremarkable.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Nuchal\nligament calcifications seen.\n\nMultilevel degenerative disc disease, most severe at C6-7. Small posterior\nintervertebral osteophytes, but no high-grade spinal canal stenosis. \nUncovertebral and facet osteophytes cause mild-to-moderate neural foraminal\nstenosis at multiple levels. Partial opacification of the mastoid air cells\non the left.\n\nMetallic artifact is seen adjacent to a large mass, which appears to be\narising from the left lobe of the thyroid causing rightward deviation of the\ntrachea, measuring 4.2 x 3.0 cm (series 2, image 62). Partially visualized\nlung apices are within normal limits. No cervical lymphadenopathy.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Multilevel multifactorial mild-to-moderate degenerative changes.\n3. Large heterogeneous left lobe of the thyroid measuring up to 4.2 cm, and\ncausing rightward deviation of the trachea, which should be followed up with a\nthyroid ultrasound on a nonemergent basis, if not already performed.\n\nRECOMMENDATION(S): Thyroid ultrasound on a nonemergent basis.\n Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no cervical fracture. There is no abnormal prevertebral soft tissue\nswelling or edema. Multilevel mild to moderate degenerative changes are most\nsevere at the C6-C7 level with endplate sclerosis and intervertebral disc\nspace loss. No high-grade central canal or neural foraminal stenosis is\nevident. Minimal anterolisthesis of C7 on T1 is unchanged, degenerative in\netiology.\n\nClips are noted within the thyroid bed with apparent absence of the right\nthyroid gland and heterogeneously enlarged left thyroid lobe measuring\napproximately 2.4 x 4.0 cm (03:59). This results in mild rightward shift of\nthe upper trachea, unchanged. There is no cervical adenopathy. Moderately\nsevere calcifications involve the carotid bulbs bilaterally. Lung apices are\nclear. Nuchal ligament calcifications are unchanged.", "output": "1. No acute cervical fracture or malalignment.\n\n2. Enlarged heterogeneous left thyroid lobe results in mild rightward\ndeviation of the trachea. If not already performed, this should be further\nevaluated with ultrasound on a nonemergent basis.\n\nRECOMMENDATION(S): Thyroid ultrasound." }, { "input": "This examination is mildly limited due to motion artifact. Within these\nlimitations:\n\nAlignment is normal. No fractures are identified.There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nModerate degenerative changes throughout the cervical spine, most severe at\nC6-7. Small posterior intervertebral osteophytes, but no high-grade spinal\ncanal stenosis. There is also multilevel mild-to-moderate neural foraminal\nstenosis due to a combination of uncovertebral and facet osteophytes.\n\nLarge heterogeneous left thyroid nodule measuring 4.1 x 3.7 cm in maximum\naxial ___ with rightward deviation of the trachea. The patient is\nstatus post right hemithyroidectomy. Adjacent surgical clips are seen. No\ncervical lymphadenopathy.\n\nSmooth septal thickening at the bilateral lung apices likely reflects fluid\noverload. There are multiple punctate pulmonary nodules on the right\nmeasuring up to 4 mm (series 301, image 83). Partial opacification of the\nleft mastoid air cells re-demonstrated. Severe atherosclerotic calcification\nof the aortic arch and at the origin of the head and neck vessels.", "output": "1. Mildly limited examination due to motion artifact. Within these\nlimitations, no evidence of fracture or traumatic malalignment.\n2. Large heterogeneous left thyroid nodule measuring up to 4.1 cm with\nrightward deviation of the trachea.\n3. Smooth septal thickening at the bilateral lung apices, likely reflecting\nfluid overload.\n4. Right pulmonary nodules measuring up to 4 mm, for which no specific follow\nup is recommended in a low risk patient.\n\nRECOMMENDATION(S): For incidentally detected multiple solid pulmonary nodules\nsmaller than 6mm, no CT follow-up is recommended in a low-risk patient, and an\noptional CT follow-up in 12 months is recommended in a high-risk patient.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nUltrasound of the thyroid gland is also recommended for further evaluation." }, { "input": "There is minimal anterolisthesis of C4 on C5. There is a subtle superior\nendplate compression fracture of C7 vertebral body (02:56). No associated\nretropulsion or alignment abnormality.\n\nNo fractures are identified.There is no significant canal or foraminal\nnarrowing.There is no prevertebral edema. Moderate degenerate changes,\nincluding loss of intervertebral disc space height, is most notable at C5-C6.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Mild superior endplate compression deformity of C7 is likely acute or\nsubacute. No associated alignment abnormality or retropulsion.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 6:08 pm." }, { "input": "There is dislocation of the right C4-C5 facet joint with moderate\nanterolisthesis of C4 on C5 measuring approximately 5 mm. There is\nhyperdense thickening posterior to the C4-C5 joint space with flattening of\nthe anterior spinal canal; epidural hematoma is probable. In addition, the\ndislocation encroachs on the right transverse foramina and injury to the right\nvertebral artery at this level is not excluded. There is minimal prevertebral\nsoft tissue swelling. Multilevel background degenerative changes are\nmoderate. Bilateral neural foraminal narrowing is moderate at multiple\nlevels. There is a broad-based central disc bulge at C5-C6 indents the\nanterior thecal sac.\nBilateral dependent parenchymal opacities in the lungs are likely from\naspiration.", "output": "1. Right C4-5 facet dislocation with anterolisthesis of C4 on C5. Effacement\nof the anterior thecal sac at this level raises concern for epidural\nhematoma. Recommend further evaluation with MRI.\n2. Consider CTA to further assess right vertebral artery - given potential for\nvascular injury.\n3. Extensive bilateral dependent parenchymal lung opacities, likely from\naspiration.\n\nNOTIFICATION: The findings, impression, and images were discussed with Dr.\n___. by ___, M.D. in person on ___ at 1835h, 1\nminutes after discovery of the findings.\nThe CTA recommendation and possible right vertebral artery injury was\ndiscussed with Dr. ___ on the telephone by Dr. ___ on ___ at 754\npm." }, { "input": "There is no acute fracture or traumatic malalignment of the cervical spine. \nThere is no prevertebral soft tissue swelling. Multilevel degenerative disc\ndisease is noted, most evident at C5-C6 and C6-C7 demonstrating intervertebral\ndisc height loss with endplate sclerosis and subcortical cystic changes. \nThere is also mild bilateral neural foraminal narrowing at C5-C6 secondary to\nuncovertebral hypertrophy. Mild C4-C5 anterolisthesis is also noted. There\nis no spinal canal stenosis. There is no evidence of infection or neoplasm.", "output": "1. No acute fracture or traumatic malalignment of the cervical\n2. Multilevel degenerative disc disease most evident at C5-C6 demonstrating\ndisc height loss and mild bilateral neural foraminal narrowing." }, { "input": "There is mild anterolisthesis of C7 on T1, likely degenerative and chronic in\netiology. Otherwise, alignment is normal. No fractures are\nidentified.Multilevel moderate degenerative changes are seen, most extensive\nat C4-5 through C6-7 and notable for intervertebral disc height loss, endplate\nirregularity, and osteophyte formation. Multilevel mild central canal\nstenosis is most pronounced at C5-6 and C6-7. Additionally, mild right neural\nforaminal narrowing at C5-6 and bilateral neural foraminal narrowing at C6-7\ndue to uncovertebral spurring is demonstrated.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable apart from minimal\nlinear hyperdensity in the right apex, of doubtful clinical significance.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.No significant degenerative\nchanges are noted. No evidence of critical spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling. There is no evidence\nof infection or neoplasm.\n\nThe thyroid and visualized lung apices are unremarkable. Partial\nopacification of the right inferior mastoid air cells suggests ongoing\ninflammation.", "output": "No fracture or subluxation identified." }, { "input": "Dental amalgam streak artifact and motion limits study. There is minimal\nanterolisthesis of C3-C4 vertebral level is again seen.No fractures are\nidentified. There is near complete fusion of the C4 and C5 vertebral bodies\nagain noted. Fusion of bilateral C2-3 facets are again noted. Schmorl's\nnodes and endplate sclerosis are not seen throughout the cervical spine.\n\nThere is loss of intervertebral disc height throughout the cervical spine with\nvacuum disc phenomena noted at C5-6 and C6-7.\n\nAt C2-3 there is no bony vertebral canal or neural foraminal narrowing.\n\nAt C3-4 again is noted disc bulge, better seen on recent cervical spine MRI,\nand facet joint hypertrophy, with at least mild vertebral canal and at least\nmoderate bilateral neural foraminal narrowing.\n\nAt C4-5 disc osteophyte complex and facet joint hypertrophy result in at least\nmild vertebral canal narrowing and no definite evidence of bony neural\nforaminal narrowing.\n\nAt C5-6 there is disc osteophyte complex, facet joint hypertrophy, at least\nmild vertebral canal and at least moderate bilateral bony neural foraminal\nnarrowing.\n\nAt C6-7 there is disc osteophyte complex, facet joint hypertrophy, with at\nleast mild spinal canal and at least moderate bilateral bony neural foraminal\nnarrowing.\n\nAt C7-T1 there is no definite bony vertebral canal or neural foraminal\nnarrowing.\n\n There is no prevertebral soft tissue swelling.Within the limits of this\nnoncontrast study, there is no evidence of infection or neoplasm. Limited\nimaging lungs demonstrate scarring is seen in the right lung apex. There is a\n1.3 cm hypodensity in the left thyroid lobe (03:58).", "output": "1. Dental amalgam streak artifact and motion limits study.\n2. No acute fracture traumatic malalignment.\n3. Moderate cervical spondylosis with multilevel mild-to-moderate bony\nvertebral canal and moderate neural foraminal stenosis, as above, and better\nevaluated on the dedicated MR ___ from ___.\n4. 1.3 cm left thyroid lobe lesion. Please see recommendations below.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Streak artifact from dental amalgam substantially limited evaluation at C2. \nThere is also mild motion artifact related to the aerodigestive tract at C5\nthrough C7.\n\nThe bones are demineralized. No displaced fracture is seen. No evidence for\nprevertebral edema. Minimal anterolisthesis of C4 on C5 without disc space\nwidening or distraction of the posterior elements. Disc space narrowing is\nmild at C4-C5, and severe at C3-C4, C5-C6 through C7-T1. Evaluation of spinal\ncanal detail is technically limited. Disc protrusions and endplate\nosteophytes indent the ventral thecal sac with up to moderate spinal canal\nnarrowing at C6-C7. There is multilevel neural foraminal narrowing by\nuncovertebral and facet osteophytes.\n\nIncluded lung apices demonstrate extensive interstitial septal thickening with\nsuperimposed ground-glass opacities and left greater than right traction\nbronchiectasis, as well as solid subpleural airspace opacity in the superior\nsegment of the left lower lobe, unchanged compared to the ___\nchest CT allowing for differences in technique.\n\nThere is bilateral medialization of the carotid arteries, which indent the\nposterior pharyngeal wall.\n\nThere are right thyroid nodules, measuring up to 11 mm on the prior chest CT,\nwhich not warrant sonographic evaluation in this age group according to the\nACR guidelines.\n\nConcurrent head CT is reported separately.", "output": "1. Streak artifact from dental amalgam substantially limited evaluation at C2.\nThere is also mild motion artifact related to the aerodigestive tract at C5\nthrough C7. \\\n2. No evidence for a fracture.\n3. Minimal anterolisthesis of C4 on C5 is almost certainly degenerative,\nthough there are no comparison exams to confirm chronicity.\n4. Interstitial lung disease with traction bronchiectasis at left greater than\nright lung apices is similar to the ___ chest CT allowing for\ndifferences in technique.\n5. Right thyroid nodules, up to 11 mm on the recent chest CT, which do not\nwarrant sonographic evaluation in this age group according to the ACR\nguidelines." }, { "input": "There is loss of the normal lumbar lordosis, mild anterolisthesis at L4-L5\nlevel, likely degenerative with no evidence of spondylolysis. Multilevel,\nmultifactorial degenerative changes are visualized throughout the lumbar\nspine, including diffuse osteopenia and sclerotic changes.\nThere is no evidence of abnormal enhancement after contrast administration.\n\nAt T11 T12, there is mild irregular contour of the endplates, consistent with\nSchmorl's node, there is no evidence of spinal canal stenosis or neural\nforaminal narrowing.\n\nAt T12-L1 level, there is mild narrowing of the intervertebral disc space and\nmild diffuse disc bulge with no evidence of neural foraminal narrowing or\nspinal canal stenosis.\n\nAt L1-L2 level, there is Schmorl's node and diffuse disc bulge causing mild\nleft-sided neural foraminal narrowing (2:32), there is no evidence of central\nspinal canal stenosis.\n\nAt L2-L3 level, there is anterior and posterior spondylosis, narrowing of the\nintervertebral disc space and diffuse disc bulge causing moderate bilateral\nneural foraminal narrowing, there is mild bilateral articular joint facet\nhypertrophy resulting in mild spinal canal stenosis (2:144).\n\nAt L3-L4 level, there is small Schmorl's node, anterior and posterior\nspondylosis, diffuse disc bulge causes moderate bilateral neural foraminal\nnarrowing (2: 156), there is mild bilateral articular joint facet hypertrophy\nresulting in mild spinal canal stenosis.\n\nAt L4-5 level, there is diffuse disc bulging causing moderate bilateral neural\nforaminal narrowing, additionally there is articular joint facet hypertrophy\nand ligamentum flavum thickening resulting in moderate spinal canal stenosis\n(2:168).\n\nAt L5-S1 level, there is diffuse disc bulge causing moderate bilateral neural\nforaminal narrowing, there is moderate articular joint facet hypertrophy and\nligamentum flavum thickening causing mild to moderate spinal canal stenosis.\n\nThe sacroiliac joints are unremarkable. Small punctate vascular\natherosclerotic calcifications are seen in the abdominal aorta and iliac\narteries.", "output": "1. Mild anterolisthesis at L4-L5 level, likely degenerative, with no evidence\nof spondylolysis.\n2. Multilevel, multifactorial degenerative changes throughout the lumbar\nspine, including diffuse osteopenia and sclerotic changes, more significant\nfrom L2-L3 through L5-S1 levels.\n3. There is no evidence of abnormal enhancement after contrast administration." }, { "input": "There is mild anterolisthesis of C2 relative to C3, minimal anterolisthesis of\nC3 relative to C4, most likely degenerative. There is multilevel loss of disc\nheight with extensive anterior and posterior osteophytosis resulting in mild\nspinal canal narrowing in multiple levels. Moderate central canal narrowing\nis seen at C6/C7. There is no prevertebral soft tissue swelling. No acute\nfracture identified. There is multilevel bilateral facet bony spurring. \nThere is multilevel moderate to severe neuroforaminal narrowing worse\nbilaterally C3-4 and C4-5.\n\nA small 9 mm subcutaneous lesion likely represents a sebaceous cyst along the\nleft inferior occiput (series 3, image 20).", "output": "1. No acute fracture or dislocation. Multilevel moderate to severe\ndegenerative change with multilevel anterolisthesis and moderate to severe\nneuroforaminal narrowing worse at C3-4 and C4-5 and mild to moderate central\ncanal narrowing, worst at C6/C7." }, { "input": "Mild anterolisthesis of C3 on C4 and retrolisthesis of C4 on C5 is more\naccentuated than on prior, likely due to progressive degenerative changes at\nthese levels, notable for right greater than left facet joint hypertrophy at\nC3-4. Intervertebral disc height loss with posterior osteophytes and left\ngreater than right uncovertebral joint hypertrophy seen at C4-5 and less\nextensively at C5-6 as well. Severe left foraminal narrowing noted at C4-5. \nElsewhere, vertebral bodies are well aligned.\n\nThere is no prevertebral edema. Retropharyngeal course of the right common\ncarotid artery is noted. Atherosclerotic calcifications seen at the carotid\nbulbs bilaterally. Thyroid is unremarkable. Lung apices are within normal\nlimits given respiratory motion. There is a 9 mm nodule in the superficial\nportion of the right parotid gland, unchanged since ___ and is most likely an\nintra parotid lymph node. Degenerative changes seen at the left\ntemporomandibular joint.", "output": "Degenerative changes without fracture or traumatic malalignment." }, { "input": "There are 5 lumbar-type vertebrae. There are laminectomies at L3 and L4. \nThere is instrumented posterior fusion of L4 and L5 with paired pedicle\nscrews, which was present on the ___ radiographs. The hardware is\nwell positioned without evidence for loosening or other complications.\n\nThere is relatively hypodense material extending from the laminectomy beds\ninto the midline posterior paravertebral tissues, 2.4 cm AP x 1.8 cm\ntransverse in maximal axial cross-section on image 3:46. In the absence of\nintravenous contrast, it is not clear whether this is granulation tissue or\npostsurgical seroma. There is also minimal low density in the midline\nsubcutaneous fat at the L3-4 level, which may represent variation tissue or\nminimal fluid, surrounding by mild scarring in the subcutaneous fat.\n\nThere is minimal retrolisthesis of L3 on L4, grade 1 anterolisthesis of L4 on\nL5, unchanged compared to the ___ radiographs. There is also\nminimal retrolisthesis of L5 on S1, not adequately assessed on the prior\nradiographs, but present on the ___ MRI. Vertebral body heights are\nnormal. No concerning bone lesions are seen.\n\nEvaluation of the spinal canal or neural foramina by CTs limited compared to\nMRI.\n\nNo significant spinal canal or neural foraminal narrowing is seen from T12-L1\nthrough L2-3 levels.\n\nAt L3-4, there is a minimal retrolisthesis with a mild disc bulge, as well as\nbilateral facet arthropathy. The spinal canal is decompressed by the\nlaminectomies. Neural foramina are mildly narrowed.\n\nAt L4-5, there is a grade 1 anterolisthesis and facet arthropathy. Evaluation\nof the spinal canal is limited by hardware related artifact. The neural\nforamina are mildly foreshortened without evidence for significant narrowing.\n\nAt L5-S1, there is a minimal retrolisthesis with a mild disc bulge and\nadvanced , right greater than left facet arthropathy. No spinal canal\nnarrowing is seen. There is mild to moderate right and mild left neural\nforaminal narrowing.\n\nThere are mild degenerative changes in the partially visualized sacroiliac\njoints.\n\nThere is a 4 mm circumscribed hypodense lesion in the lateral aspect of the\nright hepatic lobe at the level of the portal vein, image 3:2, which is not\nfully characterized, but statistically likely to represent a cyst or\nhemangioma. There is a bilobed hypodense lesion in the lower right hepatic\nlobe measuring 2.2 x 1.1 cm on image 3:20, slightly denser than expected for\nsimple cyst. The latter lesion is partially visualized on the localizer\nsequence of the ___ MRI, but not adequately characterized.\n\nIn the lower pole of the left kidney, there is a 4.0 x 3.8 x 2.5 cm\ncircumscribed exophytic lesion with density compatible with a simple cyst,\nthough not fully evaluated in the absence of intravenous contrast. \nDiverticula are noted in visualized portions of the colon. Vascular\ncalcifications are noted.", "output": "1. S/p L3 and L4 laminectomies with instrumented posterior fusion at L4-5. No\nevidence for hardware related complications. Unchanged alignment since\n___.\n2. Small amount of hypodense material extending from the laminectomy beds into\nthe midline posterior paravertebral tissues. In the absence of intravenous\ncontrast, it is not clear whether this represents granulation tissue or a\npostsurgical seroma.\n3. Minimal hypodensity in the midline subcutaneous fat at L3-4. In the\nabsence of intravenous contrast, it is not clear whether this represents fluid\nand granulation tissue.\n4. Evaluation of the spinal canal at L4-5 is limited by hardware related\nartifact. No significant spinal canal narrowing is seen at other lumbar\nlevels, within the limits of noncontrast CT.\n5. At L3-4, there is mild to moderate right and mild left neural foraminal\nnarrowing, similar to the prior MRI.\n6. Incompletely characterized bilobed 2.2 x 1.1 cm lesion in the lower right\nhepatic lobe.\n\nRECOMMENDATION(S):\n1. If clinically warranted, lumbar spine MRI could be obtained for better\nevaluation of the granulation tissue versus fluid extending from the\nlaminectomy beds into the posterior paravertebral tissues, and in the\nsubcutaneous fat. The spinal canal at ___ also be better assessed on\nMRI.\n2. Ultrasound is suggested for further characterization of the bilobed right\nlower hepatic lesion, if it was not previously characterized elsewhere." }, { "input": "Alignment is normal. No fractures are identified. There are moderate\nmultilevel degenerative changes as evidenced by loss of intervertebral disc\nspace height, endplate sclerosis and anterior and posterior osteophyte\nformation. There is mild retrolisthesis of C3 on C4 and C4 on C5, likely\ndegenerative. There is moderate neural foraminal narrowing bilaterally at\nC4-5 due to uncovertebral and facet osteophytes. There is mild to moderate\nmultilevel canal narrowing due to intervertebral osteophytes, most pronounced\nat C3-4 and C4-5. There is no prevertebral soft tissue swelling.\n\nThere is a 1.2 cm spiculated nodule in the right lung apex (___).", "output": "1. No acute fracture or traumatic malalignment.\n2. 1.2 cm spiculated nodule in the right lung apex. Recommend correlation\nwith prior imaging or history of surgery to assess stability. Otherwise,\nrecommend a dedicated chest CT for further evaluation.\n3. Moderate multilevel degenerative disease, most pronounced at C4-5.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Society Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___" }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nPartially visualized at least 1.2 cm nodule noted in the right lobe of the\nthyroid.", "output": "1. No cervical spine fracture or malalignment.\n2. Partially visualized 1.2 cm thyroid nodule. As the entire nodules not\nvisualized, nonurgent thyroid ultrasound could be performed to further\ncharacterize." }, { "input": "Minimal anterolisthesis of C4 on C5 is indeterminate in chronicity, but may be\nrelated to degenerative changes. Alignment is otherwise normal.No fractures\nare identified.There are mild multilevel degenerative changes of the cervical\nspine with diffuse disc height loss and small anterior and posterior\nintervertebral osteophytes. Posterior intervertebral osteophytes cause mild\nto moderate canal narrowing at the C3-4 through C6-7 levels. Uncovertebral\nand facet hypertrophy cause neural foraminal narrowing several levels, severe\nat the left C3-4 level and left C4-5 level. There is no prevertebral soft\ntissue swelling.\n\nImaged lung apices are clear. Thyroid gland is unremarkable. No cervical\nlymphadenopathy.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Multilevel moderate degenerative changes. Minimal C4 on C5 anterolisthesis\nis likely degenerative in etiology." }, { "input": "Study is very limited due to limitations of patient positioning and\nconsiderable resultant artifact, limiting assessment of bone and soft tissue\ndetail.\n\nAllowing for this, there is an acute comminuted fracture of the radial head\nextending to the articular surface. There is a 9 mm bony fragment\nposterolateral to the capitulum -- as there is no obvious distal humeral donor\nsite, this likely arises from radial head. On the available images, the\ncoronoid process is grossly intact. However, due to the limitations of the\nstudy, a small coronoid fracture cannot be excluded. Remainder of the\nproximal ulna is intact. The ulnar trochlear articulation and, allowing for\nthe radial head fracture, the radio capitellar articulation both appear\ngrossly congruent.\n\nLimited assessment of surrounding soft tissue depicts a small amount of elbow\njoint effusion and considerable soft tissue swelling about the elbow.", "output": "1. Acute comminuted fracture of the radial head with intraarticular extension.\nLargest bony fragment measures up to 9 mm and is displaced to lie adjacent to\nthe capitulum. This results in a relatively sizable defect involving the\narticular surface of the radial head.\n2. No large coronoid process fracture detected, though a tiny coronoid process\nfracture cannot be entirely excluded. Please see comment above." }, { "input": "There is no traumatic malalignment No acute fractures are identified.There is\nmultilevel degenerative changes of the cervical spine with vertebral body and\ndisc space height loss, worst at C5 through T1, resulting in moderate spinal\ncanal stenosis due to disc bulge and uncovertebral hypertrophy. There is\nmild-to-moderate narrowing of the left neural foramen at C3-C4, C4-C5 and\nC5-C6. There is no prevertebral soft tissue swelling.The imaged portion of the\nlung apices are clear. The thyroid is unremarkable. Mild calcifications at\nthe carotid bulbs are seen.", "output": "1. No acute traumatic malalignment or acute fracture." }, { "input": "There are 5 lumbar-type vertebral bodies. No fractures are identified. Mild\nanterolisthesis of L5 on S1 is noted with mild to moderate degenerate changes\nat this level. Multilevel degenerative changes are also noted with multiple\ndisc bulges, not well assessed by CT. Spinal canal narrowing is seen at L3-L4\nand L4-L5. There is no evidence of infection or neoplasm. The SI joints are\nunremarkable.\n\nThe imaged portions of the abdomen and pelvis show extensive calcification of\nthe abdominal aorta and common iliac arteries. There is focal dilatation of\nthe abdominal aorta up to 2.9 cm. A large cysts in the lower pole of the\nright kidney is again seen.", "output": "No acute fracture. Multilevel degenerative changes." }, { "input": "There is no evidence acute fracture or traumatic malalignment. There is\nmoderate, multilevel and multifactorial degenerative change seen throughout\nthe cervical spine, minimally increased from ___. This produces moderate\nspinal canal narrowing at C4-5. There is no evidence of prevertebral soft\ntissue abnormality or swelling.\n\nMild interlobular septal thickening and 15 mm right upper lung ground-glass\nopacity may related to edema. Follow-up chest CT is recommended.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Moderate Degenerative changes.\n3. A 1.5 cm ground glass opacity in right upper lobe should be followed with\nrepeat CT in ___ months." }, { "input": "No acute fracture or change in overall alignment when compared with ___ CT neck exam. There is ankylosis spanning C4-5 levels with\nintervertebral disc height narrowing again noted at multiple levels though\nmost pronounced at C5-6 and C6-7. No prevertebral edema. No critical\nnarrowing of the central spinal canal or at the neural foraminal level. There\nis slight reversal of cervical lordosis. Mild scarring at the lung apices\nnoted with mild upper lobe emphysema. The imaged thyroid is unremarkable.", "output": "No acute fracture or traumatic alignment abnormality. Degenerative changes as\nstated above." }, { "input": "There are diffuse osteopenic changes. There is no acute fracture in the\ncervical spine. 2 mm anterolisthesis of C2 on C3 and C3 on C4 is most likely\ndegenerative in nature, although no prior studies are available to compare for\nstability. Multilevel degenerative changes are noted in the form of\nanterior/posterior osteophytes, mild loss of intervertebral disc space height\nand uncovertebral hypertrophy, which results in mild spinal canal narrowing at\nC4-C5, C5-C6 and C6-C7. No prevertebral soft tissue swelling.\n\n The thyroid gland is heterogeneous in appearance, and likely contains\nmultiple small hypodense nodules. Partially visualized lung apices shows\nbilateral pleural scarring, more significant in the right apex.", "output": "1. No acute fracture in the cervical spine. No prevertebral edema.\n2. 2 mm anterolisthesis of C2 on C3 and C3 on C4 are most likely degenerative,\nbut clinical correlation is recommended if there is concern for ligamentous\ninjury as no prior studies are available to compare for stability.\n3. Heterogeneous appearing thyroid gland, likely containing several small\nhypodense nodules. If clinically warranted, this could be evaluated with\ndedicated thyroid ultrasound on a nonurgent basis." }, { "input": "There is no evidence of cervical spine fracture. There is no prevertebral\nsoft tissue swelling. There are severe age advanced degenerative changes with\nin the cervical spine most pronounced at the C5 through C7 levels where there\nis complete loss of disc space. Facet fusion is seen within the upper\ncervical spine. The bones are demineralized. There is spinal canal narrowing\nat multiple levels, most severe at C6/7. There is no gross evidence of\ninfection or neoplasm. There is biapical scarring right greater than left.\nThe thyroid is unremarkable.", "output": "1. No evidence of cervical spine fracture.\n2. Severe multilevel degenerative changes." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling.\n\nSevere degenerate changes of the cervical spine are most pronounced at C5\nthrough C7, where there is complete loss of disc space. Spinal canal\nnarrowing is present at multiple levels, most severe at C6-C7, as described on\nthe prior study. There is no evidence of infection or neoplasm.\n\nBiapical pleural parenchymal scarring with right upper lobe bronchiectasis is\nunchanged since the prior study. The imaged thyroid is normal.", "output": "1. No evidence of fracture or malalignment.\n\n2. Severe multilevel degenerative changes with severe spinal canal narrowing\nand multiple levels of severe neural foraminal narrowing are similar in\nappearance since ___." }, { "input": "There is grade 1 anterolisthesis of L4 on L5.No acute lumbar spinal fracture\ndetected.Severe degenerative changes of the lumbar spine are most pronounced\nat L4-L5, where there is endplate sclerosis, severe disc space narrowing, and\nosteophytosis. There is a large posterior disc bulge causing moderate central\ncanal narrowing at L3-L4. There is no prevertebral soft tissue swelling.\n\nIncidental note is made of a large amount of hyperdense stool in the colon.", "output": "1. No evidence of acute lumbar spinal fracture.\n\n2. Grade 1 anterolisthesis of L4 on L5.\n\n3. Severe degenerative changes of the lumbar spine, most pronounced at L3-L4\nand L4-L5. At L3-L4, there is a large posterior disc bulge causing moderate\ncentral canal narrowing." }, { "input": "Alignment is unchanged. No acute fractures are identified. Note is made of\nthe vertically oriented lucency through the anterior inferior endplate and\nosteophyte at C5 which was present on scout view from prior head CT. There are\ndiffuse sclerotic lesions compatible with known metastatic prostate cancer. \nThere is expansion of the clivus due to associated lesion. Degenerative\nchanges noted most extensively at C5-6 with intervertebral disc height loss,\nposterior osteophytes and uncovertebral joint hypertrophy contributing to\nleast mild canal narrowing. Facet joint hypertrophy at multiple levels are\nalso noted resulting in up to moderate foraminal narrowing seen at C5-6 on the\nleft.\n\nThere is mild prevertebral edema centered at the C4 vertebral body level.\n\nThere is a moderate right pleural effusion. Thyroid cartilage is sclerotic on\nthe right compatible with metastatic disease.", "output": "1. No acute fracture or malalignment.\n2. Prevertebral edema noted at the C4 level which in the trauma setting raises\nconcern for ligamentous injury. Consider MRI.\n3. Osseous metastases.\n4. Right pleural effusion." }, { "input": "There is diffuse sclerosis throughout the entirety of the cervical spine as\nwell as T1 and the visualized ribs, consistent with known metastatic prostate\ncancer, and overall similar in extent to the prior CT from ___.\n\nThere is a nondisplaced fracture through the right C5 pedicle (series 2, image\n48), and right transverse process new since ___ and involving the\ntransverse foramem. Lucencies through the left lateral C4 facet as well as\nthe anterior/inferior aspect of the C5 vertebral body (series 2, image 41, 39;\nseries 602, image 34) are unchanged in appearance from ___.\n\nNo malalignment is demonstrated. There are partially imaged bilateral pleural\neffusions, right greater than left.", "output": "1. There is a nondisplaced fracture through the right C5 pedicle (series 2,\nimage 48), and transverse process new since ___ and involving the right\ntransverse foramen. Recommend neck CTA to evaluate for arterial injury.\n2. Lucencies through the left lateral C4 facet as well as the\nanterior/inferior aspect of the C5 vertebral body are chronic and appear\nunchanged from ___.\n3. Diffuse sclerosis throughout the entirety of the cervical spine as well as\nT1 and the visualized ribs, consistent with known metastatic prostate cancer,\nand overall similar in extent to the prior CT from ___.\n4. Bilateral pleural effusions, right greater than the left." }, { "input": "There is no evidence of fracture or malalignment. There is no prevertebral\nsoft tissue swelling. There is no evidence of spinal canal stenosis or neural\nforaminal narrowing.\n\nThe thyroid gland is unremarkable. There is no cervical lymphadenopathy.\nVisualized lung apices are clear.", "output": "Normal study." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C4-5 through C6-7 and notable for loss of\nintervertebral disc height, osteophytosis, small posterior disc bulges and\nligamentum flavum thickening causing mild spinal canal stenosis at C4-5.There\nis no prevertebral edema.\n\nThe thyroid is unremarkable. A small apical right pneumothorax is seen. \nThere is biapical scarring. A 7 mm right apical nodule is noted.", "output": "1. No acute fracture traumatic malalignment.\n2. Small apical right pneumothorax.\n3. 7 mm right upper lobe nodule, may be related to underlying scarring,\nhowever recommend follow up chest CT per the ___ criteria (see below)\nor comparison to prior imaging if available.\n\nRECOMMENDATION(S): For incidentally detected single solid pulmonary nodule\nmeasuring 6 to 8 mm, a CT follow-up in 6 to 12 months is recommended in a\nlow-risk patient, optionally followed by a CT in ___ months. In a high-risk\npatient, a CT follow-up in 6 to 12 months, and a CT in ___ months is\nrecommended.\n\nSee the ___ ___ Guidelines for the Management of Pulmonary\nNodules Incidentally Detected on CT\" for comments and reference:\n___\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 11:23 am, 20\nminutes after discovery of the findings." }, { "input": "The anterior atlanto-dental interval is prominent measuring 2.5 mm, increased\nfrom prior MR where it measured approximately 1.5 mm. The apparent change may\nbe technical or from age indeterminate ligamentous injury. There is no\nprevertebral edema. No fractures are identified.\n\nDegenerative changes are present most extensive at C4-C5, C5-C6, and C6-C7\nincluding disc space narrowing, endplate sclerosis, uncovertebral hypertrophy,\nand facet arthropathy. Most significant canal narrowing which is mild to\nmoderate is present at C6-C7.\n\nThe thyroid and included lung apices are unremarkable. Calcifications of the\nbilateral carotid arteries is noted.", "output": "No fracture. The anterior atlanto-dental interval appears slightly widened\ncompared to from prior MRI. The apparent change may be technical or from age\nindeterminate ligamentous injury. If focal tenderness, MR could be obtained\nto evaluate for acute ligamentous injury.\n\nNOTIFICATION: The findings were discussed with Dr. ___, M.D. by\n___, M.D. on the telephone on ___ at 4:25 ___, 5 minutes after\ndiscovery of the findings." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes most\nnotable for intervertebral disc height loss, posterior osteophytes and\nuncovertebral joint hypertrophy at C3-4, C5-6 and C6-7. Mild to moderate\nforaminal narrowing noted on the right at C5-6 and C6-7. There is no\nprevertebral edema.\n\nThere is lucency throughout the bones with more focal lesion identified in the\nC3 spinous process.\n\nThere is a 1.4 cm right thyroid nodule.", "output": "No cervical spine fracture or malalignment.\nLucency within the C3 spinous process. While this could be due to osteopenia\nthere is possibility of an underlying lesion. Consider nonurgent MRI on an\noutpatient basis to further characterize if clinically warranted." }, { "input": "The patient is somewhat rotated in position. Of note, there is limited\nassessment of C1 and C2 interval due to patient positioning. Additionally,\nthere is motion artifact at C7-T1 causing suboptimal assessment of the level. \nDespite those limitations, no acute fracture is seen.There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.", "output": "1. Study is limited due to patient positioning,, including limited assessment\nof the C1/C2 interval. Additionally, motion artifact at C7/T1 makes\nassessment at this level suboptimal. Given the above, no acute fracture or\ntraumatic malalignment is demonstrated." }, { "input": "Again seen are postsurgical changes related to prior anterior spinal fusion of\nC5-C6 with screws and plate. There is 2 mm anterolisthesis of C2 on C3. The\nalignment of the cervical spine is otherwise maintained. The prevertebral\nsoft tissues are unremarkable. The vertebral body heights are maintained.\n\nThe visualized posterior fossa structures appear unremarkable. The thyroid\ngland appears unremarkable there is biapical scarring. Otherwise, visualized\nlung apices are clear. No cervical lymphadenopathy is seen.\n\nContrast is seen surrounding the cervical spinal cord without any evidence of\ncontrast extravasation.\n\nAt C2-C3, neural foramen and spinal canal are patent.\n\nAt C3-C4, the spinal canal is patent. There is left facet arthropathy causing\nmoderate left neural foramen narrowing. The right neural foramen is patent.\n\nAt C4-C5, there is central disc protrusion indenting the ventral thecal sac. \nRight uncovertebral and facet arthropathy causes severe right neural foramen\nnarrowing. Left neural foramen is patent.\n\nAt C5-C6, central disc osteophyte complex indents the ventral aspect of the\ncord causing moderate spinal canal stenosis. Bilateral uncovertebral and\nfacet arthropathy results in mild right and moderate to severe left neural\nforamen narrowing.\n\nAt C6-C7, bilateral neural foramen and spinal canal are patent.\n\nAt C7-T1, bilateral neural foramen and spinal canal are patent.", "output": "1. No evidence of contrast extravasation in the cervical spine to suggest CSF\nleak.\n2. Anterior spinal fusion at C5-C6 with screws and plate device.\n3. Multilevel multifactorial degenerative disease of the cervical spine with\nneural foramen and spinal canal narrowing at multiple levels, worst at C5-C6\nwith moderate spinal canal stenosis and moderate to severe left neural\nforaminal narrowing. Also seen severe right neural foramen narrowing at C4-C5\nand moderate left neural foraminal narrowing at C3-C4." }, { "input": "THORACIC SPINE:\nThe alignment of the thoracic spine is maintained. There is mild compression\ndeformity along the superior endplate of T6 vertebrae, unchanged compared to\nthe prior MRI. The vertebral body heights are maintained at all other levels.\n\nThere is dependent atelectasis in bilateral lung bases. The visualized\nprevertebral, paravertebral and paraspinal soft tissues appear otherwise\nunremarkable.\n\nAt T1-T2, there is ossification of the ligamentum flavum indenting the dorsal\nthecal sac. There is right paracentral disc protrusion indenting the ventral\nthecal sac at T6-T7. Also seen is facet arthropathy with ligamentum flavum\nthickening at T8-T9, T9-T10, T10-T11 and T11-T12 indenting the dorsal thecal\nsac at these levels, worst at T10-T11 on the left.\n\nThe neural foramen are patent at all levels.", "output": "1. No evidence of contrast extravasation in the thoracic spine to suggest CSF\nleak.\n2. Mild multilevel multifactorial degenerative disease of the thoracic spine\nwithout neural foramina or spinal canal narrowing at any level ." }, { "input": "Based on the count down from the level of C2 vertebrae, there is partial\nsacralization of the L5 vertebrae with rudimentary ribs at T12 vertebrae.\n\nThere is high density contrast seen in the left paraspinal musculature at the\nlevel of T12-L1 vertebrae as seen on image 3: 25 - 37 suggestive of CSF leak\nat the level of T12- L1 left neural foramen.\n\nThe alignment of the lumbar spine is maintained. The vertebral body heights\nare maintained at all levels. The visualized prevertebral, paravertebral and\nparaspinal soft tissues appear unremarkable. The conus terminates at L1.\n\nAt T12-L1, bilateral neural foramen and spinal canal are patent.\n\nAt L1-L2, there is bilateral facet arthropathy. Bilateral neural foramen and\nspinal canal are patent.\n\nAt L2-L3, there is mild disc bulge with bilateral facet arthropathy indenting\nthe ventral and dorsal thecal sac respectively. Neural foramen and spinal\ncanal are patent.\n\nAt L3-L4, there is loss of disc height and signal with broad-based disc,\nsuperimposed central disc protrusion and endplate osteophyte with bilateral\nfacet arthropathy and ligamentum flavum thickening resulting in mild spinal\ncanal stenosis and mild bilateral neural foramen narrowing, left greater than\nright.\n\nAt L4-L5, there is loss of disc height and signal with broad-based disc bulge,\nbilateral facet arthropathy and ligamentum flavum thickening resulting in mild\nspinal canal stenosis and mild bilateral neural foramen narrowing, left\ngreater than right.\n\nAt L5-S1, bilateral neural foramen and spinal canal are patent.", "output": "1. Based on the count down from the level of C2 vertebrae, there is partial\nsacralization of L5 vertebrae with rudimentary ribs at T12.\n2. High density contrast in the left paraspinal musculature at the level of\nT12-L1 left neural foramen suggestive of CSF leak.\n3. Multilevel multifactorial degenerative disease of the lumbar spine, worst\nat L3-L4 with mild spinal canal stenosis and mild bilateral neural foramen\nnarrowing as described above." }, { "input": "Alignment is maintained. No fractures are identified.There are multilevel\ndegenerative changes with disc space narrowing and small posterior disc\nosteophyte complexes resulting in up to mild spinal canal narrowing, worst at\nC5-C6 and C6-C7. Uncovertebral hypertrophy and facet arthropathy results in\nup to severe neural foraminal stenosis on the left at C5-C6 and C6-C7. There\nis no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or traumatic malalignment." }, { "input": "There is no evidence of fracture, or malalignment. There is no prevertebral\nsoft tissue swelling.\n\nThere are changes of degenerative disc disease with loss of height of the\nintervertebral discs and anterior and posterior osteophyte formation at\nmultiple levels.\n\nAt C2-3, there is a tiny midline protrusion of the disc that does not appear\nto contact the spinal cord. The neural foramina appear normal.\n\nAt C3-4, there is a tiny vacuum phenomenon in the spinal canal likely related\nto a midline disc protrusion. The disc protrusion indents the anterior\nsurface of the spinal cord. Uncovertebral osteophytes produce moderate\n-severe right neural foraminal narrowing.\n\nAt C4-5, a midline and left -sided intervertebral osteophytes encroach on the\nspinal canal and may flatten the left anterior surface of the spinal cord. \nUncovertebral osteophytes produce severe bilateral neural foraminal narrowing.\nThis is worse on the right, where facet osteophytes contribute to the\nnarrowing, than the left.\n\nAt C5-6, large intervertebral osteophytes encroach on the spinal canal and\nlikely compress the spinal cord appear. Imaging of the spinal cord is\nobscured by overlying artifacts. Uncovertebral osteophytes produce severe\nleft and moderate to severe right neural foraminal narrowing.\n\nThe C6-7 level demonstrates mild degenerative changes with no canal or\nforaminal encroachment.\n\nThere are small intervertebral osteophytes at C7-T1 slightly encroaching on\nthe spinal canal. The neural foramina appear normal.\n\nThe thyroid is normal. There is no cervical lymphadenopathy. Compared to the\nprior chest CT from ___ there appears to be interval progression of\nthe right apical opacities and diffuse right upper lobe and lower lobe\nground-glass opacities, which may be secondary to progression of chronic\npulmonary disease however a superimposed infectious/inflammatory process\ncannot be excluded.", "output": "1. No evidence of fracture or subluxation.\n2. Degenerative disc disease at multiple levels with osteophytes and disc\nprotrusions encroaching on the spinal canal and spinal cord.\n3. Interval progression of right apical opacities, as well as opacities in the\npartially visualized right lower lobe. This may be secondary to progression\nof patient's fibrotic disease, however an acute infectious/inflammatory\nprocess can't be excluded. A dedicated chest CT may be helpful for further\nevaluation." }, { "input": "Alignment of the cervical normal. Again noted is an expansile destructive\nlesion centered within the left lateral mass of C1, but extending posteriorly\nto involve the left transverse foramen. It does not appear to extend into the\nspinal canal. No other suspicious lytic or sclerotic lesions are identified\nin the cervical spine. No acute fractures. A well corticated linear lucency\nof the right C1 arch (series 7, image 30 and series 3, image 16) represents a\nnutrient canal. There is no prevertebral soft tissue swelling. There is no\nevidence of spinal canal or neural foraminal stenosis.\n\nThyroid gland is unremarkable. There is no cervical lymphadenopathy by size\ncriteria Partially visualized lung apices are clear.", "output": "1. Expansile lytic lesion centered within the left lateral mass of C1,\nextending posteriorly to involve the left transverse foramen. No evidence of\nspinal canal extension.\n2. No other suspicious lytic or sclerotic lesions are identified in the\ncervical spine.\n3. If there is high clinical concern for additional lesions, bone scan would\nbe more sensitive.\n\nRECOMMENDATION(S): If there is high clinical concern for additional\nmetastatic osseous lesions, bone scan would be more sensitive." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.Within the limitations of this noncontrast study, there is no\nevidence of infection or neoplasm.\n\nOn scout images, a heterogeneously hyperdense 8.3 x 7.3 cm hepatic mass is\nidentified, corresponding to patient's known treated HCC.\n\nOtherwise, partially visualized intra-abdominal structures are grossly\nunremarkable. Mild atherosclerotic calcifications are noted within the\ninternal iliac arteries bilaterally.", "output": "1. No suspicious lytic or sclerotic lesions within the lumbar spine.\n2. If there is high clinical concern, bone scan would be more sensitive for\nmetastatic lesions.\n\nRECOMMENDATION(S): If there is high clinical concern for metastatic lesions,\nbone scan would be more sensitive." }, { "input": "The patient is status post C4 through C7 anterior fusion. There is mild\nanterolisthesis of C7 on T1, likely degenerative. No fractures are\nidentified.Multilevel degenerative changes of the noted worse at C3-4 and\nC7-T1. There is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no acute fracture or new malalignment. Anterolisthesis of C7 on T1\nis likely degenerative and similar compared to prior. Anterior fixation\nhardware seen spanning C4 through C7. The C4, C5, and C6 vertebral bodies are\nfused. There is no evidence of hardware fracture or complication. There is\nno prevertebral edema. Left-sided facet joint hypertrophy is again seen most\nnotable at C7-T1, T1-T2 and T2-T3.", "output": "Degenerative and postoperative changes without fracture or new malalignment." }, { "input": "Cervical vertebral bodies are well aligned. There is anterolisthesis of C7 on\nT1 and T1 on T2 which could be degenerative. Multilevel postoperative changes\nare noted, specifically with right-sided laminectomies spanning C3 through C7\nwith hardware extending across the laminectomy defects. Similarly, the left\nlaminectomies are seen spanning C3 through C7. There is no acute fracture.\n\nDegenerative changes noted with intervertebral disc height loss, uncovertebral\njoint and posterior osteophyte formation spanning C3-4 through C6-7. There is\nup to moderate foraminal narrowing seen at C5-6, left worse than right.\n\nSeveral osseous lucencies are identified, specifically within the intra\narticular pillar of T1 on the right (602:16) and the intra articular pillar\nand transverse process on the left at C7.\n\nFluid identified in the soft tissues in the midline posteriorly measuring 2.0\ncm AP x 1.5 cm TRV by approximately 4.3 cm cc, presumably postoperative given\nrecent surgery.\n\nAtherosclerotic calcifications noted left carotid bulb. There is a 9 mm\nnodule in the right lobe of the thyroid. Lung apices are clear.", "output": "1. Postsurgical changes extending from C3 through C7 with bilateral\nlaminectomies and hardware traversing the laminectomy sites on the right.\n2. No acute fracture.\n3. Anterolisthesis of C7 on T1 and T1 on T2 which could be degenerative though\nclinical correlation is suggested.\n4. Lucent lesions, potentially related to adjacent facet joint degenerative\nchanges though infiltrative process is possible. Correlation with prior\nimaging, presumably performed elsewhere is suggested." }, { "input": "There is no evidence of acute cervical spine fracture. Minimal\nanterolisthesis of C3 on 4, and C4 on 5 is noted and had been present on scout\nfrom prior chest CT from ___. There is mild compression deformity of\nthe C6 vertebral body, with minimal height loss, unchanged compared to prior\nstudies. Multilevel, multifactorial degenerative changes include extensive\nbilateral facet arthropathy, greater on the left, as well as multilevel disc\nspace narrowing and anterior and posterior osteophytosis. There is no\ncritical spinal canal narrowing. No prevertebral soft tissue swelling is\npresent.\n\nPolypoid mucosal thickening is present in the left maxillary sinus (3:4). \nSimple fluid density bilateral pleural effusions are present at the pulmonary\napices. Right thyroid lobe nodules are again noted.\nChronic right humerus fracture is visualized on the scout film.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Multilevel degenerative changes.\n3. Bilateral pleural effusions.\n4. Left maxillary sinus inflammatory disease." }, { "input": "Minimal anterolisthesis of C3 on 4, and C4 on 5 is similar to prior. Mild\ncompression deformity of the C6 vertebral body is similar to prior. No acute\nfractures are identified. Multilevel, multifactorial degenerative changes\nincluding extensive bilateral facet arthropathy, greater on the left, as well\nas multilevel disc space narrowing and anterior and posterior osteophytosis\nare similar to prior. There is no critical spinal canal stenosis. There is no\nprevertebral soft tissue swelling.\n\nBilateral pleural effusions at the pulmonary apices are similar to prior. \nSmall right thyroid lobe nodules are again seen. Chronic right humerus\nfracture is again seen on the scout image.", "output": "Degenerative disc disease.\nNo acute fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Only minimal degenerative\nchanges seen.There is no prevertebral edema. Aerosolized secretions are seen\nin the left sphenoid sinus.\n\nThe thyroid gland is homogeneous. There is minimal biapical pleural scarring.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There are 5 non rib-bearing lumbar type vertebral bodies. Alignment is\nnormal. Vertebral body heights are preserved. No fractures are identified. \nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. There is no suspicious focal bone lesion. The conus\nmedullaris terminates at the T12-L1 level.\n\nT12-L1: There is mild narrowing of the intervertebral disc space. There is a\ntrace left paracentral disc protrusion minimally indenting the ventral thecal\nsac without significant spinal canal narrowing. The neural foramina are\npatent.\n\nL1-L2: There is moderate narrowing of the intervertebral disc space. There is\na mild posterior disc bulge and mild disc protrusion extending superiorly\n(image 34, series 602b), which in conjunction with ligamentum flavum\nhypertrophy mildly narrows the spinal canal. Disc bulge mildly narrows the\nsub foraminal recesses. The neural foramina themselves are patent.\n\nL2-L3: The intervertebral disc space is relatively well preserved. There is\na mild posterior disc bulge mildly indenting the ventral thecal sac, without\nsignificant spinal canal narrowing. The neural foramina are patent.\n\nL3-L4: There is a moderate posterior disc bulge which mildly narrows the\nspinal canal, more significant towards the left, extending partially into the\nleft neural foramen (image 51, series 2).\n\nL4-L5: There is a posterior disc bulge with a large broad-based left\nparacentral disc protrusion, with a small portion extending inferiorly, which\ncauses severe spinal canal narrowing with a displacement of numerous\ntraversing nerve roots with impingement of the traversing left L5 nerve root. \nMild articular joint facet hypertrophy is seen at this level.\n\nL5-S1: The intervertebral disc space is relatively well preserved. There is\nmild diffuse posterior disc bulge without significant spinal canal narrowing\n(image 76, series 2. The neural foramina are patent.\n\nThere is a 27 mm simple density right interpolar renal cyst (image 12, series\n2). Trace atherosclerotic calcifications are noted along a normal caliber\ndistal abdominal aorta. Sigmoid diverticulosis is minimally imaged. The\nremainder of the visualized retroperitoneum is grossly unremarkable.", "output": "1. Degenerative changes as above, most notable for an L4-L5 posterior disc\nbulge with large focal left paracentral protrusion with extension inferiorly\nwhich produces severe spinal canal stenosis, and impinges upon the traversing\npre foraminal L5 nerve root, with probable impingement of several traversing\nsacral nerve roots.\n2. Less severe degenerative changes at other levels, as described in detail\nabove.\n3. No evidence of lumbar spine fracture." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. The lung apices are clear. The thyroid is unremarkable. \nThere is no lymphadenopathy by CT size criteria.", "output": "No acute traumatic cervical spine fracture or malalignment." }, { "input": "Minimal anterolisthesis of the C3 on C4 vertebral bodies is likely\ndegenerative.There is no acute fracture. There is no prevertebral soft tissue\nabnormality.\n\nC2-3: No significant spinal canal stenosis or neural foraminal narrowing.\nC3-4: Moderate left neural foraminal narrowing related to facet hypertrophy.\nC4-5: Disc bulge with mild spinal canal stenosis and moderate right neural\nforaminal narrowing related to facet hypertrophy.\nC5-6: No significant spinal canal stenosis. Moderate bilateral neural\nforaminal narrowing.\nC6-7: Moderate left neural foraminal narrowing.", "output": "No acute fracture or prevertebral soft tissue abnormality of the cervical\nspine." }, { "input": "No evidence of cervical malalignment. No acute fractures are identified. \nMild degenerative changes noted at C5-6 with intervertebral disc height loss,\nposterior osteophytes and a disc bulge as well as mild uncovertebral joint\nhypertrophy. There is mild secondary canal narrowing and minimal foraminal\nnarrowing at this level. There is no prevertebral soft tissue swelling.\n\nThe visualized lung apices are clear. The thyroid is unremarkable. There is\nmild mucosal thickening of the bilateral maxillary sinuses.", "output": "No evidence of traumatic cervical malalignment or acute fracture." }, { "input": "There is minimal retrolisthesis of C6 on C7, likely degenerative in etiology. \nThere is no prevertebral edema. No fractures are identified.\n\nThe patient has congenitally short pedicles, which results in diffuse mild\ncentral canal narrowing.Multilevel severe degenerative changes are seen, most\nextensive at C6-C7 and notable for disc space narrowing, disc bulging,\nendplate sclerosis, osteophytosis and facet hypertrophy resulting in moderate\nto severe central canal narrowing and moderate bilateral neural foraminal\nnarrowing at this level.\n\nThe thyroid and included lung apices are unremarkable.", "output": "1. No fracture or prevertebral soft tissue swelling.\n2. Multilevel severe degenerative changes, including moderate to severe canal\nnarrowing and moderate bilateral neural foraminal narrowing at C6-C7." }, { "input": "There is minimal anterolisthesis of C5 on C6. Alignment is otherwise normal.\nNo fractures are identified. There is no critical spinal canal stenosis. \nDegenerative changes notable for intervertebral disc height loss and\nuncovertebral joint hypertrophy, particularly on the right at C4-5. Posterior\nosteophytes and uncovertebral joint hypertrophy noted at C6-C7 resulting in\nmoderate bilateral foraminal narrowing. Right facet joint hypertrophy is most\nnotable at C5-6 but also seen C3-4 and C4-5. There is no prevertebral soft\ntissue swelling.\n\nCalcifications noted within the thyroid which is otherwise unremarkable. The\nlung apices are clear.", "output": "1. Minimal anterolisthesis of C5 on C6 is thought to be degenerative in\nnature, but without priors for comparison, is indeterminate. If there is\nclinical concern for ligamentous injury, MRI C-spine should be considered.\n2. No fracture." }, { "input": "There is no acute fracture or prevertebral soft tissue swelling. There is\ngrade 1 anterolisthesis of C4 on C5. Multilevel, multifactorial degenerative\nchanges are noted with disc space narrowing, vertebral body osteophyte\nformation, and subchondral sclerosis. There is also significant uncovertebral\nand facet hypertrophy leading to mild left-sided neural foraminal narrowing at\nC4-C5 and C6-C7.\n\nThere is no cervical lymphadenopathy. Smooth septal thickening at the lung\napices suggest pulmonary edema.", "output": "1. No acute fracture.\n2. Grade 1 anterolisthesis of C4 on C5. While finding may be degenerative in\nnature, given that no prior imaging study is available, recommend correlation\nwith site of tenderness, and if clinically indicated, a cervical spine MRI may\nbe obtained for further evaluation.\n3. Partially visualized lung suggest pulmonary edema. Please refer to ___ due report for chest x-ray study with accession ___ for\nfurther details. Recommend clinical correlation." }, { "input": "Again seen is anterolisthesis of C4 on C5, unchanged since the prior\nexaminations and likely degenerative in nature. Also seen are multilevel\ndegenerative changes including vertebral body height loss and osteophytosis. \nNo fractures are identified.Degenerative changes result in bilateral neural\nforaminal and mild spinal canal narrowing, unchanged from prior exam. \nNeuroforaminal narrowing is most prominent at C4-C5 and C6-C7 with there is\nmild left neural foraminal narrow, unchanged since prior examination. There is\nno prevertebral soft tissue swelling.Degenerative pannus posterior to the dens\nis unchanged.\n\nAgain noted is interlobular septal thickening at the lung apices, which in the\nappropriate clinical context, may be related to pulmonary edema. The\nvisualized thyroid gland is atrophic demonstrating a punctate calcification in\nthe right lobe, stable from ___. There is no lymphadenopathy by size\ncriteria.", "output": "1. No acute traumatic fracture.\n2. Stable degenerative changes as described above, including 4 mm\nanterolisthesis of C4 on C5." }, { "input": "Again seen is approximately 4 mm of anterolisthesis of C4 on C5, unchanged\ncompared to ___ and likely degenerative in nature. Overall, alignment is\nunchanged.No fractures are identified.Again seen are moderate to severe\nmultilevel degenerative changes including loss of height of the intervertebral\ndiscs, uncovertebral hypertrophy, facet arthropathy, as well as anterior and\nposterior osteophytosis. These findings are most prominent at C4-5 and C6-7.\nNo significant canal or foraminal narrowing. There is no prevertebral soft\ntissue swelling.\n\nThyroid is small, but overall appears unremarkable. Again noted is\ninterlobular septal thickening at the lung apices, which in the appropriate\nclinical context, may be related to pulmonary edema.", "output": "Degenerative changes in the cervical spine without fracture or traumatic\nsubluxation." }, { "input": "Anterolisthesis of C4 on C5 is unchanged compared to prior CT. There is no\nnew malalignment. There is no fracture. Degenerative changes include\nintervertebral disc height loss and posterior osteophytes, most notable C5-6\nand C6-7. At C3-4 there is a disc bulge which partially effaces the ventral\nCSF. There is no critical canal or foraminal narrowing. There is no\nprevertebral edema.\n\nAtherosclerotic calcifications noted at the carotid bulbs. Lung apices are\nclear.", "output": "No cervical spine fracture or acute malalignment." }, { "input": "Minimal anterolisthesis C3 on C4 and 4 mm anterolisthesis of C4 on C5, not\nsignificantly changed. No fractures are identified.Moderate uncovertebral,\nendplate, and facet osteophytosis. A combination of partially calcified\nposterior disc bulges and/or protrusions, endplate osteophytes, and\nspondylolisthesis result in at least mild multilevel spinal canal narrowing\nsimilar to the prior examination. There is mild multilevel bilateral neural\nforaminal narrowing.There is no prevertebral soft tissue swelling.There is\nmoderate bilateral carotid bifurcation calcification.\n\nNo focal consolidation is seen in the imaged apices. Thyroid gland is\nsomewhat atrophic.", "output": "1. No evidence of fracture.\n2. Moderate to severe cervical spondylosis including unchanged 4 mm of\nanterolisthesis of C4 on C5 with at least mild multilevel spinal canal and\nneural foraminal narrowing." }, { "input": "There is grade 1 anterolisthesis at L3 upon L4 level, multilevel,\nmultifactorial degenerative changes throughout the lumbar spine including\ndiffuse osteopenia, narrowing of the intervertebral disc spaces, vacuum disc\nphenomenon.\n\nAt T12-L1, there is mild anterior and posterior spondylosis is, apparently\ncausing mild right-sided neural foraminal narrowing, there is no evidence of\ncentral spinal canal stenosis.\n\nAt L1-L2, there is spondylosis and mild disc bulge, bilateral articular joint\nfacet hypertrophy and ligamentum flavum thickening, apparently causing mild\nspinal canal stenosis.\n\nAt L2-L3 level, there is diffuse disc bulge causing mild-to-moderate bilateral\nneural foraminal narrowing, bilateral articular joint facet hypertrophy and\nmild ligamentum flavum thickening resulting in moderate spinal canal\nnarrowing.\n\nAt L3-L4 level, there is diffuse disc bulge and spondylosis causing moderate\nbilateral neural foraminal narrowing and probably moderate to severe spinal\ncanal stenosis with underlying articular joint facet hypertrophy ligamentum\nflavum thickening.\n\nAt L4-5 level, there is spondylosis and mild disc bulge with calcification of\nthe disc towards the neural foraminal regions (series 3, image 46), there is\nno evidence of central spinal canal stenosis, bilateral articular joint facet\nhypertrophy and ligamentum flavum thickening causes mild posterior thecal sac\ndeformity, there is partial calcification of the ligamentum flavum\nbilaterally.\n\nAt L5-S1 level, there is mild spondylosis and partially calcified disc causing\nanterior thecal sac deformity and moderate bilateral neural foraminal\nnarrowing, there is calcification of the ligamentum flavum bilaterally\narticular and articular joint facet hypertrophy resulting in mild spinal canal\nnarrowing.\n\nThe sacrum is notable for thinning of the bone from S2 level, partially\nevaluated, probably representing dural ectasia versus a prominent arachnoid\ncyst, if clinically warranted, correlation with MRI of the lumbar and sacrum\nare recommended for further characterization.\n\nMild bilateral degenerative changes are visualized in the sacroiliac joints\nwith vacuum phenomenon. Vascular atherosclerotic calcifications are\nvisualized in the abdominal aorta and iliac arteries.", "output": "1. Grade 1 anterolisthesis identified at L3-L4 level, probably degenerative in\nnature.\n2. Multilevel, multifactorial degenerative changes throughout the lumbar spine\nas described detail above.\n3. Thinning of the bone at the level of S2 in the sacrum, partially evaluated,\nprobably consistent with dural ectasia versus are a prominent arachnoid cyst,\ncorrelation with MRI of the lumbar and sacrum are recommended for further\ncharacterization.\n\nRECOMMENDATION(S): Thinning of the bone at the level of S2 in the sacrum,\npartially evaluated, probably consistent with dural ectasia versus are a\nprominent arachnoid cyst, correlation with MRI of the lumbar and sacrum are\nrecommended for further characterization." }, { "input": "The alignment of the thoracic vertebral spine demonstrate multilevel,\nmultifactorial degenerative changes consistent with mild increased kyphotic\ncurvature, diffuse osteopenia, no acute thoracic spine fractures are\nidentified, vacuum disc phenomenon is identified from T6-T7 through T12-L1\nlevels.\n\nThere is narrowing of the intervertebral disc spaces throughout the thoracic\nspine, unchanged posterior disc bulging noted at T4-T5 and posterior\nspondylosis with small posterior calcification and disc bulging at T9-T10\ncausing mild anterior thecal sac deformity, grossly there is no evidence of\nsevere spinal canal stenosis.\n\nOther findings: The visualized aspect of the lungs demonstrate persistent\nbilateral atelectasis and air bronchogram on the right, partially evaluated\nthis exam, correlation with dedicated CT of the chest is recommended. \nCoronary atherosclerotic disease appears unchanged. Persistent mild dilation\nof the main pulmonary artery and mild dilation of the ascending thoracic\naorta, partially evaluated in this exam. Vascular atherosclerotic\ncalcifications are again seen involving the proximal celiac trunk and SMA.", "output": "1. Multilevel, multifactorial degenerative changes throughout the thoracic\nspine as described above with no evidence of acute fracture thoracic spine\nfracture, or significant spinal canal narrowing.\n2. Moderate multilevel degenerative changes throughout the cervical spine as\ndescribed above, more significant at T4-T5, and T9-T10 levels.\n3. Other findings as described above.\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "Exam is limited secondary to motion. Within that limitation there is no\nevidence of traumatic malalignment or acute fracture. There is congenital\nnon-fusion of the posterior arch of C2. No significant spinal canal or neural\nforaminal narrowing. No prevertebral soft tissue swelling. No evidence of\ninfection or neoplasm. Partially visualized lung apices are clear. Thyroid\ngland is normal.", "output": "No acute findings." }, { "input": "No acute fracture or traumatic subluxation.Multilevel degenerative changes\ncervical spine, with disc osteophyte complexes, disc space narrowing, few tiny\ndisc protrusions, including right paramedian shallow disc protrusion at C5-C6\nlevel. There is multilevel central canal narrowing causing multilevel\nmoderate central canal narrowing, and probably minimal effacement of the\nventral cord at few levels. Posterior element degenerative changes. \nMultilevel probably moderate foraminal narrowing.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nOther: There is a 7 mm left hyperdense thyroid nodule. The imaged lung apices\nare unremarkable. Degenerative changes left temporomandibular joint are\nadvanced. Few mildly prominent lymph nodes, largest at level 1 chain measures\n0.7 cm short axis, may be reactive.", "output": "No acute fracture.\n\nMultilevel degenerative changes, multilevel moderate central canal, moderate\nforaminal narrowing.\n\nAdvanced degenerative arthritis left temporomandibular joint.\n\n0.7 cm left thyroid nodule, no follow-up is indicated according to guidelines\nbelow.\n\nFew neck lymph nodes at the upper limits are normal, may be reactive.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is no acute fracture or subluxation involving the cervical spine. \nModerate degenerative changes are most pronounced at the C4-C5 and C5-C6\nlevels. Ossification of the posterior longitudinal ligament at C4-C5 results\nin at least moderate canal narrowing and remodeling of the cord. Multilevel\ncalcification of the ligamentum flavum is noted. There is no prevertebral\nsoft tissue swelling. Mild straightening of the normal cervical lordosis is\nfelt positional in nature. The thyroid gland is homogeneous in attenuation. \nLung apices are clear.", "output": "No acute fracture or subluxation involving the cervical spine.\nDegenerative changes and ossification the posterior longitudinal ligament at\nC5-6 result in at least moderate canal narrowing and likely remodeling of the\ncord." }, { "input": "Transitional anatomy noted at the lumbosacral junction. Assuming last\nrib-bearing vertebra is T12, there is partial lumbarization of S1 with\nrudimentary disc at S1-S2.\n\nDegenerative changes involving the lumbar spine are mild-to-moderate. \nVertebral body heights and disc spaces are preserved. Alignment is normal. \nThere is no abnormal prevertebral fluid collection or thickening. Facet\nhypertrophy is most pronounced at the L3-4 through L5-S1 levels. Disc bulges\nalso at these levels and thickening of the ligamentum flavum results in at\nleast mild canal narrowing. There is mild foraminal narrowing at L4-5 and\nL5-S1 which is worse on the right.\n\nPeripelvic cysts are present within the left kidney. The abdominal aorta is\nwithout aneurysmal dilatation. Scattered retroperitoneal nodes are noted the\nlargest in the right para-aortic station measuring approximately 4 mm in short\naxis (03:30), not pathologically enlarged by CT size criteria. Partially\nimaged pancreas is without pancreatic duct dilation. Posterior aspect of the\nright hepatic lobe is unremarkable. Imaged portions of small and large bowel\nare unremarkable.", "output": "No fracture or subluxation involving the lumbar spine." }, { "input": "There is marked thoracic kyphosis. There are compression deformities of to\nadjacent thoracic vertebral bodies. We cannot definitively determined the\nlevels involved. The appear to be mid to lower thoracic vertebral bodies. \nThere may be somewhat more loss of height of these vertebral bodies than on\nthe study of ___. There are no definite findings to indicate\nacuity of the fractures. To levels superior to the more superior of these 2\ncompressed vertebral bodies, there is a large vertebral hemangioma. There is\nno evidence of bone retropulsed into the spinal canal. CT has limited soft\ntissue contrast resolution. However, within this limitation, no soft tissue\nencroaching on the spinal canal is demonstrated on this exam. There are\nmultilevel degenerative changes including intervertebral disc space narrowing\nand endplate sclerosis and irregularity. In addition there are multiple small\nanterior osteophytes.\n\nThe descending thoracic aorta is mildly ectatic measuring 3.2 cm. The\nesophagus is mildly dilated and contains an air-fluid level.", "output": "1. Marked thoracic kyphosis.\n2. Compression fractures of 2 adjacent mid to lower thoracic vertebral bodies,\nperhaps slightly progressed since ___.\n3. Mid thoracic vertebral body containing a large vertebral hemangioma.\n4. No evidence of osseous canal encroachment. Limited sensitivity for soft\ntissue canal encroachment, but none is identified.\n5. The descending aorta is mildly ectatic measuring 3.2 cm.\n6. The esophagus is mildly dilated and contains an air-fluid level." }, { "input": "The anterior aspect of the C7 inferior endplate and majority of the T1 is not\nvisualized. There is diffuse osteopenia. Alignment is normal. No fractures\nare identified.The vertebral body heights are preserved. There is severe loss\nof disc heights at C4-5, C5-6, and C6-7. There are anterior posterior\nosteophytes. Disc bulge and posterior osteophytes cause mild spinal canal\nstenosis at C3-4. There is no prevertebral soft tissue swelling. The imaged\nvery superior lung apices show no focal consolidation.", "output": "1. The anterior aspect of the C7 inferior endplate and majority of the T1 is\nnot visualized.\n2. Given the limitation, no acute fracture or traumatic malalignment.\n3. Mild to moderate multilevel degenerative changes of the cervical spine.\n4. Diffuse osteopenia." }, { "input": "No acute fracture or subluxation is identified. There is multilevel\nmultifactorial degenerative disease with disc space narrowing, osteophyte\nformation and facet joint hypertrophy. These changes of the worst at C5-6\nwhere small posterior osteophytes cause minimal spinal canal narrowing. There\nis no prevertebral soft tissue swelling. There is calcification the carotid\nbulbs. The lung apices are unremarkable.", "output": "1. There is no evidence of fracture or traumatic subluxation.\n2. Multilevel, multifactorial degenerative changes worst at C5-6." }, { "input": "No evidence of cervical spine fracture. Overall alignment of the cervical\nspine is similar to the prior exam with unchanged mild anterolisthesis of C7\non T1. Right curvature of the cervical spine is unchanged. Straightening of\nthe cervical spine on sagittal images is also unchanged. No prevertebral soft\ntissue swelling. No osseous lesions concerning for malignancy or infection. \nThe bones remain diffusely demineralized. Multilevel severe degenerative\nchanges are noted with loss of intervertebral disc height, endplate cystic and\nsclerotic change, and anterior and posterior osteophyte formation with\nessentially complete fusion of C3 on C4. Mild to moderate central canal\nstenosis is most pronounced at C5-6 secondary to posterior osteophytes. \nMultiple levels of mild-to-moderate neural foraminal narrowing are unchanged. \nThe imaged thyroid and lung apices are unremarkable.", "output": "1. No evidence of cervical spine fracture.\n2. Unchanged alignment of cervical spine. Severe multilevel degenerative\nchanges as above.\n3. Osteopenia." }, { "input": "Alignment is unchanged compared to ___ fractures are\nidentified.Severe multilevel degenerative changes are notable for endplate\nosteophyte most notably at C5-6 and C6-7 causing moderate spinal canal\nnarrowing. There is extensive sclerotic changes of the vertebral bodies and\ndisc height loss at C2-3 through C6-7. There is no prevertebral soft tissue\nswelling.\n\nIncluded portion of the thyroid and lung apices are unremarkable. Dense\natherosclerotic calcifications noted at the carotid bulbs bilaterally.", "output": "1. No fracture is identified.\n2. Multilevel degenerative changes, similar to ___." }, { "input": "Alignment is preserved. No acute fractures are identified. Extensive\nmultilevel degenerative disc disease is noted at all levels with near complete\ndisc space narrowing throughout with multilevel small posterior disc\nosteophyte complexes.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment. Multilevel degenerative disc\ndisease." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.", "output": "1. No evidence of fracture or subluxation" }, { "input": "The previously described enhancing extradural spinal canal mass extending from\nC7-T3 is essentially in visible on this CT scan and is better assessed on\nrecent MR of the spine.\n\nThere is no fracture or malalignment. Again seen is a right-sided disc\nprotrusion at C3-4 that encroaches on the spinal canal and contacts and\nflattens the right anterior aspect of the spinal cord.\n\nThere appears to be mm calcific density in the midline of the spinal canal and\nC7 that encroaches on the spinal cord. This is poorly seen on the CT but this\nmost likely represents the meningioma defined on the spinal MR ___\nprevertebral soft tissues are unremarkable. The thyroid gland is normal. The\nlung apices are clear.", "output": "1. The previously described enhancing extradural spinal canal mass extending\nfrom C7-T3 is essentially in visible on CT and is better assessed on recent MR\nof the spine.\n2. No osseous abnormality detected.\n3. Degenerative disc disease with disc protrusion flattening the spinal cord\nat C3-4." }, { "input": "There is severe spinal canal narrowing with spinal cord compression at the\nT1-T2 vertebrae levels due to compression from a recently discovered\nextradural mass. Mild scalloping is noted at the T1 vertebrae. As the mass\nmost extensively affects the cervical spine, bony changes from the mass can be\nbetter seen on the CT C-spine from ___.\n\nAlignment is normal. No fractures are identified. Schmorl's nodes are seen at\nthe T7 and T8 inferior endplates. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nThe visualized potions of the lungs appear clear. There is no evidence of\npleural effusions or consolidations.\n\nCutaneous staples are noted at the T4 vertebral level.", "output": "1. Severe spinal canal narrowing with spinal cord compression at the T1-T2\nvertebrae levels due to compression from recently discovered mass.\n2. Mild scalloping of the T1 vertebrae.\n3. Normal alignment and no evidence of fractures." }, { "input": "Alignment is normal. No fractures are identified. There are multilevel\ndegenerative changes, worst at C6-C7 where there is loss of disc height and a\nposterior disc osteophyte complex results in up to mild canal narrowing. \nMultilevel facet arthropathy results in up to moderate neural foraminal\nnarrowing at multiple levels.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No fracture or traumatic malalignment." }, { "input": "Moderate motion artifact somewhat limits evaluation of the cervical spine.\n\nThere is no acute fracture or malalignment in the cervical spine. Minimal\ndegenerative changes of the cervical spine are noted with mild intervertebral\ndisc space narrowing and small disc bulge at C4-C5 resulting in mild spinal\ncanal narrowing. There is minimal right neuroforaminal narrowing at C3-4 due\nto uncovertebral hypertrophy. No prevertebral edema.\n\nThe aerodigestive tract appears patent. Lung apices are clear apart from\nminimal scarring. Thyroid gland appears normal. There is no cervical\nlymphadenopathy by CT size criteria.", "output": "1. No acute fracture or malalignment of the cervical spine.\n2. Mild degenerative changes with small disc bulge at C4-C5 resulting in mild\nspinal canal narrowing." }, { "input": "Re-demonstrated mild anterolisthesis of C4 over C5 and C7 over T1, and minimal\nretrolisthesis of C5 over C6.No acute fracture is seen.Sclerotic focus is\nnoted in the posterior elements of the C4 vertebra; sclerotic focus in the T1\nvertebral body; sclerotic focus in the T1 posterior elements. Above-mentioned\nsclerotic foci similar compared to the prior study. Osseous fusion of the\nleft C3/C4 facets is noted. Multilevel degenerative changes include disc\nspace narrowing at C5/C6 and C6/C7, where there also anterior and posterior\nosteophytes. Moderate narrowing of the central canal at C5/C6 and C6/C7.There\nis no prevertebral soft tissue swelling. Partially imaged lung apices are\nclear.", "output": "1. No acute fracture. Multilevel degenerative changes moderate air the\ncentral canal at C5/C6 and C6/C7. Mild anterolisthesis of C4 on C5 and C7 on\nT1, similar compared to neck CT from ___. Stable sclerotic foci in\nC4 and T1 vertebra." }, { "input": "Cervical vertebral body heights and alignment are well maintained without\nevidence of fracture or malalignment. The prevertebral soft tissue is\nunremarkable. There are minimal degenerative changes. The neural foramina\nappear grossly patent. Though CT resolution of the thecal sac is limited, the\ncontours appear preserved. The imaged lung apices are clear. The thyroid is\nunremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is no evidence of fracture or sublaxation. The prevertebral soft\ntissues are unremarkable. Minimal degenerative changes are stable.\n\nThere is no lymphadenopathy. The visualized lung apices are grossly clear. The\nthyroid gland is unremarkable.", "output": "Normal study." }, { "input": "Alignment is normal.Again seen is a Schmorl's node in the superior endplate of\nthe T1 vertebral body. No other fractures are identified. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.", "output": "Normal study." }, { "input": "Alignment is normal. No acute fractures are identified. Mild-to-moderate\nchronic degenerative changes, particularly mild-to-moderate foraminal\nnarrowing at C4-C5 on the left and mild impingement of the thecal sac\nventrally at level C3-C4 due to a focal disc protrusion. Also a nondisplaced,\nchronic-appearing, fracture of the tip of the C3 inferior articular process on\nthe right is noted (602:25).There is no prevertebral edema.\n\nIncidental note is made for an 8 x 5 mm left thyroid lobe hypodense nodule\nwhich requires no follow-up needed given size per ACR guidelines. Subtle\nright apical lung ground glass ill-defined nodular opacities are non-specific,\nbut could be secondary to infection or inflammation.\n\nPatient is status post left mastoidectomy.", "output": "1. Normal alignment with no acute fractures.\n2. Mild to moderate degenerative changes, particularly mild-to-moderate\nforaminal narrowing at C4-C5 on the left and mild impingement of the thecal\nsac ventrally at C3-C4 due to a disc bulge.\n3. Nonspecific right apical ill-defined ground-glass nodular opacities. \nPotentially infectious or inflammatory in etiology, and correlate clinically. \nDedicated chest radiograph may be helpful." }, { "input": "Exam is mildly motion degraded particularly at the C2 through C4 levels. \nAlignment is preserved. No fractures are identified.There are mild multilevel\ndegenerative changes with facet joint arthrosis, small osteophytes and small\nposterior disc bulges, most extensive at C4-5. No significant canal or\nforaminal narrowing. There is no prevertebral edema.\n\nHypodense nodules are seen in the right lobe of the thyroid measuring up to 1\ncm for which no follow-up is required for the ACR guideline. There is a large\nright pleural effusion. Atherosclerotic calcifications noted at the carotid\nbulbs bilaterally.", "output": "1. Mildly motion degraded exam without acute fracture or traumatic\nmalalignment.\n2. Mild multilevel degenerative changes of the cervical spine.\n3. Large right pleural effusion.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or ___.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is minimal anterolisthesis of C2 on 3 which can be accounted for by\nright-sided facet joint hypertrophy at this level. There is also joint space\nnarrowing and subchondral cystic change at the right C2-3 facet joint. There\nis also a small joint effusion. Alignment is otherwise normal. No fractures\nare identified. Posterior disc bulge at C3-4 causes mild to moderate spinal\ncanal stenosis. There is no prevertebral soft tissue swelling. There is\nbilateral carotid bifurcation calcification.", "output": "1. There is facet joint hypertrophy, subchondral cystic change, and a small\njoint effusion at the right C2-3 facet joint, which is likely due to\ndegenerative change. However, if there is clinical concern for an infected\nfacet joint, MRI C-spine with contrast should be considered.\n2. Minimal anterolisthesis of C2 on 3 can be accounted for by the above facet\njoint changes.\n3. No fracture or prevertebral soft tissue swelling.\n\nNOTIFICATION: Impression point number one above was discussed with Dr.\n___ by Dr. ___ telephone at 9:34 ___ on ___." }, { "input": "There is no acute fracture or traumatic malalignment. There is loss of normal\ncervical lordosis. Minimal anterolisthesis of C2 on C3 is unchanged. There\nis no prevertebral soft tissue swelling. At the right C2-C3 facet joint,\nthere is persistent joint space narrowing, subchondral cystic change and bony\nsclerosis. There is minimal increased erosion at the facet joint but not\nsignificantly increased. Large marginal osteophyte is again identified. \nThere is no bony destruction in the interim.\n\nThere are mild multilevel degenerative changes of the cervical spine with\nendplate osteophyte and disc bulges, predominantly at the C4-C5 level with\nmild indentation on the ventral thecal sac. Additional detail of the\nintrathecal sac is better assessed on recent MRI. There is no significant\nneural foraminal narrowing is identified.\n\nLimited views of the lung apices demonstrate paraseptal and centrilobular\nemphysema. Atherosclerotic calcifications of the aortic arch are identified\nextending into the origin of the major side branches. The thyroid gland is\nslightly heterogeneous but no large discrete lesion is seen. There is no\ncervical lymphadenopathy. Atherosclerotic calcifications of the bilateral\ncarotid bifurcations extending into the proximal internal carotid arteries are\nsevere.", "output": "1. Minimal interval increase in bony erosions along the right C2-C3 facet\njoint with subchondral sclerosis and cystic changes. No definite bony\ndestruction in the interim. Large marginal osteophyte is also identified. \nGiven the presence of a large osteophyte, erosive osteoarthritis is favored\nrather than chronic infection.\n2. Mild degenerative changes in the remainder of the cervical spine most\nprominent at C4-C5 with mild spinal canal stenosis.\n3. Severe atherosclerotic calcifications at the bilateral carotid\nbifurcations." }, { "input": "Alignment is normal. No fractures are identified. Mild multilevel\ndegenerative changes of the cervical spine are seen, most prominent at C5-C6. \nThere is no evidence of high-grade spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nAt the right lung apex, mild scarring is noted. The left lung apex is\nunremarkable. The thyroid gland is unremarkable. There is no cervical\nlymphadenopathy. The visualized esophagus is mildly patulous.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Vertebral bodies are well aligned. No fractures are identified. There is no\nevidence of prevertebral soft tissue swelling.\nDisc protrusion at C3-4 partially effaces the ventral CSF.\n\nThe thyroid is normal.", "output": "No cervical spine fracture or malalignment." }, { "input": "There is grade 1 anterolisthesis of L4 on L5 marked lumbar curve convex to the\nright. .Patient is status-post L3 and L4 laminectomies. Right-sided L4 pars\ndefect is likely chronic in nature given sclerotic fragmentation and\nassociated degenerative changes. Left side L4 pars interarticularis is\nintact. There is no evidence of acute fracture.There are severe multilevel\ndegenerative changes with multilevel disc space narrowing, degenerative disc\ndisease, severe lumbar facet arthritis. There multilevel diffuse disc bulges\nin the lower lumbar spine. There is L4, and partial L3, L5 laminectomies. \nThere is multilevel central canal narrowing most prominent and\nmild-to-moderate CT L2-L3 level with narrowed lateral recesses bilaterally. \nCentral canal is decompressed at L3-L4 level, and there is significant lateral\nrecess narrowing bilaterally. Central canal is decompressed at L4-5 level,\nright lateral recess is narrowed. There is multilevel moderate to severe\nforaminal narrowing, most prominent and severe at the right L4-5 foramen. \nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nA chronic dissection of the abdominal aorta with a partially calcified intimal\nflap just proximal to the aortic bifurcation is better appreciated on the same\nday abdomen and pelvis CT performed with intravenous contrast (series 2,\nimages 59-65). There is sigmoid diverticulosis. There is residual contrast\nin the urinary system. There is tiny benign cyst in the left kidney.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. There are advanced degenerative changes in the lumbar spine.\n3. Grade 1 anterolisthesis of L4 on L5, right-sided L4 pars defect." }, { "input": "No acute fracture or traumatic malalignment is seen within the cervical spine.\nThere are multi-level degenerative changes which do not result in significant\nneural foraminal or spinal canal stenosis. Degenerative disc disease is noted\nat C4-5 and C5-6 notably. Facet arthropathy is most significant at C2-3, C3-4\nand C4-5 levels.\n\nWithin the right parotid gland, there are 2 discrete hyperdense masses\napproximately 48-49 Hounsfield units, measuring 2.3 x 3.0 cm and 2.1 x 2.7 cm.\nThese are of unclear etiology and focused ultrasound and biopsy is advised. No\nprevertebral edema. Lung apices are notable for emphysema. Imaged thyroid is\nunremarkable.", "output": "1. No fracture or traumatic malalignment.\n2. Degenerative changes as stated.\n3. Right parotid gland masses detailed above for which ultrasound and biopsy\nis advised." }, { "input": "There are 5 non rib-bearing, lumbar like vertebrae. There is no fracture\ninvolving the lumbar spine. The vertebral body heights are maintained. There\nare moderate multilevel degenerative changes with loss of disc space and\nosteophytosis. Grade 1 retrolisthesis of L2 over L3 and grade 1\nanterolisthesis of L5 over S1 are unchanged from ___.\n\nRight renal hypodensities are incompletely characterized but are presumably\nsimple cysts, the largest on the right measuring 16 mm. Punctate\nhyperdensities in both kidneys may reflect small, non-obstructing stones. \nCholecystectomy clips are noted. The aorta is normal caliber but shows\nmoderate atherosclerosis. Imaged loops of bowel are nondilated.", "output": "No acute fracture of the lumbar spine." }, { "input": "There is no evidence for prevertebral edema. There is no acute subluxation. \nMild anterolisthesis of C4 on C5 and mild retrolisthesis of C5 on C6 are\nunchanged.No displaced fracture is seen allowing for loss of bone\nmineralization. Vertebral body heights are within normal limits.Disc\nprotrusions and endplate osteophytes moderately narrow the spinal canal at\nC5-C6 and mildly in narrow the spinal canal at C6-C7. There is multilevel\nneural foraminal narrowing by uncovertebral and facet osteophytes.\n\nThere is scarring at the included lung apices with calcifications on the left,\nsuggesting prior granulomatous disease. There is diffuse distention of the\nsupraglottic airway with an air-filled right laryngocele, unchanged compared\nto ___. This may be seen in the setting of obstructive airways\ndisease or secondary to prolonged increases in intrathoracic pressure, for\nexample in glass ___.\n\nThe thyroid gland is normal in size and slightly heterogenous without evidence\nfor discrete nodules.\n\nMild calcifications are again seen at bilateral carotid bifurcations and in\nbilateral intracranial vertebral arteries.", "output": "1. No evidence for an acute fracture. No acute subluxation.\n2. Multilevel degenerative disease. Diffuse distention of the supraglottic\nairway within air-filled right laryngocele, as discussed above, unchanged." }, { "input": "There is no acute fracture or traumatic malalignment. There is no\nprevertebral soft tissue swelling. There are multilevel degenerative changes\nof the cervical spine including near complete loss of disc space at multiple\nlevels, most pronounced at C3-4. Mild anterolisthesis of C7-T1 is likely\ndegenerative. Facet arthrosis is noted at multiple levels.\n\nThe thyroid is normal. The lung apices are clear. A metallic density noted in\nthe infraglottic portion of the hypopharynx, likely represents a foreign body\n(03:45).", "output": "1. No acute fracture or traumatic malalignment.\n2. Punctate metallic density noted in the infraglottic hypopharynx, likely\nrepresents a foreign body (03:45)" }, { "input": "Study is moderately degraded by motion an limited secondary to patient\npositioning.\n\nThere is mild anterolisthesis of C2 on C3, C5 on C6 and C7 on T1.\n\nFusion of the C3 through C5 vertebral bodies and C6-C7 vertebral bodies is\nidentified. The visualized osseous structures are osteopenic. No definite\nacute fracture is identified. Extensive multilevel degenerative changes noted\nthroughout the cervical spine, including endplate degenerative changes, facet\njoint hypertrophy resulting in multilevel neural foraminal stenosis and\nanterior and posterior endplate osteophytes. At the anterior superior\nendplate of T1, there is suggestion of an osteophyte fracture with corticated\nmargins and no associated prevertebral soft tissue swelling, suggestive of\nchronic fracture. There is no evidence of bony severe spinal canal stenosis.\nThere is no prevertebral soft tissue swelling.\n\nVisualized lung apices are clear.", "output": "1. Study is moderately degraded by motion and limited by patient positioning.\n2. Within limits of study, no definite acute cervical spinal fracture.\n3. Moderate to severe degenerative changes, as described. Recommend clinical\ncorrelation. Please note that ligamentous injury cannot be excluded on the\nbasis examination. If clinically indicated, consider cervical spine MRI for\nfurther evaluation.\n\nRECOMMENDATION(S): Moderate to severe degenerative changes, as described.\nRecommend clinical correlation. Please note that ligamentous injury cannot be\nexcluded on the basis examination. If clinically indicated, consider cervical\nspine MRI for further evaluation.\n\nNOTIFICATION: The updated findings and recommendation were communicated via\ntelephone by Dr. ___ to Dr. ___ (neurology) at 07:00 on ___." }, { "input": "There is no evidence of fracture or subluxation. There is no prevertebral soft\ntissue swelling. The aerodigestive tract is clear. Intervertebral osteophytes\nat C5-6 narrow the spinal canal, most marked just to the left of midline. \nThese are possibly large enough to indent the spinal cord. The neural\nforamina appear normal. The esophagus is a dilated. There are patchy\nground-glass opacities in lung apices which may be due to air trapping or\naspiration. The thyroid appears normal.", "output": "1. No evidence of fracture or subluxation.\n2. Ground-glass opacities in the lung apices could represent air trapping or\naspiration." }, { "input": "Dental amalgam streak artifact limits study. There is straightening of\ncervical lordosis. No fractures are identified.Multilevel degenerative\ndisease is seen throughout the cervical spine, including loss of disc height,\nendplate sclerosis, disc osteophyte complexes and facet joint hypertrophy. \nMost pronounced at C6-C7 where there is at least mild vertebral canal\nnarrowing. There is no prevertebral edema.\n\nThere is a 1.9 cm hypodense lesion in the left lobe of the thyroid.\nAtherosclerotic vascular calcifications are seen in bilateral carotid\nbifurcations.", "output": "1. No evidence of acute fracture or traumatic subluxation.\n2. 1.9 cm left thyroid lobe nodule. The ___ College of Radiology\nguidelines suggest thyroid ultrasound for further evaluation, if not already\nperformed.\n3. Multilevel degenerative changes as described, most pronounced at C6-7 where\nthere is at least mild vertebral canal narrowing." }, { "input": "Alignment is normal. No fractures are identified. There are anterior\npartially bridging osteophytes throughout the midthoracic spine. There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There are no suspicious osseous lesions. \nThere is mild dependent atelectasis.", "output": "No acute fracture in the thoracic spine." }, { "input": "Alignment is normal. No fractures are identified. There is no significant\ndegenerative changes, no evidence of spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling.\n\nSurgical clips seen along the right paratracheal region at the thoracic inlet.\nThyroid is unremarkable. Somewhat linear right upper lung opacities are\nnoted, potentially scarring versus atelectasis.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no evidence of acute fracture. Minimal anterolisthesis of C4 on C5\nis demonstrated, most likely degenerative in nature however no priors are\navailable for comparison. Moderate, multilevel degenerative changes seen\nthroughout the cervical spine most severe at C5-6 and C6-7. There is\nossification of the posterior longitudinal ligament at the C6 level\ncontributing to at least moderate canal narrowing. There is no prevertebral\nsoft tissue swelling.\n\nThere is a 3 mm left apical pulmonary nodule demonstrating ___ year stability\nsince prior. Right apical scarring is noted. Bilateral thyroid nodules are\nnoted measuring up to 2.6 cm in the left lobe.", "output": "1. No acute fracture is demonstrated. Moderate multilevel degenerative\nchanges are seen throughout the cervical spine. Minimal anterolisthesis of C4\non C5 is likely degenerative however no priors are available for comparison. \nIf there is concern for cervical spine injury, MRI C-spine should be\nconsidered for further evaluation. No prevertebral soft tissue swelling.\n2. Thyroid nodules as noted on prior thyroid ultrasound." }, { "input": "There is no acute fracture, traumatic malalignment or prevertebral soft tissue\nswelling. Vertebral body heights are maintained. There is mild multilevel\ndegenerative changes with disc space narrowing at C5-C6 and uncovertebral\nhypertrophy at C5-C6 with moderate to severe narrowing of the right neural\nforamen. The outline of the thecal sac is preserved. The visualized soft\ntissues are unremarkable. The thyroid gland is unremarkable. Lung apices are\nclear.", "output": "1. No acute fracture or traumatic malalignment.\n2. Degenerative changes at C5-C6 as described above." }, { "input": "There is no evidence of fracture or subluxation. Vertebral body alignment and\nheights are preserved. Incidentally, there are sclerotic foci identified\nwithin the central vertebral bodies of L3 and L4. No evidence of associated\nosseous destruction.\n\nAt L3-4, there is mild bulging of the intervertebral disc. This, along with\nfacet osteophytes and ligamentum flavum thickening mildly narrows the spinal\ncanal. The neural foramina appear normal.\n\nAt L4-5, bulging of the intervertebral disc slightly encroaches on the spinal\ncanal. The disc bulge extends laterally into the right neural foramen where\nit contacts the exiting right L4 nerve root. There is ligamentum flavum\nthickening and facet osteophytes but no compromise of the spinal canal. The\nleft neural foramen appears normal.\n\nAt L5-S1, there is a right-sided disc protrusion involving the lateral portion\nof the spinal canal and extending into the right neural foramen where it\ncompresses the exiting L5 nerve root. The disc bulge and ligamentum flavum\nthickening mildly encroach on the spinal canal. The left neural foramen\nappears normal.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "1. No evidence of fracture or subluxation.\n\n2. Degenerative disc disease with bulges at L3-4 and L4-5 and a right-sided\nprotrusion at L5-S1. These lead to contact with the right L4 nerve root and\ncompression of the right L5 nerve root.\n\n3. Incidental sclerotic foci within the L3 and L5 vertebral bodies may\nrepresent bone islands. Correlation with prior outside imaging is\nrecommended, if available. If there is concern for sclerotic metastatic\ndisease, further evaluation with nonurgent nuclear medicine bone scan could be\nconsidered." }, { "input": "Patient is status post C2-L3 cervical, thoracic and lumbar posterior spinal\nfusion. Again demonstrated, are flowing syndesmophytes and fusion of the\nanterior longitudinal ligament consistent with history of ankylosing\nspondylitis. There is diffuse osteopenia which limits evaluation for new\nsubtle fractures. However, within these limitations:\n\nCERVICAL:\nAgain demonstrated, is posterior dislodgement of the left cervical screws into\nthe paraspinal soft tissues (602: 51). In addition, the right C3 and C4\ntranspedicular screws are also dislodged posteriorly into the paraspinal soft\ntissues (602:27). The C6 right transpedicular screw appears located along the\nmargin of the superior facet near the C5-C6 facet joint. (2:40, 602:28). \nThere is a chronic moderate to severe compression fracture of C7 vertebral\nbody with increased loss of height since ___ and increased mild\nretropulsion of the inferior posterior corner compared to ___. \nNo new displaced fracture is seen allowing for loss of bone mineralization.\n\nTHORACIC:\nUnchanged appearance of the chronic fracture of the T6 vertebral body with\nretropulsion of the posterosuperior corner, as well as retrolisthesis of T5 on\nT6. Unchanged appearance of the chronic T12 vertebral body fracture with\nretropulsion of the posterosuperior corner and retrolisthesis of T11 and T12. \nOssification of the anterior longitudinal ligament is again seen with\nunchanged discontinuity at mid T12 level compared to the CTA chest from ___. No new fracture is seen allowing for loss of bone\nmineralization.\n\nAgain seen is thoracic posterior spinal fusion hardware. Lucencies along\nbilateral T11 screws on images 602:48, 602:55, are similar to the CTA chest\nfrom ___ allowing for differences in technique. A minimal lucency\nalong the left T9 screw on image 602:55 is also noted.\n\nLUMBAR:\nAlignment is overall unchanged compared to the radiographs from ___.\nAgain demonstrated are chronic fractures of L2, L3 and L4 vertebral bodies,\nstatus post vertebroplasty at L3 and L4 vertebral bodies. Ossification of the\nanterior longitudinal ligament is again seen. No evidence for acute fracture\nallowing for loss of bone mineralization. L1, L2 and L3 bilateral\ntranspedicular screws appear intact without evidence of dislodgement or\nloosening.\n\nThere is chronic healed fracture of S1 superior endplate. Mild anterior\ncortical deformity of S2-S3 on image 602:40 ___ also be secondary to chronic\nhealed fracture. Sacroiliac joints are partially fused, likely secondary to\nadvanced osteoarthritis.\n\nOTHER:\nThis exam is not technically optimized for evaluation of the included brain\nparenchyma; no concerning abnormalities are seen on limited assessment. A\nleft maxillary periapical lucency is noted, apparently associated with ___ 14,\ncervical spine images ___.\n\nNo cervical lymphadenopathy by CT criteria. The thyroid is grossly\nunremarkable. Carotid bifurcation calcifications are noted.\n\nThere is a chronic loculated right pleural effusion with chronic right lower\nlobe atelectasis. There is chronic trace left pleural effusion with chronic\nleft lower lobe atelectasis plus/minus scarring. There is a fluid level in\nthe thoracic esophagus, placing the patient at risk for aspiration. Thoracic\naortic calcifications and coronary artery calcifications are noted.\n\n2 cm right adrenal nodule on thoracic spine image 3:110, lumbar spine image\n4:14, has indeterminate density but appears unchanged in size compared to the\n___ CTA, statistically likely an adenoma. Hypodense lesions in\nboth kidneys are compatible with cysts on nonenhanced CT. Extensive\natherosclerotic calcifications are noted. There is diverticulosis of the\npartially included sigmoid colon without evidence for acute diverticulitis. A\npresumed Foley catheter is seen in the included bladder dome.\n\nThere are chronic healed fractures of bilateral medial clavicles, and chronic\nhealed fractures of multiple bilateral posterior ribs, as seen previously. \nThe ribs are not fully imaged on this exam.", "output": "1. Status post posterior instrumented fusion from C2 through L3. Posterior\ndislodgement of left cervical screws and right C3 and C4 screws. Right C6\nscrew is located along the margin of the right superior facet near the right\nC5-C6 facet joint. Unchanged small lucencies along T11 screws compared to the\nchest CT from ___. Minimal lucency along the left T9 screw.\n2. Unchanged chronic moderate to severe C7 vertebral body compression fracture\nwithout retropulsion.\n3. Unchanged chronic chronic T6 and T12 vertebral body fractures with\nretropulsion, and associated retrolisthesis at T5-T6 and T11-T12.\n4. Unchanged chronic L2, L3 and L4 vertebral fracture status post\nvertebroplasty at L3 and L4.\n5. Chronic S1 superior endplate fracture. Possible chronic fracture of the\nanterior cortex at S2-S3. Chronic healed fractures of bilateral medial\nclavicles and multiple bilateral posterior ribs.\n6. Diffuse thoracic and lumbar anterior longitudinal ligament ossification is\nunchanged as continuity at T12.\n7. Periapical lucency ___ 14.\n8. Chronic loculated right pleural effusion with chronic right lower lobe\natelectasis. Chronic trace left pleural fluid with mild left lower lobe\natelectasis or scarring.\n9. Fluid in the esophagus, placing the patient at risk for aspiration.\n10. Stable 2 cm right adrenal nodule, not fully characterized, statistically\nlikely an adenoma." }, { "input": "Alignment is normal. No fractures are identified.Multilevel moderate to severe\ndegenerative changes are noted with ossification of the posterior longitudinal\nligament and posterior disc bulges causing moderate to severe vertebral canal\nnarrowing, most pronounced at C4-C5 and C6-C7. Multilevel anterior,\nposterior, and uncovertebral osteophytosis is worse at C4-C5. There is\nmultilevel facet arthropathy including facet arthrosis at C3-C4. There is\nmild osseous right neural foraminal narrowing at C3-C4 and moderate bilateral\nneural foraminal narrowing at C4-C5. There is no prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm.\n\nEvaluation of the lung apices is limited by respiratory motion artifact. \nDespite this limitation, there are no gross abnormalities. Atherosclerotic\ncalcifications are worst at the carotid bifurcations.", "output": "1. No evidence of fracture or traumatic malalignment.\n2. Moderate to severe multilevel degenerative changes include ossification of\nthe posterior longitudinal ligament and posterior disc bulges causing moderate\nto severe vertebral canal narrowing at C4-C5 and C6-C7. Mild to moderate\nosseous neural foraminal narrowing caused by osteophytosis is also present at\nC3-C4 and C4-C5." }, { "input": "Spinal fusions streak artifact limits examination.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is grade 3 anterolisthesis of L5 on S1, with patient now status post\nplacement of spine stabilization hardware spanning L4-S1, with L5 and S1\nlaminectomies, without definite evidence of spinal hardware fracture. \nMultilevel degenerative changes of the lumbar spine are noted, including loss\nof intervertebral disc height, and endplate sclerosis, most pronounced at\nL1-2, L2-3, and L3-4. There is mild vertebral canal narrowing at L1-2 and\nL2-L3. Vertebral body heights are preserved. Question minimal age\nindeterminate L1 anterior compression deformity.\n\nThere is no paravertebral or paraspinal mass identified. The visualized\nportion of the sacroiliac joints are preserved.\n\nLimited evaluation of the abdomen is notable for extensive atherosclerotic\ndisease, with question partial visualization of abdominal aortic aneurysm (see\n400b:53). Partially visualized lungs suggest bilateral pleural effusions (see\n3:1- 15). Limited imaging of the pelvis suggests diverticulosis.", "output": "1. Study limited by presence of spine stabilization hardware.\n2. Nonspecific vertebral body endplate sclerosis at L1-2, L2-3, and L3-4\nwithout definite associated osseous destruction. Please note contrast spine\nMRI is more sensitive for the evaluation of epidural abscess or\ndiscitis-osteomyelitis.\n3. Status post placement of spine stabilization hardware spanning L4-S1, with\nL5 and S1 laminectomies, without definite evidence of hardware fracture.\n4. Degenerative changes of the lumbar spine, as described above.\n5. Extensive abdominal aorta atherosclerotic changes, with abdominal aorta\nonly partially visualized on current study. Question presence of abdominal\naortic aneurysm. If clinically indicated, consider abdominal aortic\nultrasound.\n6. Partially visualized lungs suggest bilateral pleural effusions.\n7. Question age indeterminate minimal anterior L1 compression deformity. If\nclinically indicated, lumbar spine MRI may be obtained further evaluation.\n8. Diverticulosis.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 22:11 into the Department of Radiology critical\ncommunications system for direct communication to the referring provider." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C5-7 and notable for intervertebral disc\nheight loss, bony fusion, and osteophytosis with moderate resultant moderate\ncanal narrowing which is chronic. Additionally, there is mild to moderate\nmultilevel neural foraminal stenosis, most pronounced on the right at C3-4\nbilaterally at C4-5 and on the left at C5-6. A well corticated ossific\ndensity along the right inferior articular process of C3 (series 602, image\n24) is chronic. There is no prevertebral edema.\n\nThe thyroid appears unremarkable. Mild scarring within the lung apices. Mild\natherosclerotic calcifications of the carotid bifurcations bilaterally.", "output": "1. No acute fracture or traumatic subluxation.\n2. Moderate to severe degenerative changes throughout the cervical spine\nincluding fusion of C5-C7." }, { "input": "No acute fracture or cervical malalignment is identified throughout the\ncervical spine. There is no abnormal prevertebral soft tissue swelling.\nDegenerative changes relative to prior study dated ___ have not\nsignificantly progressed. Disc space narrowing and endplate sclerosis is most\npronounced at the C5-C6 level. Uncovertebral joint arthropathy additionally\nis noted at the left C2-C3 level. Cervical alignment appears within normal\nlimits. Central canal is not adequately evaluated by this modality however no\ncritical central canal stenosis is identified. Lung apices are clear. The\nthyroid gland is unremarkable.", "output": "No acute fracture or cervical spine subluxation." }, { "input": "No evidence of traumatic cervical malalignment or acute fracture. There is\nmild vertebral body height loss involving the C5 and C6 vertebral bodies, age\nindeterminate. This is associated with uncovertebral hypertrophy and mild\ndisc bulge at this level. Findings are felt to be most in keeping with\nchronic degenerative change. There is no evidence of severe spinal canal or\nneural foraminal stenosis. No definite prevertebral soft tissues swelling is\nseen.\n\nEnteric and ET tube are incompletely evaluated on current exam.", "output": "1. No evidence of traumatic cervical malalignment or acute fracture.\n2. Mild vertebral body height loss involving C5 and C6, age indeterminate but\nfelt to be degenerative in nature as there are associated degenerative changes\nat this level.\n3. Mild diffuse soft tissue edema is identified." }, { "input": "Alignment is normal. No fractures are identified. There is mild multilevel\nfacet joint degenerative disease bilaterally. Degenerative changes are most\npronounced at the C4-5 level with loss of intervertebral disc space and\nendplate sclerosis. Small posterior disk osteophyte complexes at the C4-5 and\nC6-7 levels cause minimal central canal narrowing. There is no evidence of\ncritical spinal canal or neural foraminal narrowing. There is no evidence of\ninfection or neoplasm. A bone island is noted in the C4 vertebral body. There\nis calcification of the nuchal ligament.\n\nThe thyroid gland is normal. The imaged lung apices are clear. Intracranial\ncontents are better evaluated on concurrent CT of the head. There is\nopacification of right inferior mastoid air cells.", "output": "No evidence of acute fracture or malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified.Degenerative changes most\nnotable for intervertebral disc height loss, posterior osteophytes and\nuncovertebral joint hypertrophy most notably at C4-5. No significant canal or\nforaminal narrowing.There is no prevertebral edema.\n\nRight apical scarring is noted with rightward deviation of the trachea likely\ndue to the volume loss. Partially visualized exuberant calcifications noted\nat the medial right clavicle as seen on prior plain films. There is\nasymmetric enlargement of the left lobe of the thyroid with partially\nvisualized nodules measuring up to 1.4 cm.", "output": "No cervical spine fracture or malalignment." }, { "input": "Since the prior exam, the known L3 vertebral body fracture has significantly\nprogressed, now with 40% loss of vertebral body height. There is now\nprevertebral soft tissue swelling and/or hematoma centered at the L3 vertebral\nbody and extending to the L2-L3 and L3-L4 intervertebral disc spaces (e.g. \nSeries 3, image 52, 44). Fractures are now seen involving the pedicles at\ntheir junctions with the vertebral body. Retropulsion of a posterior fracture\nfragment which includes an osteophyte has progressed now extending 5 mm into\nthe spinal canal, previously only 3 mm, with mild-to-moderate associated\nspinal canal stenosis that flattens the left anterior aspect of the spinal\ncanal (series 3, image 47). There is moderate left and right neural foraminal\nstenosis. No new fractures at other levels. Vacuum phenomenon is noted. No\ndefinite epidural hematoma is noted.\n\nBackground degenerative disc disease is seen at other levels, most pronounced\nat L4-L5 with a moderate broad-based central disc bulge indenting the anterior\nthecal sac, similar the prior exam. This along with bilateral facet\nhypertrophy and ligamentum flavum thickening results in mild spinal canal\nstenosis. At this level right neural foraminal narrowing is mild-to-moderate\nand left neural foraminal narrowing is mild, unchanged. Grade 1\nanterolisthesis of L5 on S1 is unchanged. Bilateral neural foraminal\nnarrowing at these levels is mild, unchanged. Bilateral neural foraminal\nnarrowing at L2-L3 is moderate.\n\nA hiatal hernia is small. Nodular appearance of the left adrenal gland is\nunchanged. Moderate atherosclerotic calcifications are seen within the\nmesenteric arteries, abdominal aorta and iliac branches.", "output": "Interval progression of the known L3 vertebral body burst fracture now with at\nleast 40% loss of vertebral body height, increased retropulsion (5 mm) of the\nposterior fracture fragment into the spinal canal, new extension of fractures\nposteriorly to the pedicles bilaterally, and associated small prevertebral\nsoft tissue swelling/hematoma. Resultant mild-to-moderate stenosis of the\nanterior spinal canal. Consider MRI as clinically indicated.\n\nRECOMMENDATION(S): Consider MRI as clinically indicated.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by\n___, M.D. on the telephone on ___ at 9:43 pm, 5 minutes after\ndiscovery of the findings." }, { "input": "In comparison with the prior CT of the lumbar spine dated ___, there\nis interval progression of the known L3 vertebral body burst fracture, with\napproximately 50% of loss of the height of L3 vertebral body with increased\nvacuum phenomenon, with similar pattern of retropulsion of the superior\nendplate towards the thecal sac, causing moderate spinal canal stenosis with\napproximately 5 mm of displacement into the spinal canal, there unchanged\nbilateral pedicular fractures and grossly unchanged vacuum disc phenomenon at\nthe intervertebral disc space of L2-L3. There is minimal residual\nprevertebral soft tissue swelling at L2-L3 and L3-L4 levels.\n\nAt L3-L4 level, there is unchanged diffuse disc bulge with vacuum disc\nphenomenon, causing anterior thecal sac deformity, mild left neural foraminal\nnarrowing and moderate right neural foraminal narrowing, there is unchanged\nmild articular joint facet hypertrophy and ligamentum flavum thickening\nresulting in mild spinal canal narrowing.\n\nAt L4-5 level, there is vacuum disc phenomenon at the intervertebral disc\nspace, which is new since the prior exam, diffuse disc bulging causing\nanterior thecal fat deformity and bilateral neural foraminal narrowing,\nmoderate articular joint facet hypertrophy ligamentum flavum thickening causes\nmoderate spinal canal stenosis.\n\nAt L5-S1 level, minimal anterolisthesis remains unchanged. There is vacuum\ndisc phenomenon, new since the prior exam, diffuse disc bulging causing mild\nbilateral neural foraminal narrowing, articular joint facet hypertrophy\nligamentum flavum thickening remain unchanged. The sacroiliac joints\ndemonstrate sclerotic changes and vacuum phenomenon on the right, unchanged\nsince the prior exam.\n\nOther findings: Nodular appearance of the left adrenal gland remains\nunchanged. Vascular arteriosclerotic calcifications are visualized in the\niliac arteries, abdominal aorta as well as mesenteric arteries.", "output": "1. There is interval progression of the known L3 vertebral body burst\nfracture, with approximately 50% of loss of height at L3 vertebral body, with\nincreased vacuum phenomenon, similar retropulsion of the superior endplate\ntowards the thecal sac, producing moderate spinal canal stenosis with\napproximately 5 mm of displacement into the spinal canal. Unchanged bilateral\npedicular fractures at L4 level.\n\n2. Vacuum disc phenomenon is seen at L4-L5 and L5-S1 levels, new since the\nprior exam of the, otherwise relatively stable multilevel degenerative changes\nthroughout the lumbar spine." }, { "input": "The study is slightly degraded by motion. Within this limitation, multilevel\ndegenerative changes are again demonstrated, with loss of intervertebral disc\nspace height most notable at C4-C5, C5-6, and C6-7, associated with endplate\nsclerosis and anterior and posterior osteophytes.\nThere is canal narrowing at C3-C4, C4-C5, C5-C6, and C6-C7.\nThere is moderate and severe bilateral neural foraminal narrowing multiple\nlevels bilaterally, at C4-C5, C5-C6, and C6-C7, unchanged since the prior\nstudy. Again seen and unchanged is a chronic fracture of the posterior\nportion of the right first rib.\n\nThere is no prevertebral soft tissue edema. Again demonstrated is severe\ncentrilobular emphysema at the apices. Suture material at the apices is also\nnoted.", "output": "Moderate to severe multilevel degenerative changes without acute fracture or\ntraumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Moderate to severe multilevel\ndegenerative changes are re-demonstrated with intervertebral disc space\nnarrowing, endplate sclerosis, anterior and posterior osteophyte formation,\nand multilevel disc bulging. Again noted is multilevel moderate central canal\nstenosis at C3-4, C4-5, C5-6, and C6-7. Additionally, moderate to severe\nbilateral neural foraminal narrowing is most pronounced at C4-5 and C5-6 due\nto facet hypertrophy and uncovertebral spurring. There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm.\n\nThe visualized thyroid gland is unremarkable. Severe emphysematous changes\nare again noted in the upper lobes bilaterally with chain sutures seen in both\nlung apices.", "output": "1. No acute fracture or malalignment.\n2. Moderate to severe cervical spondylosis.\n3. Severe centrilobular emphysema in the lung apices." }, { "input": "Minimal retrolisthesis of C4 on C5 is likely degenerative in etiology. \nAlignment is otherwise unremarkable. No fractures are identified. Mild to\nmoderate multilevel degenerative changes are noted in the cervical spine most\nnotable at C4-C5, C5-C6, and C6-C7 with loss of disc space and osteophyte\nformation and moderate spinal canal stenosis and moderate to severe bilateral\nneural foraminal narrowing. There is no prevertebral edema.\n\nThere is severe bilateral upper lobe centrilobular emphysema and chain suture\nnoted in the left apex. Visualized thyroid gland is unremarkable.", "output": "1. No cervical spine fracture. No prevertebral edema.\n2. Moderate cervical spondylosis. Minimal C4 on C5 retrolisthesis is likely\ndegenerative in etiology." }, { "input": "For the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nAlignment is preserved.Compression deformity of the T12 and L1 vertebral\nbodies are unchanged since ___. No acute thoracic spinal fracture\ndetected. No paravertebral soft tissue swelling. Within the limits of this\nnoncontrast study, there is no evidence of infection or neoplasm. There is no\nevidence of bony spinal canal stenosis. Nonspecific subcentimeter mediastinal\nlymph nodes are noted without definite enlargement by CT size criteria.\n\nMild bibasilar dependent atelectasis is noted in the visualized portion lungs.", "output": "1. No evidence of acute thoracic spinal fracture.\n2. Stable T12 and L1 compression deformities compared to ___ prior\nexam.\n3. Please see concurrently obtained lumbar spine CT for description of lumbar\nspine findings." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere is stable grade 1 retrolisthesis of L5 on S1. Dextroscoliosis of the\nlumbar spine is again noted.\n\nCompression deformities of the L1, L2, and L4 vertebral bodies have not\nchanged since ___ acute lumbar spinal fracture is not\nidentified.\n\nDegenerative changes of the lumbar spine are again noted, with multilevel loss\nof intervertebral disc height, Schmorl's nodes, and facet joint arthropathy,\nmost pronounced at L5-S1, where there is grossly stable endplate sclerosis and\nosteophytosis. There is no paravertebral soft tissue swelling. No definite\nbony spinal canal stenosis is noted. The imaged abdominal aorta is moderately\ncalcified, as seen on the prior study.", "output": "1. No evidence of acute lumbar spinal fracture or traumatic malalignment.\n2. Compression deformities of the L1, L2, and L4 are unchanged since ___.\n3. Multilevel degenerative changes as described." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThe thyroid is unremarkable. Biapical scarring is mild.", "output": "No fracture or traumatic malalignment." }, { "input": "Postoperative changes involving the entire thoracic spine are seen, with\nbilateral posterior fixation rods and hooks. The posterior fixation hardware\nappears dorsally displaced. Specifically, the biilateral hooks involving the\nvertebrae from T2 to T7 appear posteriorly displaced. The T10 hook appears in\nappropriate position. Multilevel linear lucencies through the thoracic laminae\nmay be postsurgical, however, fracture resulting in posterior displacement is\npossible. An open defect in the skin and subcutaneous soft tissues overlying\nthe superior thoracic spine is identified, with air tracking freely to the\nsuperior aspect of the spinal fixation hardware. The subcutaneous soft tissues\noverlying the thoracic spine demonstrate fat stranding and edema, which\nextends inferiorly from the skin defect and appears most prominent over the\nlower thoracic spine. Given lack of administration of IV contrast,\nperipherally enhancing collection is unable to be excluded on the basis of\nthis study. Incidental note is made of probable mild left hydronephrosis,\nwhich is only partially imaged.", "output": "1. Malposition of bilateral posterior spinal fixation hardware, with dorsal\ndisplacement of hooks from the T2 to T7 vertebral bodies. Multilevel linear\nlucencies through the thoracic laminae may be postsurgical, however, fracture\nresulting in posterior hardware displacement is possible.\n2. Open defect in the skin and subcutaneous soft tissues overlying the\nsuperior aspect of the fusion hardware, with air tracking freely to spinal\nhardware. Subcutaneous soft tissue fat stranding and edema overlying the\nthoracic spine is most prominent over the lower thoracic spine. Given lack of\nIV contrast, cannot assess for a peripherally enhancing collection. Infection\nis not excluded.\n3. Probable mild left hydronephrosis, partially imaged." }, { "input": "Please note study is substantially limited due to patient positioning, beam\nhardening artifact, and lack of intravenous contrast.\n\n For the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level. Please note that this method is inappropriate for\nsurgical planning and that prior to any intervention appropriate levels must\nbe established.\n\nPatient is status post fusion of T1 through 11 with postoperative changes\ninvolving the entire thoracic spine with bilateral posterior fixation rods and\nhooks, posterior mid line staples, and bone graft material. There is mild\nlevoscoliosis with apex at T9. Multiple posterior laminectomies are again\nnoted most prominent at T1. Significant soft tissue swelling and stranding is\nseen throughout the course of the posterior spinal fusion, most prominent\nalong the upper thoracic spine from T1 through T4. At T1 through T4 posterior\nspinal rods and hooks are within bone graft material approximately 1.5-2cm cm\nposterior to the level of the lamina.\n\nSubcutaneous emphysema is seen throughout the surgical site most prominent at\nC7 the T1. At the level of T1-T2 bony changes are post laminectomy given clean\nmargins and absence of cortical irregularity. No locules of air within the\ncentral canal. Given absence of IV contrast and beam hardening artifact from\nhardware limited evaluation for fluid collection.\n\nThe prevertebral and soft tissues are within normal limits. Evidence of\nchronic healed fracture along posterior right twelfth rib. A small right\npleural effusion is stable. Again seen is probable mild left hydronephrosis,\nonly partially imaged. There is of an enlarged approximately 12 mm mesenteric\nlymph node (see series 2 image 132). Allowing for difference in technique,\nthis structure is also noted on the ___ prior CT thoracic spine\nstudy (series 2a image 107).\nPartially visualized liver demonstrates an approximately 8 mm left hepatic\nlobe hypoattenuating structure that is obscured by streak artifact (see series\n3, image 130).", "output": "1. Limited evaluation due to patient positioning, absence of IV contrast and\nbeam hardening artifact.\n2. Subcutaneous emphysema at T1-2 is nonspecific, and may be postsurgical in\nnature. However emphysematous changes secondary to infection cannot be\nexcluded on the basis of this examination. Recommend clinical correlation.\n3. Within limits of examination, no definite CT evidence of osteomyelitis or\ndiscitis identified in thoracic spine. If additional evaluation is warranted a\ncontrast enhanced study may be helpful, however this will be limited in\nevaluation due to beam hardening artifact.\n4. At T1 through T4 posterior spinal rods and hooks are suggested to being\nwithin bone graft material approximately 1.5 -2 cm posterior to the lamina. \nRecommend clinical correlation and correlation with surgical history for\nevaluation of hardware orientation.\n5. Probable mild left hydronephrosis, partially imaged.\n6. Stable small right pleural effusion.\n7. Approximately 12 mm mesenteric lymph node as described. Recommend clinical\ncorrelation.\n8. Limited evaluation of the liver suggests at least one 8 mm hypoattenuating\narea that is nonspecific. Recommend clinical correlation. If clinically\nindicated, further evaluation may be obtained via dedicated hepatic imaging.\n\nNOTIFICATION: Findings and recommendation discussed by Dr. ___ with Dr.\n___ at 17:45 on ___." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. No\nosteoblastic or lytic lesions identified. Degenerative loss of disc height is\nmild at L4-L5.\n\nT12-L1 through L2-L3: No significant spinal canal or neural foraminal\nnarrowing.\n\nL3-L4: A disc bulge and thickening of ligamentum flavum does not significantly\nnarrow the spinal canal. In combination with facet arthropathy there is mild\nbilateral neural foraminal narrowing. This is overall similar to examination\nof ___.\n\nL4-L5: A disc bulge with thickening of the ligamentum flavum results in mild\nspinal canal narrowing. In combination with mild facet arthropathy, there is\nmild right and no significant left neural foraminal narrowing, also unchanged\nfrom prior examination.\n\nL5-S1: A small disc bulge does not significantly narrow the spinal canal. \nThere is mild bilateral facet arthropathy which does not significantly narrow\nthe spinal canal. A left facet osteophyte appears to contact the traversing\nleft S1 nerve root (series 3, image 79), unchanged from prior exam.\n\nA sacral stimulator with leads entering the right S3-S4 neural foramina is\nnoted. The visualized abdominal and pelvic viscera is unremarkable. The\nparaspinal soft tissues are grossly unremarkable.", "output": "1. No acute osseous abnormality. Specifically no suspicious osteoblastic or\nlytic lesion.\n2. Mild multilevel degenerative spondylosis without evidence of high-grade\nspinal canal or neural foraminal narrowing. A left facet osteophyte contacts\ntraversing left S1 nerve root, unchanged from prior examination.\n3. Additional findings as described above." }, { "input": "Status post right laminotomy at L4-L5. The lumbar spine alignment is normal.\nNo fractures are identified.There is no prevertebral soft tissue swelling. \nThere is no evidence of abnormal enhancement.\n\nThere is multilevel disc bulging most prominent at L4-L5 where there is\nassociated ligamentum flavum thickening and facet osteophytes contributing to\nmild spinal canal narrowing, moderate right and mild left neural foraminal\nnarrowing.\n\nRedemonstrated is a left facet osteophyte at L5-S1 that appears to contact the\ntraversing left S1 nerve root.\n\nLesser degrees of spinal canal or neural foraminal narrowing are present at\nthe remaining levels of the lumbar spine.\n\nOther: Redemonstrated is a sacral stimulator with leads entering the right\nS3-S4 neural foramen. No significant change in position of the 4 mm right\nrenal stone within the renal pelvis.", "output": "1. Degenerative changes of the lumbar spine most significant at L4-L5 where\nthere is mild spinal canal narrowing and moderate right neural foraminal\nnarrowing.\n2. Redemonstrated left facet osteophyte at L5-S1, which appears to contact the\ntraversing left S1 nerve root.\n3. Right nephrolithiasis." }, { "input": "Alignment is anatomic.No acute fractures are identified. There is no evidence\nof critical spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\nVisualized portion of the thyroid is unremarkable.", "output": "No cervical spine fracture or malalignment." }, { "input": "The previously seen fracture in the anterior aspect of the right side of the\nbody of C2 vertebra is less visible. This findings indicate interval healing\nprocess. The fracture cleft is barely visible. No displacement is seen. No\nsoft tissue changes are seen. No acute fracture is identified. No\nmalalignment is seen.", "output": "Findings suggestive of interval healing at the fracture site. No new\nabnormalities." }, { "input": "There is no acute fracture or malalignment. Cervical lordosis is maintained.\nMultilevel degenerative changes are as follows:\n\nCraniocervical junction is unremarkable.\n\nAt C2-3, the there is mild uncovertebral joint hypertrophy. Posterior disk\nbulge partially effaces the ventral CSF. There is no significant foraminal\nnarrowing.\n\nAt C3-4, there is intervertebral disc height loss. Bilateral uncovertebral\njoint hypertrophy and posterior disc bulge in combination with hypertrophy of\nthe ligamentum flavum results in mild to moderate canal narrowing. There is\nmild left foraminal narrowing.\n\nAt C4-C5, there is intervertebral disc height loss and uncovertebral joint\nhypertrophy. Posterior disk bulge partially effaces the ventral CSF and\nappears to contact the ventral aspect of the cord. There is moderate left and\nmild right foraminal narrowing\n\nAt C5-6 there is intervertebral disc height loss and with subchondral cystic\nformation at the superior endplate of C6. Uncovertebral joint hypertrophy and\nposterior disc bulge contribute to all likely moderate canal narrowing. There\nis moderate left and moderate-to-severe right foraminal narrowing.\n\nAt C6-C7, there is intervertebral disc height loss and uncovertebral joint\nhypertrophy. Posterior disc bulge appears to contact the ventral aspect of\nthe cord which although limited due to technique and artifact from the\nshoulders appears slightly flattened. Moderate bilateral foraminal narrowing\nis identified, worse on the right.\n\nC7-T1 and T1-2, there is no significant canal or foraminal narrowing.\n\nAll the thyroid is diffusely heterogeneous with a 10 x 6 mm calcified nodule\nin the right lobe. Or", "output": "Multilevel degenerative changes most notable at the C6-7 level. Although\nexamination is technically limited due to inherent limitations of CT\nparticularly in this region there is at least moderate canal narrowing and\napparent flattening of the cord due to combination of uncovertebral joint\nhypertrophic changes and posterior disc bulge. Other details as above with\nless significant canal narrowing and multilevel foraminal narrowing. If more\ndetailed evaluation of the thecal sac is necessary, CT myelogram could be\nconsidered." }, { "input": "CERVICAL SPINE:\nThe alignment of the cervical spine is normal. No fractures are identified. \nThe height of the vertebral bodies are maintained.\n\nThe intervertebral disc spaces of C3-C4 and C4-C5 are moderately narrowed. \nThe intervertebral disc spaces of C5-C6 and C6-C7 are moderately to severely\nnarrowed. Anterior endplate osteophytes are present from C3-C7. The\nprevertebral soft tissues are normal.\n\nAt C2-C3, a small posterior disc osteophyte complex minimally narrows the\nventral thecal sac with no significant spinal canal or neural foraminal\nstenosis, unchanged from the prior examination.\n\nAt C3-C4, a small posterior disc osteophyte complex, abutting the ventral\nspinal cord, and bilateral uncovertebral arthrosis cause mild spinal canal\nstenosis and mild right neural foraminal stenosis, unchanged from prior\nexamination.\n\nAt C4-C5, a moderate posterior disc osteophyte complex and bilateral\nuncovertebral arthrosis cause mild to moderate spinal canal stenosis and\nmoderate bilateral neural foraminal stenosis, unchanged from the prior\nexamination.\n\nAt C5-C6 a moderate posterior disc osteophyte complex and bilateral\nuncovertebral arthrosis cause moderate spinal canal stenosis and moderate to\nsevere bilateral neural foraminal stenosis, unchanged from the prior\nexamination.\n\nAt C6-C7, a moderate posterior disc osteophyte complex and bilateral\nuncovertebral arthrosis cause moderate spinal canal stenosis and moderate to\nsevere bilateral neural foraminal stenosis, right greater than left, unchanged\nfrom the prior exam today.\n\nAt C7-T1, a posterior disc osteophyte complex and bilateral uncovertebral\narthrosis cause moderate spinal canal stenosis and mild bilateral neural\nforaminal stenosis, unchanged the prior examination.\n\nThe thyroid gland is enlarged and heterogeneous. A 0.9 cm nodule in the right\nthyroid lobe with coarse calcifications is unchanged. Atherosclerotic\nvascular calcifications are noted of bilateral vertebral and cavernous\nportions of internal carotid arteries. Soft tissue density is noted within\nthe left external auditory canal which may represent cerumen.", "output": "1. Stable multilevel spondylotic changes of the cervical spine, most\npronounced at C5-C6 and C6-C7, where there is moderate spinal canal stenosis\nand moderate to severe bilateral neural foraminal stenosis.\n2. Heterogeneous enlarged thyroid gland with nodules as described. Recommend\nclinical correlation. If clinically indicated, consider thyroid ultrasound\nfor further evaluation.\n\nRECOMMENDATION(S):\n1. Heterogeneous enlarged thyroid gland with nodules as described. Recommend\nclinical correlation. If clinically indicated, consider thyroid ultrasound\nfor further evaluation." }, { "input": "For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nThere are stable postoperative changes related to patient's known L5-S1\nlaminectomy.\n\nThere is stable grade 1 L5 on S1 retrolisthesis. No fractures are identified.\nThe height of the vertebral bodies are maintained. The intervertebral disc\nspace of L5-S1 is moderately narrowed and partially calcified. There are\nsmall anterior endplate osteophytes from L1-L5 and a moderate bridging\nosteophyte from L5-S1, unchanged from the prior examination.\n\nAt T12-L1, there is no significant posterior disc herniation, spinal canal\nstenosis or neural foraminal stenosis.\n\nAt L1-L2, there is no significant posterior disc herniation, spinal canal\nstenosis, or neural foraminal stenosis.\n\nAt L2-3, there is no significant posterior disc herniation, spinal canal\nstenosis, or neural foraminal stenosis.\n\nAt L3-L4, diffuse disc bulge, ligamentum flavum thickening, and bilateral\nfacet hypertrophy cause moderate spinal canal stenosis, unchanged from the\nprior examination. There is no significant neural foraminal stenosis.\n\nAt L4-L5, diffuse disc bulge, ligamentum flavum thickening, and bilateral\nfacet hypertrophy cause moderate spinal canal stenosis, unchanged from the\nprior examination. There is no significant neural foraminal stenosis.\n\nAt L5-S1, calcified, diffuse disc bulge, eccentric to the right, and bilateral\nfacet hypertrophy cause moderate to severe right and mild left neural\nforaminal stenosis, and right subarticular recess stenosis, unchanged from the\nprior examination. There is no significant spinal canal stenosis.\n\nThere are mild degenerative changes of the bilateral sacroiliac joints with\nvacuum disc phenomenon.", "output": "1. Multilevel degenerative changes as described, most pronounced at the L3-4\nand L4-5 levels, where there is stable moderate spinal canal stenosis,\n2. Stable L5-S1 moderate to severe right and mild left neural foraminal\nstenosis." }, { "input": "Degenerative stepwise 2 mm retrolisthesis of L1 on L2, L2 on L3, L3 on L4 and\nL4 on L5 is overall similar to examination of ___. Severe degenerative loss\nof disc height at L5-S1 with endplate sclerosis and calcification of the\nresidual disc is slightly progressed from prior examination. There is new\nvacuum disc phenomenon at L3-L4 and L4-L5 with mild-to-moderate loss of disc\nheight. A new L3 inferior endplate Schmorl's node (series 11, image 48) is\nidentified. No evidence of acute displaced fracture. No suspicious\nosteoblastic or lytic lesions.\n\nT12-L1 through L2-L3: Mild degenerative changes including disc bulges do not\nsignificantly narrow the spinal canal or neural foramina. Degenerative\nchanges appear overall similar to prior examination\n\nL3-L4: A disc bulge and thickening of the ligamentum flavum results in what\nappears to be moderate spinal canal narrowing (series 3, image 48; series 11,\nimage 49), progressed from prior exam. There is also mild right greater than\nleft neural foraminal narrowing.\n\nL4-L5: A disc bulge with thickening of the ligamentum flavum results in mild\nto moderate spinal canal narrowing, slightly progressed from prior\nexamination. There appears to be at least moderate right and mild-to-moderate\nleft neural foraminal narrowing, also progressed from prior exam.\n\nL5-S1: A right central disc extrusion partially calcified is similar to prior\nexamination. There is no high-grade spinal canal narrowing. Loss of disc\nheight and facet arthropathy results in moderate to severe right and moderate\nleft neural foraminal narrowing, similar to slightly progressed from prior\nexam.\n\nAtherosclerotic calcification of the abdominal aorta and iliac vessels. 1 cm\nsimple cyst of the left kidney. Otherwise, the remainder the visualized\nabdominal and pelvic viscera and paraspinal muscles are unremarkable.", "output": "1. Interval progression of degenerative changes, most prominent at L3-L4 where\nthere appears to be likely moderate spinal canal narrowing, and at L4-L5 where\nthere is mild-to-moderate spinal canal narrowing with at least moderate right\nand mild-to-moderate left neural foraminal narrowing. No definite high-grade\nspinal canal narrowing.\n2. At L5-S1, there remains moderate to severe right and moderate left neural\nforaminal narrowing, similar to slightly progressed from prior exam.\n3. Additional findings as described above.\n\nRECOMMENDATION(S): If there remains clinical suspicion for critical spinal\ncanal stenosis, MRI would be more sensitive, if there no contraindications. \nIf there are contraindications, CT myelogram may yield additional information." }, { "input": "Please note study is limited secondary to limited opacification of nerve root\nsleeves.\n\nFor the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nStable 2 mm retrolisthesis of L1 on L2, L2 on L3, L3 on L4 and L4 and L5 is\nagain noted. Levoscoliosis of lumbar spine is again noted.\nThere is a Schmorl's node along the inferior endplate of the L3 vertebral\nbody, unchanged. Again question partial fusion of L5 and S1 vertebral bodies.\nOtherwise, vertebral body heights are grossly preserved.\n\nThe visualized portion of the spinal cord is grossly preserved in caliber with\nconus noted at approximately L1-2 level.\n\nThere is severe degenerative disc space height loss at L5-S1 with endplate\nsclerosis and calcification of the residual disc. Grossly stable vacuum disc\nphenomenon at L3-L4 and L4-L5 with disc space height loss.\n\nAt T12-L1 there is no definite vertebral canal or neural foraminal narrowing.\n\nAt L1-2 there is disc bulge, ligamentum flavum thickening, mild vertebral\ncanal and no definite neural foraminal narrowing.\n\nAt L2-L3, there is a disc bulge, facet joint hypertrophy, epidural fat,\nligamentum flavum thickening, mild spinal canal and mild bilateral neural\nforaminal narrowing.\n\nAt L3-L4, there is disc bulge, facet joint hypertrophy, epidural fat,\nligamentum flavum thickening, moderate spinal canal and at least mild\nbilateral neural foraminal narrowing.\n\nAt L4-L5, there is disc bulge, facet joint hypertrophy, epidural fat,\nligamentum flavum thickening, mild-to-moderate spinal canal and at least\nmoderate bilateral neural foraminal narrowing.\n\nAt L5-S1, there is a disc bulge with posterior disc osteophyte complex\nsuggested contact bilateral descending S1 nerve roots (see 2:86), facet joint\nhypertrophy, ligamentum flavum thickening, no spinal canal, and severe\nbilateral neural foraminal narrowing.\n\nOTHER:\nProbable atherosclerotic calcifications of the abdominal aorta is noted. \nLimited imaging of the abdomen demonstrates diverticulosis. Limited imaging\nof the kidneys demonstrates an approximately 8 mm right renal lesion with\naverage Hounsfield units of approximately 5HU (see 301:42) and nonspecific\nright renal focal calcification without definite evidence of hydronephrosis\n(see 301:51).", "output": "1. Study is limited secondary to limited opacification of nerve root sleeves.\n2. Multilevel lumbar spondylosis and epidural fat, most pronounced at L3-4,\nwhere there is moderate vertebral canal and mild bilateral neural foraminal\nnarrowing.\n3. L5-S1 bilateral severe neural foraminal narrowing.\n4. L4-5 at least moderate bilateral neural foraminal narrowing suggested.\n5. Please note lumbar spine MRI is more sensitive for the evaluation of neural\nforaminal narrowing.\n6. Diverticulosis.\n7. Atherosclerotic vascular disease.\n8. Left renal probable cyst and right renal probable nonobstructing calculus\nversus calcification." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal narrowing. There is no evidence of infection\nor neoplasm.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "Alignment is normal. No fractures are identified.There are mild multilevel\ndegenerative changes of the cervical spine including uncovertebral\nosteophytosis, facet arthropathy and intervertebral disc space narrowing. \nThis is most prominent at C5-C6 and C6-C7 where there is mild-to-moderate\nbilateral neural foraminal narrowing. No evidence of severe spinal canal\nstenosis. There is no prevertebral soft tissue swelling.\n\nThe visualized thyroid is unremarkable. Bilateral lung apices are clear.", "output": "No evidence of acute fracture or traumatic cervical malalignment." }, { "input": "Hairline fracture base of C7 spinous process, sagittal image 31, axial series\n2, image 65, 66.. Mild height loss superior C7 endplate, no fracture line, no\nadjacent edema, may be chronic. No other fractures. Normal spine alignment. \nNo prevertebral edema.\n\nDegenerative changes are most pronounced at C3-C4, C4-C5 where facet joint\nhypertrophy causes mild to moderate neural foraminal narrowing. There is no\nevidence of spinal canal stenosis.There is no prevertebral soft tissue\nswelling. Biapical lung scarring.", "output": "1. Nondisplaced fracture C7 spinous process.\n2. Mild loss superior C7 endplate, likely chronic.\n3. No prevertebral edema.\n4. Degenerative changes.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 8:22 am, 5 minutes after\ndiscovery of the findings." }, { "input": "There is no acute fracture or malalignment of the thoracic or lumbar spine. \nVertebral body heights are preserved. Mild multilevel degenerative disc\ndisease noted including anterior osteophytosis, intervertebral disc space\nnarrowing, and facet arthropathy. There is a mild grade 1 anterolisthesis of\nL5 on S1. S1 is partially lumbarized. Mild disc bulge L3-4 results in mild\ncentral canal narrowing. Facet arthropathy is most pronounced L3-4 and L4-5. \nThere is no evidence of high-grade spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\n\nThe partially visualized intrathoracic, intra-abdominal and pelvic soft\ntissues are notable for cholelithiasis, hepatic steatosis, vascular\natherosclerotic calcifications, calcified uterine fibroid and diverticulosis.", "output": "1. No evidence of acute fracture or traumatic malalignment involving thoracic\nand lumbar spine.\n2. Mild multilevel degenerative disc disease. Mild grade 1 L5 on S1\nanterolisthesis is likely chronic in etiology.\n3. Cholelithiasis.\n4. Hepatic steatosis.\n5. Calcified uterine fibroid.\n6. Diverticulosis." }, { "input": "Alignment is normal. No fractures are identified.There are prominent changes\nof degenerative disc disease with anterior and posterior intervertebral\nosteophyte formation as well as loss of disc height and endplate sclerosis at\nmultiple levels.\n\nAt C2-3, intervertebral osteophytes and a disc bulge mildly encroach on the\nspinal canal and just touch the anterior surface of the spinal cord. There is\nmoderate right and mild left neural foraminal narrowing due to uncovertebral\nand facet osteophyte formation.\n\nAt C3-4, intervertebral osteophytes and a mild disc bulge slightly flatten the\nanterior surface of the spinal cord. There is moderate right-sided neural\nforaminal narrowing due to uncovertebral and facet osteophyte formation.\n\nAt C4-5, intervertebral osteophytes narrow the spinal canal and slightly\nflatten the anterior surface of the spinal cord. Uncovertebral and facet\nosteophytes produce mild left and moderate right neural foraminal narrowing.\n\nAt C5-6, intervertebral osteophytes narrow the spinal spinal canal and\nmoderately flatten the spinal cord. Uncovertebral osteophytes produce\nmoderate -severe bilateral neural foraminal narrowing.\n\nAt C6-7, intervertebral osteophytes narrow the spinal canal and flatten the\nspinal cord. Uncovertebral osteophytes produce severe bilateral neural\nforaminal narrowing.\n\nThe C7-T1 and included portions of the upper thoracic spine demonstrate no\nspinal canal or neural foraminal narrowing.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.", "output": "1. Degenerative disc disease at multiple levels with spinal canal and neural\nforaminal narrowing. ." }, { "input": "There is no cervical spine fracture. Minimal anterolisthesis of C7 on T1 is\nlikely degenerative in nature given facet joint hypertrophy bilaterally at\nthis level. Degenerative changes including disc height loss, posterior\nosteophytes and uncovertebral joint hypertrophy is most extensive at C5-C6 and\nalso at C6-C7. There is no prevertebral soft tissue abnormality.\n\nThyroid is heterogeneous without discrete nodule. Scarring identified at the\nlung apices. Aberrant right subclavian artery is identified.", "output": "No cervical spine fracture.\nMinimal anterolisthesis of C7 on T1 is likely degenerative in nature although\nclinical correlation regarding need for additional imaging is suggested." }, { "input": "Alignment is normal. No fractures are identified.At C5-C6, moderate to severe\ndegenerative changes including posterior osteophyte formation cause mild\nneural foraminal stenosis bilaterally and canal stenosis with likely\nencroachment on the spinal cord. Moderate degenerative changes involving C1,\nC2, and the skull base are noted as well without acute fracture or\ndislocation. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm. A tunneled right IJ central venous\ncatheter is partially evaluated. A multinodular thyroid is incidentally\nnoted. Nodularity in the nasal cavity may reflect polyps. There is an\nair-fluid level in the sphenoid sinus on the right.", "output": "1. No evidence of fracture or malalignment of the cervical spine.\n2. Moderate degenerative changes at C5-C6 causing mild neural foraminal\nstenosis and spinal canal stenosis with likely encroachment on the spinal\ncord." }, { "input": "No fracture is identified through the cervical spine. Straightening of the\ncervical lordosis is noted. There is no prevertebral soft tissue swelling. \nMultilevel degenerative changes are most pronounced at the C3-C4 level. \nNumerous lytic lesions involve the cervical spine, the largest within C6\nvertebral body, most consistent with provided history of multiple myeloma. \nLung apices demonstrates a large nonhemorrhagic left pleural effusion. The\nthyroid gland is unremarkable.", "output": "1. No acute fracture or malalignment.\n2. Large left nonhemorrhagic pleural effusion incompletely imaged and better\nassessed on same date CT torso.\n3. Numerous lytic lesions are in keeping with provided history of multiple\nmyeloma." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C3-C4 and C4-C5 notable for severe right\nand severe left neural foraminal stenosis, respectively. There is no\nprevertebral edema.\n\nThe thyroid is enlarged and contains multiple nodules. The included lung\napices are unremarkable.", "output": "No acute fracture or traumatic malalignment.\n\nModerate to severe multilevel degenerative changes.\n\nMultinodular thyroid. If not previously performed, thyroid ultrasound may be\nconsidered." }, { "input": "There is no evidence of acute fracture or traumatic malalignment. There is\nmultilevel mild degenerative change with multilevel mild disc space narrowing.\nThere is no soft tissue swelling.", "output": "1. No acute fracture or dislocation. Mild degenerative change." }, { "input": "Alignment is normal. No fractures are identified. There is mild\nintervertebral disc space narrowing and spurring at the C5-C6 level. There is\nno evidence of significant spinal canal or neural foraminal stenosis. There is\nno prevertebral soft tissue swelling.\n\nThere is pneumatized fluid in the oropharynx. Fractures of the left maxilla\nand zygomatic process are better evaluated on same day maxillofacial CT.\n\nThere is a hemangioma of the T1 vertebral body (2:664). Endotracheal tube and\nenteric tube are partially visualized. There is there is consolidation at the\nposterior aspect of the left upper lung, better assessed on concurrent CT\nchest.", "output": "1. No fracture or malalignment of the cervical spine.\n2. Left-sided facial fractures are better evaluated on same day maxillofacial\nCT." }, { "input": "There is mild dextroscoliosis centered at L2 level, the patient is status post\nleft L2-L3 hemilaminectomy (400b:52, 401b:47). Severe L2-L3 degenerative\nchanges are present with grade 1 retrolisthesis of L2 on L3, near complete\nloss of intervertebral disc space, osteophyte formation, subchondral\nsclerosis, and extensive subchondral cyst formation. Soft tissue stranding\noverlying the operative site is noted without clear focal fluid collection\n(02:36). The previously seen enhancing endplate signal is not evaluated on\nthis noncontrast CT. No fractures are identified. There is no prevertebral\nsoft tissue swelling. The remainder of the examination is unremarkable.", "output": "Multilevel degenerative changes, appear more severe at L2-L3 level, status\npost left hemilaminectomy with soft tissue stranding overlying the surgical\nsite without focal fluid collection. Abnormalities described on recent MRI\nare not well visualized on this noncontrast CT, please refer to the MRI of the\nlumbar spine report for details." }, { "input": "Fusion hardware streak artifact limits study. Within these confines:\n\n For the purposes of numbering, the lowest rib bearing vertebral body was\ndesignated the T12 level.\n\nGrossly stable minimal dextroscoliosis centered at L2 and grade 1\nretrolisthesis of L2 on L3 is again noted. There has been interval L2-3\nposterior fusion, with metallic screws projecting through the bilateral\npedicles at L2 and L3, L3 laminectomy and bone graft material placed. \nExpected postsurgical changes include soft tissue stranding, a small amount of\nair in the paraspinal soft tissues and spinal canal, as well as dense bone\ngraft material in the posterior soft tissues.\n\nThere is near complete loss of the intervertebral disc space, osteophyte\nformation, subchondral cyst formation, and subchondral sclerosis at L2-3. New\nvacuum disc phenomena is noted at L1-2. At least mild bony vertebral canal\nstenosis is again noted at L3-4 and L4-5 secondary to ossified posterior disc\nbulges. Facet joint arthropathy and loss of intervertebral discs height is\nnoted throughout lumbar spine.", "output": "1. Fusion hardware streak artifact limits examination.\n2. Interval L2-L3 posterior fusion and laminectomy with associated\npostsurgical changes as described. Within limits of study, no definite\nevidence of spinal fusion hardware fracture.\n3. Grossly stable minimal dextroscoliosis centered at L2 and grade 1 L2 on L3\nretrolisthesis.\n4. Multilevel degenerative changes as described, most pronounced at L2-3. At\nleast mild bony vertebral canal stenosis again noted L3-4 and L4-5." }, { "input": "Anterior fusion hardware spanning C5 through C7 without evidence for hardware\nfailure. There is 3 mm anterolisthesis of C3 on C4 with a partial fusion\nposteriorly. The remainder of the vertebral body heights are well maintained.\nThere is no suspicious focal osseous lesion.\nThere are multilevel, multifactorial degenerative changes of the visualized\ncervical spine including the aforementioned intervertebral disc space loss.\nThere are multilevel degenerative changes of the posterior elements with\nfusion of the facets at the level of C3 and C4. The prevertebral soft tissue\nis unremarkable. The neural foramina appear grossly patent.\n\nThe previously identified anterior epidural fluid collection extending from\nthe C5 through T2 level is far better appreciated on the same day MR\nexamination and is not well appreciated on today's CT exam.\n\nEndotracheal tube and upper enteric tube are partially visualized.\nThe imaged lung apices are unremarkable.\nA small ground-glass attenuation nodule in the right upper lung measuring\napproximately 2 mm, there is also seen on the prior CTA chest of ___.", "output": "1. Anterior epidural fluid collection from C5 through T2 level is better\nevaluated on the same day MR and is not well characterized on today's CT exam.\n2. Anterior fusion of C5 through C7 without evidence for hardware failure.\n3. Multilevel degenerative changes as above.\n4. A small ground-glass attenuation nodule in the right upper lung measuring\napproximately 2 mm, there is also seen on the prior CTA chest of ___." }, { "input": "Anterior epidural abscess extending from the C4/5 level through to the T-tube\nlevel is not readily apparent on the CT examination and was for better\ncharacterized on the prior MR.\n\n___ post posterior spine surgery, in the mid thoracic spine, with bilateral\nlaminectomy.\nNo obvious fluid collections noted on the CT. The thoracic vertebral body\nheights and alignment are well maintained without fracture or malalignment. \nThere are mild multilevel degenerative changes with some intervertebral disk\nspace narrowing. The neural foramina appear patent. The posterior spinal\nelements are well preserved. There is no prevertebral soft tissue swelling. \nThere is no suspicious focal osseous lesion.\n\nThere is partial collapse/ consolidation of the left lower lobe with left\npleural effusion.\nSmall right upper lobe nodule, better seen on prior CTA Chest of ___.\nThe remainder the visualized lungs are clear. Endotracheal tube, right central\nvenous catheter and upper enteric tube are in place. The visualized portion of\nthe retroperitoneum is grossly unremarkable.", "output": "1. Anterior epidural abscess is better characterized on the same day MR and is\nnot readily characterized on CT.\n2. No fracture or malalignment of the thoracic spine or suspicious focal bony\nlesions. Status post prior posterior spine surgery.\n3. Partial atelectatic collapse of the left lower lobe." }, { "input": "Patient is status post C5-T4 posterior fusion without evidence of hardware\nfracture or loosening. Patient is also status post C5-T1 corpectomy. Streak\nartifact secondary to hardware limits diagnostic evaluation. There is\nanterolisthesis of C3 over C4 and C4 over C5, unchanged.No fractures are\nidentified.There is anterior posterior osteophyte formation from C3-C4. There\nis ankylosis of the posterior vertebra of C3 and C4. There is no prevertebral\nsoft tissue swelling. There is no evidence of infection or neoplasm.\n\nAt C2-3 there is no spinal canal or neural foraminal stenosis.\n\nAt C3-4 there is mild neural foraminal narrowing on the right secondary to\nuncovertebral and facet osteophytes. There is no spinal canal stenosis..\n\nAt C4-5 there is mild spinal canal and neural foraminal narrowing due to\nuncovertebral and facet osteophytes. Please note that the intervertebral disc\nis better characterized on prior MR.\n\n___ C5-6 there is mild spinal canal and neural foraminal stenosis due to\nuncovertebral and facet osteophyte. Previously seen flattening of the left\nventral spinal cord is better evaluated on prior MR.\n\n___ C6-7 there is no spinal canal or neural foraminal stenosis.\n\nAt C7-T1 there is no spinal canal or neural foraminal stenosis.", "output": "1. Status post C5-T4 posterior fusion evidence of hardware associated failure\nand status post C5-T1 corpectomy.\n2. No fracture.\n3. Multilevel degenerative disease of the cervical spine.\n4. Spinal canal and neural foraminal stenosis as described above. Please note\nthat these are better characterized on MR ___." }, { "input": "There is no acute fracture or subluxation which involves the cervical spine. \nThere is no prevertebral soft tissue swelling or edema. Cervical alignment is\nwithin normal limits. Multilevel degenerative changes are mild. Lung apices\nare clear. The thyroid appears homogeneous in attenuation without a focal\nlesion. There is no cervical adenopathy.", "output": "No acute fracture or malalignment involving the cervical spine." }, { "input": "There is 3 mm of anterolisthesis of C4 on C5, 2 mm anterolisthesis of C5 on\nC6, 3 mm anterolisthesis of C6 on C7, and 3 mm anterolisthesis of C7 on T1.\nThese are most likely degenerative, as there is no prevertebral soft tissue\nswelling to suggest that these findings are acute. The C3 and C4 vertebrae\nare congenitally fused. Superior endplate deformity of the T2 vertebral body\nis also likely chronic.Multilevel degenerative changes of the cervical spine\nare moderate, with at most mild canal narrowing at C6-7. Neural foraminal\nnarrowing is most severe at C2-3 on the right, where it is moderate. There is\nno prevertebral soft tissue swelling.\n\nThe imaged thyroid gland is unremarkable. Lung apices are described on the\nconcurrent CT torso.", "output": "1. Multilevel anterolisthesis is most likely degenerative in nature as there\nis no prevertebral soft tissue swelling or other finding to suggest acuity. \nHowever, in the absence of prior cervical spine imaging, ligamentous injury\ncannot be entirely excluded in the setting of trauma. Comparison with prior\ncervical spine CT if available or MRI is recommended if there is clinical\nconcern for ligamentous injury.\n2. Superior endplate deformity of the T2 vertebral bodies is also likely\nchronic.\n\nRECOMMENDATION(S): Comparison with prior cervical spine CT or if there is\nhigh clinical concern for ligamentous injury MRI cervical spine." }, { "input": "There are 5 non-rib-bearing lumbar type vertebral bodies. Fusion hardware is\npresent at L3 and L4. Old screw tracts are noted in L5 where there has been a\nprior laminectomy. There mild degenerate changes moderate canal stenosis\nL2-L3. Evaluation of the intrathecal sac is limited by modality. Evaluation of\ncord compression is limited.\nThe paraspinal soft tissues are unremarkable.", "output": "Lumbar spine hardware and moderate canal stenosis the L2-L3 stenosis.\nEvaluation of the intrathecal sac is limited by modality." }, { "input": "Thoracic spine: There is multilevel degenerative disc disease of the thoracic\nspine. There are multilevel small posterior disc protrusions without evidence\nof cord compression or neural impingement within the thoracic spine. There is\nalso multilevel facet arthropathy.\n\nThe paraspinal and prevertebral soft tissues surrounding the thoracic spine\nare unremarkable. There is a nerve stimulator spanning the T8-T10 levels.\n\nLumbar spine: There is multilevel degenerative disc disease of the lumbar\nspine. There are postoperative changes of a prior L3 through S1 laminectomies\nwith posterior stabilization hardware at the L3-L4 level.\n\nAt the T12-L1 level, the spinal canal and neural foramina appear normal.\n\nAt the L1-L2 level, there is mild bilateral facet arthropathy. The spinal\ncanal and neural foramina appear normal.\n\nAt the L2-L3 level, there is a disc bulge with posterior disc protrusion and\nbilateral facet arthropathy and ligamentum flavum thickening which cause\nsevere spinal canal narrowing.\n\nAt the L3-L4 level, there are postoperative changes, as described. The spinal\ncanal and neural foramina appear normal.\n\nAt the L4-L5 level, there are postoperative changes, as described. The spinal\ncanal and neural foramina appear normal.\n\nAt the L5-S1 level, there are postoperative changes, as described. The spinal\ncanal appears normal. There is probable mild bilateral neural foraminal\nnarrowing, right greater than left.", "output": "1. Postoperative changes, as described, including multilevel laminectomies and\nstabilization hardware at L3-L4.\n2. Disc bulge, disc protrusion, bilateral facet arthropathy, and ligamentum\nflavum thickening at the L2-L3 level which causes severe spinal canal\nnarrowing." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThyroid is unremarkable. Lung apices are clear. There is medialization of\nthe right true vocal cord and aryepiglottic fold and enlargement of the\npiriform sinus suggesting right vocal cord paralysis. Soft tissue swelling\nnoted in the right supraclavicular region.", "output": "1. No acute fracture or traumatic malalignment.\n2. Findings suggestive of right vocal cord paralysis.\n\nNOTIFICATION: Update discussed by Dr. ___ with ___ at 18:25 on ___." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are seen, most extensive at C3-4 and notable for posterior\nosteophytosis, uncovertebral hypertrophy and facet hypertrophy contributing to\nmild to moderate spinal canal narrowing, moderate left neural foraminal\nnarrowing and mild right neural foraminal narrowing at this level.\n\nAt C4-C5 level, there is bilateral uncovertebral hypertrophy causing mild\nright and moderate to severe left-sided neural foraminal narrowing. There is\nno evidence of central spinal canal stenosis.\n\nAt C5-C6 level there is anterior and posterior spondylosis, vacuum disc\nphenomenon, bilateral uncovertebral hypertrophy more significant on the left\ncausing severe left-sided neural foraminal narrowing, there is no evidence of\ncentral spinal canal stenosis there is no prevertebral edema.\n\nAt C6-C7 level, there is posterior spondylosis bilateral uncovertebral\nhypertrophy, slightly more pronounced on the left causing moderate to severe\nleft-sided neural foraminal narrowing.\n\nC7-T1 level, there is no evidence of significant neural foraminal narrowing or\nspinal canal stenosis.\n\nThe thyroid gland and included lung apices are unremarkable.", "output": "1. No acute fracture or traumatic malalignment of the cervical spine.\n\n2. Multilevel, multifactorial degenerative changes throughout the cervical\nspine as described detail above, more significant at C3-C4 level." }, { "input": "Alignment is normal. No acute cervical spine fractures are identified. \nModerate to severe multilevel degenerative changes, include intervertebral\ndisc height narrowing, osteophyte formation, and subchondral cystic changes. \nModerate to severe canal narrowing is most pronounced at C3-C4. Multilevel\nmoderate to severe bilateral neural foraminal narrowing is most pronounced on\nthe left at C3-4, on the left at C4-5, and bilaterally at C5-6. A sclerotic\nfocus within the C6 vertebral body appears unchanged. There is no\nprevertebral edema.\n\nEvaluation of lung apices is limited by respiratory motion. Mild biapical\npleuroparenchymal scarring. Visualized thyroid gland is unremarkable. \nIncidentally seen are calcified tonsilliths within the palatine tonsils.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate to severe cervical spondylosis with multilevel moderate to severe\ncentral canal and neural foraminal narrowing, most pronounced at C3-4." }, { "input": "Lumbar alignment is anatomic. Vertebral body heights are preserved. A L3\nvertebral body bone island is identified. There is a calcified L5-S1 disc\nloss of disc height. There is fusion of the L5-S1 facets.\n\nL1-L2: Disc with mild calcifications and minimal intervertebral osteophytes\nresults in moderate spinal canal narrowing in conjunction with epidural fat. \nThere is no significant neural foraminal narrowing.\n\nL2-L3: A small disc with mild intervertebral osteophytes results in mild\nspinal canal narrowing. There is mild bilateral neural foraminal narrowing.\n\nL3-L4: A disc with mild calcifications and intervertebral osteophytes which\nin conjunction with epidural fat and thickening of ligamentum flavum results\nin moderate to severe spinal canal narrowing. There is no significant neural\nforaminal narrowing.\n\nL4-L5: A small disc bulge, demonstrating mild calcifications does not\nsignificantly narrow the spinal canal. There is no significant neural\nforaminal narrowing.\n\nL5-S1: There is no significant spinal canal or neural foraminal narrowing.\n\nMultiple surgical staples in the upper abdomen is noted. Chain staples from a\nileal conduit is also identified in the right lower quadrant with adjacent\nsurgical clips. There is a 1.3 cm nodule of the anterior limb of the right\nadrenal gland, similar appearance to prior CT examination of ___. The left\nadrenal gland is mildly nodular without focal lesion. The remainder of the\nvisualize prevertebral paraspinal soft tissues are grossly unremarkable,\nnoting mild atherosclerotic calcification of the abdominal aorta.", "output": "1. Ankylosis of the bilateral L5-S1 facets is noted.\n2. At L1-L2, a disc with mild calcifications and mild intervertebral\nosteophytes results in moderate spinal canal narrowing.\n3. At L3-L4 a disc with minimal calcifications and intervertebral osteophytes,\nin conjunction with epidural fat and thickening of ligamentum flavum results\nin moderate to severe spinal canal narrowing.\n4. Additional findings described above.\n5. 1.3 nodule of the right adrenal gland anterior limb, similar appearance to\nexamination of ___, presumably representing an adenoma. This is incompletely\nevaluated on the current examination. If there is high clinical suspicion,\nthis could be further evaluated with dedicated MRI adrenal mass protocol.\n\nRECOMMENDATION(S): 1.3 nodule of the right adrenal gland anterior limb,\nsimilar appearance to examination of ___, presumably representing an adenoma.\nThis is incompletely evaluated on the current examination. If there is high\nclinical suspicion, this could be further evaluated with dedicated MRI adrenal\nmass protocol" }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm. Visualized\nthyroid gland and lung apices are clear.", "output": "Normal study." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid is unremarkable. The lungs are better evaluated on same-day chest\nCT.", "output": "No acute fracture or traumatic malalignment of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified. Mild degenerative disc\ndisease at C5-6 noted with endplate spurring. In addition, facet arthropathy\nis noted at C4-5 on the right. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.", "output": "No acute fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified. Mild degenerative change\nat the C5/C6 level include intervertebral disk space narrowing and anterior\nand posterior osteophytes. There is no evidence of significant spinal canal or\nneural foraminal narrowing. There is no prevertebral soft tissue swelling.\nThe lung apices are clear.", "output": "1. No acute fracture or dislocation.\n\n2. A 1.5 cm left thyroid nodule. Thyroid ultrasound on a non-emergent basis\nis recommended.\n\nNOTIFICATION: Findings emailed to the ED QA nurses by ___ at 0115 ___." }, { "input": "Thoracic spine: There is no acute fracture or traumatic subluxation.\n\nModerate degenerative changes are seen throughout the thoracic spine including\nposterior osteophytosis resulting in moderate to severe canal narrowing at\nT7/T8. Anterior and posterior osteophytosis is seen at T8, T9 and T9, T10. \nDiffuse intervertebral disc space narrowing is of seen at this level.\n\nThe visualized lungs are unremarkable. Note is made of a small hiatal hernia\nwith a suture line along the stomach.\n\nLumbar spine: No acute fracture or traumatic subluxation. Minimal\ndegenerative changes are seen throughout the lumbar spine. No significant\nsoft tissue abnormalities seen.", "output": "1. No acute fracture or traumatic subluxation within the thoracic or lumbar\nspine.\n2. Moderate degenerative changes throughout the thoracic spine including\nposterior osteophytosis worst at T7/T8 resulting in moderate to severe spinal\ncanal narrowing. Please note that the spinal cord is incompletely evaluated\non this exam. If there is further clinical concern or new symptoms are\npresent, a MRI may be helpful for further evaluation." }, { "input": "Patient is status post anterior cervical discectomy and fusion spanning C4\nthrough C7. There is no evidence of periprosthetic lucency or hardware\nfracture. Cervical vertebral bodies are maintained in height and alignment\nnoting fusion at the postoperative levels. There is no fracture.\n\nAt C2-3, there is a small disc bulge partially effacing the ventral CSF\nwithout significant canal or foraminal narrowing.\n\nAt C3-4, there is mild uncovertebral joint hypertrophy and a left central disc\nprotrusion partially effacing the ventral CSF. In combination with ligamentum\nflavum thickening there is at least mild canal narrowing.\n\nAt C4-5, no definite canal or foraminal narrowing noting artifact from\nposterior fixation hardware.\n\nAt C5-6 there is left uncovertebral joint hypertrophy contributing to mild\nleft foraminal narrowing. No visualized canal or right foraminal narrowing\nnoting artifact limiting detailed evaluation at this level.\n\nAt C6-7, there are posterior osteophytes which efface the ventral CSF. There\nis at least mild perhaps moderate canal narrowing. Uncovertebral joint\nosteophytes contribute to moderate left and mild-to-moderate right foraminal\nnarrowing\n\nAt C7-T1, there is no significant canal or foraminal narrowing\n\nIncluded paraspinal soft tissues are unremarkable.", "output": "1. Postoperative changes of anterior cervical discectomy and fusion spanning\nC4 through C7.\n2. Posterior osteophytes at C6-7 contributing to at least mild/moderate canal\nnarrowing." }, { "input": "Cervical and thoracic spinal fusion hardware streak artifact limits\nexamination.\n\nFor the purposes of numbering, the highest rib-bearing vertebral body was\ndesignate the T1 level.\n\nVertebral body alignment is preserved. The visualized osseous structures are\nosteopenic. Grossly stable minimal T11 anterior compression deformity and\nsuperior endplate Schmorl's noted again seen. Postsurgical changes related to\npatient's known T7 and T8 laminectomies and T7 through T9 posterior spinal\nfusion are again noted. Within limits of study, no definite evidence of\nfusion hardware fracture or loosening is identified. Within limits of study,\nno definite evidence of acute thoracic spine fracture.\n\nGrossly stable loss of intervertebral disc height is again noted throughout\nthe thoracic spine. Multilevel degenerative changes including endplate\nsclerosis, disc osteophytes, and facet joint hypertrophy are again seen.\n\nAt T7-8, there has been interval reduction of the patient's previously noted\ndisc osteophyte complexes, with left greater than right paracentral residual\ndisc osteophytes.\n\nDisc osteophytes at T4-5 and T5-6 again demonstrate at least mild vertebral\ncanal narrowing, unchanged. There is no definite evidence of severe bony\nvertebral canal or neural foraminal narrowing.\n\nOTHER:\nWithin the limits of this noncontrast study there is no paravertebral or\nparaspinal mass identified. Right middle lobe emphysematous changes are noted\n(see 04:57).\n\nLimited imaging of the abdomen demonstrates hiatal hernia with probable\nsurgical material (see 301: 74-93).\n\nNonspecific subcentimeter mediastinal retroperitoneal lymph nodes are seen,\nwithout definite enlargement by CT size criteria.\n\nLimited imaging of the abdomen demonstrates 5 mm left adrenal nodule with\naverage Hounsfield units approximately of -14 (see 301: 103-107).", "output": "1. Cervical and thoracic spinal fusion hardware streak artifact and osteopenia\nlimits examination.\n2. Postsurgical changes related to patient's known T7 through T9 posterior\nfusion and T7 and T8 laminectomy without definite evidence of fusion hardware\nfracture or loosening, within limits of study.\n3. Interval reduction of T7-8 disc osteophytes compared to ___ prior\nexam, with residual left greater than right paracentral osteophytes noted. \nPlease see concurrently obtained\n4. Grossly stable multilevel thoracic spondylosis as described with at least\nmild vertebral canal narrowing at T4-5 and T5-6, without definite evidence of\nmoderate or severe bony vertebral canal or neural foraminal narrowing.\n5. Grossly stable chronic minimal T11 anterior compression deformity.\n6. Cervical and thoracic spine MRI for description of vertebral canal neural\nforaminal narrowing.\n7. Please see concurrently obtained noncontrast cervical spine CT and\nnoncontrast cervical and thoracic spine MRI for description cervical\nstructures.\n8. Nonspecific subcentimeter mediastinal retroperitoneal lymph nodes as\ndescribed, which may be reactive.\n9. Hiatal hernia with probable surgical material.\n10. Left adrenal approximately 5 mm probable adenoma as described." }, { "input": "T-spine: Alignment is normal. No fractures are identified. Multilevel\ndegenerative changes are notable for bridging anterior osteophytes at T4-5 and\nT6-11. There is no evidence of spinal canal or neural foraminal\nstenosis.There is no evidence of infection or neoplasm. Esophagus is mildly\ndistended and fluid filled with an incidental small hiatal hernia.\n\nL-spine: Alignment is normal. No acute fractures are identified. Compression\nfractures at L3, L4, and L5 vertebral bodies are unchanged compared to ___ degenerative changes are notable for posterior disc bulge\ncausing moderate spinal canal narrowing at L2-3 and L3-4. There is no\nevidence of neural foraminal stenosis.There is no evidence of infection or\nneoplasm. 2.6 cm right renal cyst is noted.", "output": "1. No fracture is identified.\n2. Chronic compression fractures at L3, L4, L5 vertebral bodies are unchanged\ncompared to ___.\n3. Fluid filled, distended esophagus with a small hiatal hernia." }, { "input": "Alignment is normal, noting slight reversal of normal cervical lordosis. No\nfractures are identified. There is no evidence of spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.\n\nParaseptal emphysema noted at the lung apices.", "output": "No fracture or traumatic malalignment." }, { "input": "There is exaggeration of the normal cervical lordosis, unchanged compared to\nprior. Otherwise, alignment is normal. No fractures are identified.There is\nno prevertebral soft tissue swelling. Stable spinal cord calcification at the\nlevel C2.\n\nMultilevel degenerative disc disease, most severe at C5-6. There is also\nmoderate to severe neural foraminal stenosis at multiple levels bilaterally\ndue to a combination of uncovertebral and facet osteophytes. Small posterior\nintervertebral osteophytes cause mild narrowing the spinal canal. No\nhigh-grade spinal canal stenosis.\n\nThe lung apices are clear. No cervical lymphadenopathy. Again, there is a\nlarge hypodense nodule arising from the right lobe of the thyroid measuring\napproximately 3.0 x 2.0 cm.\n\nChronic healed right proximal humerus fracture is visualized on the scout\nimages.", "output": "1. No evidence of fracture or traumatic subluxation.\n2. Extensive multilevel multifactorial degenerative changes.\n3. Unchanged hypodense nodule arising from the right lobe of the thyroid\nmeasuring up to 3.0 cm." }, { "input": "Alignment is maintained. No acute fractures are identified. Moderate\ndegenerative changes are seen in the cervical spine with loss of\nintervertebral disc height, subchondral sclerosis, and osteophyte formation. \nThere is no prevertebral soft tissue edema. There is mild-to-moderate\ncervical spondylosis with mild to moderate vertebral canal narrowing resulting\nin mild deformation of the spinal cord. There is no significant neural\nforaminal stenosis. The visualized portions of the lung apices appear grossly\nclear. The thyroid gland appears unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate degenerative changes in the cervical spine with mild-to-moderate\nvertebral canal narrowing." }, { "input": "No fractures are identified. Very minimal C3 on C4, C4 on C5, and C5 on C6\nanterolisthesis is likely degenerative in etiology. There is fusion of the C1\nand C2 vertebral bodies and facets bilaterally. Extensive degenerative\nchanges of the atlanto-occipital joints bilaterally are demonstrated. Mild\nintervertebral disc space narrowing is seen at multiple levels. No high-grade\ncentral canal narrowing. Facet hypertrophy and uncovertebral spurring result\nin bilateral moderate to severe neural foraminal narrowing. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nVisualized lung apices are clear. Thyroid gland is atrophic.", "output": "1. No acute fracture or prevertebral soft tissue swelling.\n2. Moderate to severe degenerative changes including fusion of the C1 and C2\nvertebral bodies and facets bilaterally and marked degenerative changes of the\natlanto-occipital joints bilaterally.\n3. Mild multilevel anterolisthesis is likely degenerative in etiology." }, { "input": "Mild anterolisthesis of C5 on C6 is stable. No fractures are identified.Mild\nmultilevel degenerative changes of the cervical spine are noted, consistent\nwith diffuse osteopenia, anterior and posterior osteophytes, disc space\nnarrowing, and endplate sclerosis centered at C5 through C7. Small posterior\ndisc bulge at C2-C3 and multilevel small posterior disc osteophyte complexes\nare causing mild spinal canal narrowing at C5-C6, and C6-C7. Fusion of\nbilateral C3-C4 facets are noted. No neural foraminal stenosis. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nLimited evaluation lung apices demonstrate centrilobular emphysema with mild\ninterlobular septal thickening consistent with vascular congestion.", "output": "1. No evidence of acute cervical spine fracture or malalignment.\n2. Mild multilevel degenerative changes of the cervical spine with multilevel\nmild spinal canal narrowing at C2-C3, C5-C6, and C6-C7\n3. Stable mild anterolisthesis of C5 on C6.\n4. Centrilobular emphysema with vascular congestion." }, { "input": "There is no acute fracture or malalignment in the cervical spine. \nDegenerative disc disease is noted at multiple levels with small disc\nosteophyte complex is noted posteriorly at C4-5 and C5-6 levels. No\nprevertebral edema. There is facet degenerative disease at C2-3 and C3-4\nbilaterally. There is mild to moderate multilevel neural foraminal narrowing\ndue to uncovertebral joint hypertrophic changes in the lower cervical spine. \nNo prevertebral edema. The aerodigestive tract appears patent. Multiple\nthyroid nodules are noted, the largest measuring approximately 2.2 x 1.9 cm. \nThyroid nodular calcification also noted. There are secretions noted in the\ntrachea. A nonspecific ground-glass opacity is partially visualized at the\nright apex on series 3, image 69 measuring 11 x 11 mm, likely unchanged.", "output": "1. No acute fracture or alignment abnormality.\n2. Degenerative changes as stated above.\n3. Multiple thyroid nodules which can be further assessed by a nonemergent\nultrasound in the absence of prior workup." }, { "input": "Alignment is normal. No cervical spine fractures are identified.There is no\nsevere canal or foraminal narrowing. Multilevel degenerative changes are\npresent an progressed from ___ with sclerosis and irregular contour at the\nsuperior endplate of C6, likely consistent with Schmorl's node, osteophytosis,\nfacet arthropathy. There is no evidence of prevertebral edema.\n\nThere is opacification of the left mastoid air cells. The thyroid appears\nnormal. Emphysematous changes are seen in the lung apices..", "output": "1. No evidence of acute cervical spine fracture or traumatic malalignment.\n\n2. Interval progression in the cervical spine degenerative changes, more\nsignificant at C6 level, consistent with Schmorl's node." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges include intervertebral disc height loss. Schmorl's node seen at the\nsuperior endplate of C6. There is no critical canal or foraminal narrowing.\n\nThere is a 2.1 cm nodule in the right lobe of the thyroid which is partially\nvisualized. Triangular fatty lesion inferior to the right submandibular gland\n(03:48) may represent a lipoma and measures 2.1 x 1.6 cm, previously similar. \nPleural based biapical scarring is noted.", "output": "Degenerative changes without fracture or acute malalignment." }, { "input": "Alignment of the thoracic spine is normal. There is no evidence of fracture\nor subluxation. There is no evidence of critical central canal or neural\nforaminal narrowing. Mild predominately anterior osteophytic spurring is seen\nwithin the lower thoracic spine.\n\nIn the lumbar spine, alignment is normal. There is a mild compression\ndeformity of the super anterior endplate of L1 with radiolucent lines\ncompatible with an acute fracture. There is no retropulsion of fracture\nfragments. There have been laminectomies from L3 through L5. Mild multilevel\ndegenerative changes are seen including height loss at L5-S1 with associated\nendplate sclerosis and posterior disc osteophyte complex. There is mild\ngeneralized osteopenia in the thoracic and lumbar spine. No critical central\ncanal stenosis seen.\n\nScattered mediastinal and hilar lymph nodes are not pathologically enlarged by\nCT size criteria. Heart size is top normal with coronary artery\ncalcifications. There is moderate bibasilar atelectasis and apical\npredominant centrilobular emphysema. Evaluation of the partially imaged lungs\nis otherwise limited by respiratory motion. The partially imaged aorta and\nproximal iliac arteries show moderate atherosclerosis. Retro aortic left\nrenal vein is demonstrated. The partially imaged solid organs in included\nloops of small large bowel are grossly normal although incompletely evaluated.", "output": "1. Acute Mild compression deformity of the superior anterior endplate of L1\nwithout retropulsion and no evidence of critical central canal or neural\nforaminal narrowing.\n2. Moderate bibasilar atelectasis and centrilobular emphysema." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nedema. Moderate multilevel degenerative changes are present, as evidenced by\ndisc height loss, uncovertebral osteophytes and facet hypertrophy. However,\nthere is no critical canal or foraminal narrowing. The patient is status post\nleft parotidectomy. As before, there is slight asymmetry with thickening of\nthe soft tissue in the left nasopharynx, unchanged since ___.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "Evaluation is slightly limited due to motion and streak artifact from dental\namalgam. Within this limitation, alignment is unchanged with mild\nanterolisthesis of C3 on C4 and C6 on C7.No fractures are identified.Moderate\nmultilevel degenerative changes are present with loss of intervertebral disc\nheight, endplate irregularity, mild osteophyte formation, and fusion of the C2\nand C3 facet joints bilaterally and right C5 and C6 facet joint. \nAdditionally, marked pannus formation is seen at C1-2 level posteriorly with\nerosive changes in the dens. No high-grade central canal stenosis is present.\nMultilevel moderate to severe neural foraminal stenosis is seen, most\npronounced on the left at C3-4 and on the right C4-5. There is no\nprevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Moderate atherosclerotic calcifications are seen at the carotid\nbifurcations.\n\nVisualized thyroid gland is unremarkable. Mild pulmonary edema is seen in the\nlung apices.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate multilevel degenerative changes.\n3. Mild pulmonary edema within the visualized lung apices." }, { "input": "There is a leftward curve lumbar spine. Fracture involving the L1 vertebral\nbody is re-identified with fracture fragments extending anterior and posterior\nfrom the superior endplate. No extension into the pedicles is seen. There is\nslightly greater than 50% height loss.\n\nT12-L1: There is retropulsion of a superior L1 endplate fracture fragment\napproximately 9 mm into the central canal. There is moderate narrowing of the\ncentral canal, moderate to severe right and mild to moderate left foraminal\nnarrowing.\n\nL1-2: No significant central stenosis seen. There is severe right and\nmoderate left foraminal narrowing.\n\nL2-3: Disc desiccation is demonstrated with a disc bulge and osteophytes\nencroach on the right more so than left neural foramina. There is no\nsignificant central stenosis. Mild left and moderate approaching severe right\nforaminal narrowing are seen.\n\nL3-4 disc desiccation disc bulge are present. There is no significant central\nstenosis. There is moderate right and mild approaching moderate left\nforaminal narrowing.\n\nL4-5: Vacuum phenomenon is seen along with mild disc bulge. Osteophytes\nencroach on the inferior aspect of neural foramina. No significant central\nstenosis present. There is moderate bilateral foraminal narrowing.\n\nL5-S1: There is vacuum phenomenon and mild disc protrusion. Osteophytes\nencroach on inferior aspect neural foramina. No significant central stenosis\nseen. Mild approaching moderate left and mild right foraminal narrowing are\npresent.\n\nApproximately 2 mm nonobstructive left renal stone is seen. Calcifications of\nthe abdominal aorta present. There are mild degenerative changes of the\nsacroiliac joints.", "output": "1. L1 compression fracture with retropulsed fragment into the central canal\nand associated moderate central stenosis and mild to moderate foraminal\nnarrowing as detailed above.\n2. Additional levels of lumbar spondylosis with mild to nearly severe\nforaminal narrowing as detailed above.\n\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation." }, { "input": "Rightward curve lower thoracic spine is seen. The L1 vertebral body is\nincompletely imaged and the L1 compression fracture is incompletely imaged. \nPlease see the lumbar spine CT scan report from the same day for further\ndetails. No thoracic spine fractures are seen.\n\nThere are degenerative changes most pronounced at the lower thoracic spine. \nEndplate degenerative change is and Schmorl's nodes are most pronounced at the\ninferior endplate of T12. There is mild to moderate right and moderate left\nT12-L1 foraminal narrowing.\n\nCalcifications of the thoracic aorta are noted. Carinal lymph node (4; 38)\nmeasures approximately 8 mm in shortest dimension. This is similar to the\nprior study. Coronary calcifications are noted. There is probable partial\natrophy of the pancreas which is incompletely imaged. There are apical\nopacities more pronounced on the right than the left which may be related to\nscarring. There is mild posterior right pleural thickening that may have\nprogressed. Calcifications of the bronchial tree are seen.", "output": "1. Rightward curve thoracic spine.\n2. Lower thoracic spondylosis detailed above.\n3. No thoracic spine fracture. Incompletely imaged L1 fracture. Please see\nseparately dictated lumbar spine CT scan report for further details.\n4. Possible right greater than left apical scarring and thickening of the\nright posterior pleura may have progressed over the interval. Clinical\ncorrelation suggested.\n\n\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation.\n\nRECOMMENDATION(S): Possible right greater than left apical scarring and\nthickening of the right posterior pleura may have progressed over the\ninterval. Clinical correlation suggested.\n\nNOTIFICATION: The impression and recommendation above was entered by Dr.\n___ on ___ at 16:42 into the Department of Radiology\ncritical communications system for direct communication to the referring\nprovider." }, { "input": "No fractures are identified. There are multilevel degenerative changes most\npronounced at C4/C5 and C5/C6. Minimal anterolisthesis of C4/C5 is likely\ndegenerative in nature. There is no evidence of critical canal narrowing\nalthough there is narrowing at multiple levels, most pronounced at C5/C6. \nThere is no prevertebral soft tissue swelling. Retropharyngeal course of the\ncommon and internal carotid arteries is noted. There is an 11 mm hypodense\nright thyroid nodule. The lung apices are notable for biapical scarring. \nTracheal diverticulum seen at the right posteriolateral aspect of the trachea\nat the thoracic inlet.", "output": "1. No evidence of cervical spine fracture.\n2. Multilevel degenerative changes." }, { "input": "Dental amalgam streak artifact limits study.\n\nThere is reversal of the cervical lordosis. Calcification of the posterior\nlongitudinal ligament bridging C3 and C4 is noted. A linear lucency is seen\nalong the superior endplate C6, given surrounding sclerotic margins and lack\nof prevertebral soft tissue swelling, this is likely degenerative in nature. \nVertebral body heights are preserved. There is no definite evidence of acute\nfracture.\n\nMultilevel degenerative changes are seen, most extensive at C4-5 and C5-6 and\nnotable for loss of intervertebral disc height, subchondral sclerosis,\nSchmorl's node formation, facet arthrosis, uncovertebral hypertrophy, and\nosteophytosis.There is no prevertebral edema.\n\nThe thyroid is preserved. Septal thickening is noted in the lung apices\nsuggestive of pulmonary edema. A nasogastric tube and bilateral central\ncatheters are partially visualized.", "output": "1. Dental amalgam streak artifact limits study.\n2. Within limits of study, no definite evidence of acute fracture.\n3. Probable multilevel cervical spondylosis as described. Please note MRI of\nthe cervical spine is more sensitive for the evaluation of ligamentous injury.\n4. Question pulmonary edema on limited imaging of lungs. Consider dedicated\nchest imaging for further evaluation." }, { "input": "No displaced fracture is seen. No subluxation. No evidence for prevertebral\nedema. Disc protrusions and endplate osteophytes mildly indent the ventral\nthecal sac at multiple levels. There is multilevel neural foraminal narrowing\nby uncovertebral and facet osteophytes.\n\nVisualized lung apices are clear. The thyroid is grossly unremarkable. Right\npalatine tonsilliths are likely sequela of prior infections. There is\nopacification of bilateral mastoid tip air cells. Concurrent head CT is\notherwise reported separately.", "output": "1. No evidence for a fracture. No subluxation.\n2. Multilevel degenerative disease." }, { "input": "Multilevel degenerative changes include facet arthropathy, loss of\nintervertebral disc height, and osteophytosis. Alignment is normal. No\nfractures are identified.There is no significant bony vertebral canal\nstenosis. There is no prevertebral soft tissue swelling.Imaged portion of the\nthyroid is unremarkable. Imaged portion of the lung apices is unremarkable.", "output": "No acute fracture or malalignment." }, { "input": "There is no acute fracture, malalignment, or prevertebral soft tissue\nabnormality. Calcification of the nuchal ligament at the C4 and 5 levels is\nunchanged. There moderate multilevel degenerative changes, with mild spinal\ncanal narrowing and mild bilateral neural foraminal narrowing at the C5-6 and\nC6-7 levels, unchanged. Emphysema with bulla lung apices, more pronounced on\nthe right, is again seen. The thyroid gland is unremarkable. There are\nbilateral carotid bifurcation calcifications.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "There is no acute fracture, malalignment, or prevertebral soft tissue\nabnormality. There are moderate degenerative changes at the L1-2 level, with\nsclerosis and subchondral cyst formation. There is bilateral L5 spondylolysis\nwithout spondylolisthesis. There is no critical spinal canal stenosis. Mild\nbilateral neural foraminal narrowing is noted L4-5. The visualized pre and\nparavertebral soft tissues are unremarkable.\n\nAs seen previously, multiple pancreatic calcifications are re- demonstrated\nwith dilatation of the pancreatic duct measuring up to 6 mm, compatible with\nchronic pancreatitis. Mild calcified atherosclerotic disease is seen within\nthe abdominal aorta.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality." }, { "input": "There is no evidence of cervical spine fracture. There is no prevertebral\nsoft tissue swelling. There are multi-level degenerative changes most\npronounced at C5/C6, C6/C7, and C7/T1. There are multilevel disc bulges which\ncauses moderate canal narrowing most pronounced at the C5/6 and C6/7 levels. \nThere is no evidence of infection or neoplasm. There is moderate\ncentrilobular emphysema. The thyroid is unremarkable.", "output": "No evidence of cervical spine fracture." }, { "input": "Alignment is normal. No fractures are identified. Mild multilevel\ndegenerative changes are seen throughout the cervical ___ at C5\nthrough C7 with anterior, and posterior osteophytes, endplate sclerosis and\ndisc space narrowing. Well corticated ossific fragment along the anterior\nsuperior aspect of C5 vertebral body is consistent with a chronic osteophyte\nfragment. Mild canal narrowing at C5-C6 from posterior osteophytes as well as\nmild left and moderate right neural foraminal narrowing at this level. No\nprevertebral soft tissue swelling.\n\nCalcification of the carotid arteries bulbs are noted. Limited assessment of\nthe lung apices demonstrates biapical, right greater than left, paraseptal and\ncentrilobular emphysema.", "output": "1. No acute fracture or acute malalignment.\n2. Mild multilevel degenerative changes most prominent at C5-C6 with mild\ncanal narrowing, as well as mild left and moderate right neural foraminal\nnarrowing at C5-C6.\n3. Paraseptal and centrilobular emphysema." }, { "input": "No fractures are identified.Moderate multilevel degenerative changes are seen\nthroughout the cervical spine most notable at C2-C3, and C4 through C6 with\ndisc space narrowing, anterior osteophytes, and subchondral sclerosis. Mild\nretrolisthesis of C5 on C6 is noted. At C2-C3 there is a large central disc\nherniation causing severe canal narrowing. No prevertebral soft tissue\nswelling. There is no evidence of infection or neoplasm. Moderate mucosal\nthickening of the maxillary sinus are noted bilaterally. Mild emphysema\nnoted.", "output": "1. No acute fracture.\n2. Mild retrolisthesis of C5 on C6 is likely degenerative. Clinical\ncorrelation is recommended to assess for focal tenderness.\n3. Moderate multilevel degenerative changes most notable at C2-C3 with large\nposterior central disc herniation causing severe canal narrowing. Of note this\nplaces the patient at increased risk for cord injury with mild trauma." }, { "input": "Alignment is normal. No fractures are identified. There multilevel\ndegenerative changes are seen, most prominent at C4-C6, with anterior\nosteophyte formation, endplate sclerosis, and vacuum disc phenomenon. There is\nno evidence of infection or neoplasm.\n\nThe thyroid is unremarkable. Bilateral lung apices demonstrate emphysematous\nchanges.", "output": "No acute fracture or vertebral malalignment." }, { "input": "No fractures are identified.Alignment is normal. There are moderate\nmultilevel degenerative changes in the cervical spine with intervertebral disk\nspace narrowing and anterior and posterior osteophytes. Mild central canal\nnarrowing is seen at the C3-C4, C4-C5, and C5-C6 vertebral levels due to\nposterior disc-osteophyte complexes without critical stenosis. There is mild\nneural foraminal narrowing, most pronounced on the right at C4-5 and C5-6.\nThere is no evidence of prevertebral swelling. There is no evidence of\ninfection or neoplasm.\n\nPatient is intubated with enteric tube seen in the esophagus. Emphysematous\nchanges are noted in the lung apices.", "output": "1. No acute fracture or subluxation in the cervical spine.\n2. Moderate multilevel degenerative changes, particularly at the C3-C6\nvertebral levels.\n3. Emphysematous changes in the lung apices." }, { "input": "No traumatic malalignment is identified. No fractures are identified. There is\nno prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm. Hypodense nodules in bilateral thyroid lobes measuring up to 8 mm\nto not require follow-up per ACR guidelines.\nDegenerative changes are noted in the cervical spine.\nAt C3-4, there is mild bilateral neural foraminal narrowing and moderate\nspinal canal narrowing.\nAt C4-5, there is mild right and severe left neural foraminal narrowing.\nAt C5-6, there is severe right and mild left neural foraminal narrowing.", "output": "1. No fracture is identified." }, { "input": "Alignment is normal. No acute fractures are identified. There are multilevel\ndegenerative changes including anterior posterior osteophytes and loss of\nintervertebral disc space height. There is moderate multilevel neural\nforaminal narrowing, most pronounced on the left at C3-4. Osseous fusion of\nthe left C3/C4 facets is seen. There is no severe spinal canal\nnarrowing.There is no prevertebral soft tissue swelling. There is a 1.1 cm\nhypodense nodule in the right thyroid lobe.", "output": "1. No acute fracture or traumatic malalignment. Multilevel degenerative\nchanges.\n2. 1.1 cm hypodense right thyroid nodule. Per ACR guidelines, no imaging\nfollow-up is recommended." }, { "input": "No acute cervical spine fracture is identified. There is no prevertebral soft\ntissue swelling. There is no evidence of traumatic malalignment.\n\nMild to moderate degenerative changes are seen throughout the cervical spine,\nwith anterior, and posterior osteophytosis, worst at C5/C6. Mild disc\nprotrusion is seen at C5/C6 resulting in mild thecal sac indentation.\n\nMultiple bilateral large hypodense thyroid nodules are identified. There is\nno cervical lymphadenopathy. The visualized apices of the lungs are clear.", "output": "1. No cervical spine fractures identified.\n2. Multiple large bilateral hypodense thyroid nodules. A non urgent thyroid\nultrasound is recommended for further evaluation.\n\nRECOMMENDATION(S): A non urgent thyroid ultrasound is recommended for further\nevaluation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm.\n\nMild to moderate degenerative changes are seen throughout the lumbar spine\nwith extensive endplate degenerative changes, including prominent Schmorl's\nnodes, most prominent at L2 an L3. Mild disc bulging is seen at L4/L5, with\nmild thecal sac narrowing.\n\nLimited evaluation of the pelvis demonstrates a distended bladder, as well as\nmild fecal impaction within the rectum.\n\nA soft tissue mass with calcifications is seen within the right abdomen,\nmeasuring 3.1-cm x 4.1-cm, with adjacent mesenteric stranding and tethering of\nthe bowel loops, concerning for carcinoid. Incidental note is made of a 9-mm\nhypodense lesion arising from the mid pole of the right kidney (3;10)", "output": "1. No acute fractures identified. Mild degenerative changes identified.\n2. Soft tissue mass in the right abdomen with calcifications measuring up to\n4.1-cm, with tethering of the adjacent bowel loops and mesenteric stranding,\nlikely secondary to carcinoid. Recommend correlation with prior outside\nhospital imaging. If no priors are available, a dedicated CT of the abdomen\nand pelvis with contrast is recommended.\n3. 9-mm hypodense lesion in the midpole of the right kidney, likely secondary\nto a simple renal cyst, however can be further characterized by a renal\nultrasound.\n\nRECOMMENDATION(S): Dedicated CT of the abdomen and pelvis with contrast.\n\nNOTIFICATION: Updated findings were d/w Dr. ___ at 11:30p on the day of the\nexam by phone by Dr. ___." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling. There is no evidence of infection or neoplasm within the\nlimits of this noncontrast enhanced study. Visualized lung apices and thyroid\nlobes are unremarkable.", "output": "No evidence of traumatic subluxation or fracture." }, { "input": "Alignment is normal.The ring of C1 is incompletely formed, likely congenital. \nNo fractures are identified.There is no prevertebral soft tissue swelling.A\nlarge sclerotic lesion within the spinous process of T1 likely represents a\nbone island (series 602 B image 38). There is no evidence of infection or\nneoplasm.\n\nThere is severe degenerative disc disease from C4 through C7. There are\nmultilevel posterior intervertebral osteophytes causing mild-to-moderate\nspinal canal stenosis. There is also multifactorial multilevel neural\nforaminal stenosis most severe at C4-5 on the right.\n\nThe thyroid is heterogeneous, but no discrete nodules are visualized. There\nis asymmetric soft tissue on the right adjacent to the cricoid cartilage\nmeasuring approximately 1.8 x 1.3 cm (series 2, image 38), which may represent\na lymph node conglomerate.", "output": "1. No acute fracture or traumatic malalignment.\n2. Asymmetric soft tissue on the right adjacent to the cricoid cartilage\nmeasuring up to 1.8, which may represent a lymph node conglomerate, and should\nbe followed up with a CT neck with contrast or MR.\n\n___: CT neck with contrast or MR." }, { "input": "Alignment is normal. No fractures are identified. Incompletely fused\nposterior arch of C1 is incidentally noted, similar to prior. There is no\nprevertebral soft tissue swelling.\n\nModerately severe degenerative disc disease with disc height loss and endplate\nsclerosis are redemonstrated, most notable from C4 through C7. These findings\nare overall similar without substantial interval change when compared to the\n___ cervical spine CT. Multilevel mild bilateral neural foraminal\nstenosis is also noted as well as mild central canal narrowing, most notably\nat C3-C4 and C4-C5.\n\nPreviously seen lobulated soft tissue density lesion along the right side of\nthe neck adjacent to the cricoid cartilage has slightly increased in the\ninterim now measuring 2.2 x 1.5 x 1.8 cm, previously measuring 1.8 x 1.3 x 1.8\ncm (4:38, 602:14). Thyroid gland is unremarkable. Imaged lung apices\ndemonstrate pleuroparenchymal calcified scarring.", "output": "1. No evidence of cervical spine fracture or traumatic malalignment.\n2. Moderately severe multilevel degenerative disc disease most notable from\nC4-C7 is overall similar to the ___ cervical spine CT.\n3. Slight interval growth in size of the now 2.2 x 1.5 x 1.8 cm lobulated soft\ntissue density lesion in the right upper neck just lateral to the cricoid\ncartilage. Outpatient neck MRI with contrast is recommended for further\nevaluation.\n\nRECOMMENDATION(S): Outpatient neck MRI is recommended for further evaluation\nright neck lesion." }, { "input": "Postoperative changes are again seen in the lower lumbar spine with L3 and L4\nlaminectomies and bone graft material adjacent to the facets. The L4 and L5\nvertebral bodies are essentially fused. Grade 1 anterolisthesis and right\nlateral subluxation of L4 on L5 is seen noting that the vertebral bodies are\nessentially fused. Retrolisthesis of L1 on L2, and L2 on L3 are similar\ncompared to MRI. Intervertebral disc height loss at L1-L2 with vacuum disc\nphenomenon is seen. There are some likely degenerative changes seen adjacent\nto L1 inferior endplate with adjacent sclerosis in this region and extending\nmore extensively to involve the lower half of the vertebral body. Disc height\nloss with vacuum disc phenomenon and degenerative changes seen centered at the\nL2-3 disc with sclerosis of the adjacent endplates, eccentric to the right.\n\nMRI provides more detailed evaluation of the spinal canal and thecal sac.\n\nAtherosclerotic calcifications noted in a normal-caliber abdominal aorta.\n\nThere is no evidence of soft tissue abnormality in the retroperitoneum or\nparaspinal soft tissues. Relative atrophy noted of the right psoas compared to\nthe left. There is a 6 mm calculus in the region of the mid left ureter\nwithout visualized upstream hydroureter noting the entire kidney is not\nevaluated included for evaluation of hydronephrosis. Of note, this stone was\npresent on PET-CT from ___.", "output": "Degenerative and postoperative changes in the lumbar spine. Sclerosis adjacent\nto the inferior endplate of L1 and endplates adjacent to the L2-L3\nintervertebral disc. While metastatic disease is not entirely excluded,\ndegenerative changes is considered more likely." }, { "input": "No evidence of fracture or subluxation. No prevertebral edema.\nThe imaging at C2-3 and C3-4 demonstrates no spinal canal or neural foraminal\nnarrowing.\nAt C4-5, intervertebral osteophytes and a small midline disc protrusion\nflatten the anterior surface of the spinal cord. Uncovertebral and facet\nosteophytes produce moderate right and severe left neural foraminal narrowing.\nAt C5-6, intervertebral osteophytes narrow the spinal canal and likely\nencroach on the spinal cord. Uncovertebral and facet osteophytes produce\nsevere left and moderate right neural foraminal narrowing.\nAt C6-7 D, C7-T1 and the included portions of the upper thoracic spine there\nis no evidence of spinal canal or neural foraminal compromise.\nVisualized lung apices are clear. The thyroid gland is normal. Left mastoid\nair cells are underpneumatized.", "output": "1. No evidence of fracture or subluxation.\n2. Mild multilevel degenerative changes." }, { "input": "There is no acute cervical fracture or malalignment. There is no prevertebral\nsoft tissue abnormality.\n\nMultilevel degenerative changes are present, most significantly at levels\nC4-C7. Mild multilevel central canal narrowing as well as mild bilateral\nneural foraminal narrowing is seen without critical stenosis.\n\nThe thyroid is enlarged bilaterally without focal lesions. There is no\ncervical lymphadenopathy.\n\nThe visualized lung apices are clear.\n\nSignificant calcified atherosclerotic disease is noted at the left common\ncarotid artery bifurcation.", "output": "1. No evidence of acute fracture or malalignment.\n2. Thyromegaly without focal lesions." }, { "input": "There is no acute fracture or traumatic alignment abnormality. Multilevel\ndegenerative disc disease is noted with small posterior disc osteophyte\ncomplexes. Facet arthropathy and uncovertebral joint hypertrophic changes\nresult in mild to moderate neural foraminal stenosis at multiple levels. No\ncritical central canal or neural foraminal stenosis. Mild prominence of the\nthyroid with tiny right-sided nodules noted. Lung apices are clear. No\nprevertebral edema.", "output": "No acute fracture or traumatic malalignment. Multilevel degenerative changes." }, { "input": "Straightening of cervical lordosis may be positional.No fractures are\nidentified.Degenerative changes of the cervical spine are moderate and include\nintervertebral disc height loss posterior osteophytes and uncovertebral joint\nhypertrophy, as well as ligamentum flavum thickening. Spinal canal narrowing\nis most prominent and moderate at the C5-6 level. There is no severe neural\nfemoral narrowing. There is no prevertebral soft tissue swelling.\n\nThe imaged lung bases clear. There is a partially imaged 5 mm right thyroid\nnodule with coarse calcification, not meeting ACR criteria for further\nultrasound evaluation.", "output": "Moderate degenerative changes of the cervical spine with no acute fractures or\ntraumatic subluxation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nsevere spinal canal or neural foraminal stenosis. There is no prevertebral\nsoft tissue swelling.\n\nMild paraseptal emphysema is most pronounced in the bilateral lung apices. \nMild centrilobular emphysema is most pronounced in the bilateral lower lobes. \nThere is bilateral dependent atelectasis. Partially visualized is a 5.6 cm\nsimple cyst in the right upper pole kidney.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild paraseptal and centrilobular emphysema." }, { "input": "No fractures are identified. Alignment is normal. There has been interval\nprogression degenerative disease in the lumbosacral spine compared to ___,\nmost pronounced at L4-5 and L5-S1 where there is loss of intervertebral disc\nspace height, endplate sclerosis, subchondral cystic change, vacuum phenomena\nand anterior and posterior osteophytosis. Prominent disc bulges are noted at\nL3-4 and L4-5 which result in at least moderate spinal canal narrowing. There\nis no prevertebral soft tissue swelling.\n\nModerate atherosclerotic calcifications are noted within the visualized\nabdominal aorta and iliac vessels. Again seen is a 5.5 cm simple renal cyst\nin the right upper pole. Partially visualized is a hyperdense lesion within\nthe left mid kidney, which likely represents a hemorrhagic or proteinaceous\ncyst.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild interval progression of degenerative disease in the lumbosacral spine\ncompared to ___. Prominent disc bulges are noted at L3-4 and L4-5 which\nresult in at least moderate canal narrowing.\n3. Partially visualized is a hyperdense lesion within the left mid kidney,\nwhich likely represents a hemorrhagic cyst. If clinically indicated, a\nnonurgent renal ultrasound may be obtained for further evaluation." }, { "input": "Alignment is normal. No fractures are identified. There are moderate\nmultilevel degenerative changes throughout the cervical spine as evidenced by\nloss of intervertebral disc space height, subchondral cystic change and\nanterior and posterior osteophytosis. There is mild-to-moderate multilevel\nneural foraminal narrowing due to uncovertebral osteophytes and facet\nhypertrophy, most pronounced on the left at C3-4 and C5-6. There is no\nevidence of spinal canal stenosis.There is no prevertebral soft tissue\nswelling.\n\nModerate paraseptal emphysema is noted in the bilateral lung apices.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate multilevel degenerative changes, as above." }, { "input": "There is 3 mm of retrolisthesis L3 over L4 and 4 mm of retrolisthesis L5 over\nS1, similar in appearance to prior study. No fractures are identified.\n\nThere are mild to moderate multilevel degenerative changes of the lumbar\nspine, most prominent at L3-4 to L5-S1, with intervertebral disc height loss,\nendplate sclerosis, and osteophyte formation. Moderate disc bulges are seen\nat L4-5 and L5-S1. Mild-to-moderate bilateral foraminal narrowing at the\nlevel of L5-S1. There is no evidence of high-grade spinal canal delete. No\nevidence of sclerotic or lytic lesions\n\nThere is no prevertebral soft tissue swelling. Mild atherosclerotic disease is\nnoted.\n\nRe-demonstrated is a partially visualized simple cyst in the right kidney. A\npartially visualized hyperdense cyst lesion is noted in the left mid kidney\nand unchanged from prior.", "output": "1. No evidence of acute fracture or malalignment.\n2. Mild to moderate degenerative changes of the lumbar spine, which have not\nsignificantly progressed compared to prior study on ___.\n3. Partial visualization of hyperdense lesion in the left kidney, grossly\nunchanged from prior." }, { "input": "No evidence of malalignment of the cervical spine nor fracture.There is no\nevidence of spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.Bilateral lung apices are clear.", "output": "No evidence of malalignment or fracture of the cervical spine." }, { "input": "No acute fracture or dislocation is seen. Multi level degenerative changes\nare re-demonstrated with disc space narrowing worst C3 through C7 where there\nis also endplate sclerosis and anterior posterior osteophytes. No\nprevertebral soft tissue swelling is seen. Multilevel bilateral neural\nforamina narrowing is seen, left greater than right, particularly in the mid\nto lower cervical spine. There is also mild central canal narrowing at C5/C6.\nPartially imaged old-appearing fracture of the right clavicle.", "output": "1. No acute fracture or dislocation. Multilevel degenerative changes\nincluding left greater than right neural foraminal narrowing and mild central\ncanal narrowing, at least at C5/C6." }, { "input": "Limited examination despite repeated imaging due to patient motion. No gross\nfracture or subluxation is identified. There is no prevertebral soft tissue\nswelling. Vertebral body heights and intervertebral disc spaces appear\nmaintained. No significant degenerative changes are identified. The\naerodigestive tract is clear. The lung apices are clear. The thyroid is\nnormal.", "output": "Motion limited exam. No gross fracture or subluxation.\n\nNOTIFICATION: The changes to the wet read were discussed by Dr. ___ with\nDr. ___ on the telephone on ___ at 11:01 ___, 10 minutes after\ndiscovery of the findings." }, { "input": "Again seen is a compression fracture of C6 vertebral body with interval\nincrease in sclerosis, and redemonstration of a minimally displaced anterior\ninferior C6 vertebral body fracture. There is no evidence of retropulsion\ncomponent or involvement of the posterior elements.\n\nMultilevel degenerative changes are again noted, including loss of\nintervertebral disc height, disc osteophyte complex, and facet joint\nhypertrophy with no moderate or severe bony spinal canal stenosis noted. \nThere is ossification of the posterior longitudinal ligament from C3-C4\nthrough C6-C7, with C6-C7 intervertebral disc space calcification again seen.\n\nThe thyroid gland and visualized lung apices appear unremarkable. Scattered\nsubcentimeter nonspecific lymph nodes are noted throughout the neck\nbilaterally, without definite enlargement by CT size criteria. Nonspecific\nbilateral mastoid fluid is noted.\n\nC2-3 through C4-C5: There is central disc protrusion with mild spinal canal\nstenosis. There is no neural foraminal narrowing.\n\nC5-6 and C6-C7: There is a disc bulge with mild spinal canal stenosis and\nmild bilateral neural foraminal narrowing.", "output": "1. C6 chronic compression fracture with interval increase in sclerosis, with\nno associated retropulsion component or cord compression.\n2. Mild multilevel degenerative changes as above.\n3. Ossification of the posterior longitudinal ligament from C3-C4 through\nC6-C7." }, { "input": "There is no evidence of traumatic malalignment or fracture.. Grade 1\nanterolisthesi of C3 on C4 and C5 over C6. Mild-to-moderate degenerative\nchanges with endplate sclerosis, osteophyte formation and subchondral cysts. \nMultilevel facet and uncovertebral joint arthropathy with osteophyte\nformation. There is no evidence of high-grade spinal canal or neural\nforaminal stenosis. There is no prevertebral soft tissue swelling.The\nvisualized lung apices are unremarkable. There are degenerative changes of\nthe temporomandibular joints. Heterogeneous bulky thyroid gland with multiple\nnodules particularly in the right lobe, measuring up to 9 mm. Atherosclerotic\ncalcifications involving the carotid bifurcations.", "output": "1. No evidence of traumatic malalignment or fracture.\n2. Bulky heterogeneous thyroid gland with multiple nodules. This can be\ncorrelated for history of thyroid disease.\n\nRECOMMENDATION(S): Thyroid nodule. No follow up recommended.\nAbsent suspicious imaging features, unless there is additional clinical\nconcern, ___ College of Radiology guidelines do not recommend further\nevaluation for incidental thyroid nodules less than 1.0 cm in patients under\nage ___ or less than 1.5 cm in patients age ___ or older.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified. A bifid spinous process is\nnoted at C4. There is no evidence of spinal canal or neural foraminal\nstenosis. There is no prevertebral soft tissue swelling.Lung apices are clear.\nThyroid gland is normal. Imaged lung apices are clear.", "output": "No fracture or subluxation." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nspinal canal or neural foraminal stenosis. There is no prevertebral soft\ntissue swelling.\n\nThyroid and lung apices are unremarkable.", "output": "No fracture or traumatic malalignment." }, { "input": "There is a mild levoconvex scoliosis of the lumbar ___ about L3. No\ntraumatic subluxation is present.No acute fractures are identified. There is\nno high-grade spinal canal or neural foraminal stenosis. Degenerative changes\nare moderate and include intervertebral disc height loss with vacuum space\nphenomena, subchondral sclerosis and mild osteophytosis, most prominent at\nL2-L3 and L4-L5. Mild central canal narrowing is noted at multiple levels,\nmost pronounced at L4-5 due to posterior disc bulge and ligamentum flavum\nhypertrophy. Additionally, mild bilateral neural foraminal narrowing is seen\nat multiple levels, most pronounced at L4-L5 and L5-S1 due to facet\nhypertrophy and uncovertebral spurring. There is diffuse generalized bone\ndemineralization. There is no prevertebral soft tissue swelling. There is no\nevidence of infection or neoplasm.\n\nLimited views of the abdomen demonstrate a partially imaged left renal cyst\nand mild to moderate atherosclerotic calcifications. Partial images of the\nbilateral lung bases demonstrate mild basilar atelectasis.", "output": "1. No acute fracture or traumatic subluxation.\n2. Moderate lumbar spondylosis." }, { "input": "Alignment is normal. No fractures are identified.Multilevel degenerative\nchanges are moderate and include intervertebral disc height loss, subchondral\nsclerosis and anterior and posterior osteophytosis, most prominent at C6/7 and\nC7/T1. Fusion of the left C3/C4 facet is demonstrated. Mild multilevel\ncentral canal narrowing and bilateral neural foraminal narrowing is most\npronounced at C6/C7 there is no prevertebral edema.\n\nThe thyroid is within normal limits. The lung apices are not visualized.", "output": "No acute fracture or traumatic subluxation." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "Normal study." }, { "input": "There is a small chip fracture of the right transverse process of C6. There\nare no acute fracture of the cervical spine. Acute lordosis at C6-7 is likely\ndegenerative, however, in the absence of prior imaging, ligamentous injury\ncannot be excluded. There is no prevertebral soft tissue edema. Prominence of\nthe soft tissues at the base of the neck raises concern for a hematoma.\n\nThere are severe multilevel degenerative changes with loss in disk space and\nosteophytosis, worst at C5-6, where there is near complete fusion.\n\nHigh-density material surrounding the dens is degenerative in etiology. The\nincluded thyroid and soft tissues of the neck are unremarkable. A nondisplaced\nleft first rib fracture and the lung apices are better evaluated on the\nconcurrent chest CT.", "output": "1. Small chip fracture involving the right transverse process of C6.\n2. Acute lordosis at C6-7 is likely degenerative, however, in the absence of\nprior imaging, ligamentous injury cannot be excluded.\n3. Nondisplaced left first rib fracture.\n4. Prominence of the soft tissues at the base of the neck raises concern for\nunderlying hematoma.\n\nNOTIFICATION: The final impression was discussed by Dr. ___ with Dr.\n___ telephone on ___ at 5:48 ___, 5 minutes after discovery of\nthe findings." }, { "input": "There is an obliquely oriented, minimally distracted fracture involving the\nanterior inferior aspect of the T12 vertebral body, extending inferiorly to\ninvolve the inferior endplate. No additional fracture identified. Alignment\nis normal.\n\nThere is sacralization of the L5 vertebral body. Moderate to severe\nmultilevel degenerative change is noted, including bridging anterior\nosteophytosis and multilevel disc space narrowing, most severe at L4-L5, and\nanterior and posterior osteophyte formation. Multilevel mild central canal\nstenosis is present. Additionally, bilateral neural foraminal stenosis is\nmost pronounced at L1-2, L2-3, L3-4 and L4-5. Small sclerotic focus within\nthe left iliac bone and right sacrum, consistent with bone islands.\n\nCalcification in the right hepatic lobe is compatible with a granuloma. \nPatient is status post cholecystectomy. Small hiatal hernia. Extensive\natherosclerotic calcification within the abdominal aorta. Coarse central\ncalcification within the prostate.", "output": "1. No evidence of fracture or traumatic malalignment involving the lumbar\nvertebral bodies.\n2. Redemonstration of an obliquely oriented, minimally distracted fracture\ninvolving the anterior inferior aspect of the T12 vertebral body, extending\ninferiorly to involve the inferior endplate. No additional fracture\nidentified." }, { "input": "Osseous structures are diffusely demineralized. Obliquely oriented fracture\ninvolving the anterior inferior aspect of the T12 vertebral body, extending\ninferiorly through the inferior endplate, with minimal distraction is\ndemonstrated. Minimal adjacent paravertebral soft tissue swelling noted. No\nadditional fractures identified.\n\nAlignment is normal. Multilevel severe degenerative changes noted, including\nflowing anterior bridging osteophytosis compatible with diffuse idiopathic\nskeletal hyperostosis. There is no evidence of severe spinal canal or neural\nforaminal stenosis. There is a 9 mm sclerotic focus within the T9 vertebral\nbody, consistent with bone island.\n\nExtensive atherosclerotic calcification along the aortic arch and descending\naorta. Mild dependent bibasilar atelectasis. Small granuloma noted within\nthe right lower lobe and left lung base. Calcified left hilar lymph node also\nnoted. Few mildly prominent hilar lymph nodes. Secretions noted within the\ntrachea. The gallbladder is surgically absent. Small hiatal hernia.", "output": "1. Obliquely oriented, mildly distracted fracture involving the anterior\ninferior aspect of the T12 vertebral body, extending inferiorly through the\ninferior endplate.\n2. No evidence of traumatic malalignment.\n3. Diffuse idiopathic skeletal hyperostosis." }, { "input": "There is 3 mm of aaanterolisthesis of C2 on C3 which appears similar prior.No\nfractures are identified.There are mild multilevel degenerative changes of the\ncervical spine worse at the C3-4, C4-5, and C5-6 levels where there is disc\nheight loss. Mild central canal narrowing is demonstrated at C3-4 due to\nposterior osteophyte. No significant spinal canal stenosis. Facet\nhypertrophy causes mild neural foraminal narrowing at the right C5-6 level. \nThere is no prevertebral soft tissue swelling.Thyroid gland is unremarkable. \nThere is pleuroparenchymal scarring and calcified granulomas noted in the\napices bilaterally as well as centrilobular emphysema. No cervical\nlymphadenopathy. Partially opacified inferior right mastoid air cells are\nnoted. A chronic appearing deformity of the right first rib is noted.", "output": "1. No acute fracture or traumatic malalignment.\n2. Mild degenerative changes of the cervical spine as described above." }, { "input": "Unchanged anterolisthesis of C2 on C3, measuring 3 mm and C6 on C7 measuring\n1-2 mm. Alignment is otherwise unremarkable. No fractures are identified. \nMild multilevel degenerative change is similar in appearance to prior study,\nmost notably including moderate disc space narrowing at C3-C4, C4-C5, and\nC5-C6. Mild central canal narrowing is demonstrated at C3-C4 secondary to\nposterior osteophyte. There is moderate neural foraminal narrowing on the\nleft at C3-C4, and on the right at C5-C6, secondary to uncovertebral\nosteophytes. There is no prevertebral soft tissue swelling.Thyroid gland is\nunremarkable. Right apical scarring and calcified granuloma is again seen. \nThere is centrilobular emphysema at the bilateral lung apices. Chronic\ndeformity of the right first rib is unchanged.", "output": "1. No evidence of acute fracture or traumatic malalignment.\n2. Mild multilevel degenerative change most notably involving C3-C4, C4-C5,\nand C5-C6, as described above." }, { "input": "Alignment is unchanged noting minimal anterolisthesis of C2 on C3. No\nfractures are identified.Multilevel degenerative changes are notable for\nintervertebral disc height loss. Uncovertebral joint hypertrophy is most\nextensive C3-4 resulting in moderate left foraminal narrowing. Bilateral\nfacet joint hypertrophy noted at C2-3. No secondary critical canal or\nforaminal narrowing.There is no prevertebral edema.\n\nThe thyroid is unremarkable. Centrilobular emphysema is noted as well as\ncalcified biapical scarring. Chronic deformities of the upper right ribs also\nnoted.", "output": "No cervical spine fracture or acute malalignment." }, { "input": "No evidence of traumatic malalignment. No fractures are identified.There are\nmild multilevel degenerative changes, worst at C4-C5 with intervertebral loss\nof disc height and anterior and posterior osteophytosis. No significant\nspinal canal narrowing. There is mild bilateral neural foraminal narrowing at\nC3-C4 and C4-C5 as a result of facet arthropathy and uncovertebral spurring. \nThere is no prevertebral edema.\n\nThe thyroid is heterogeneous with scattered small hypodensities visualized\nthroughout the gland, likely nodules, the largest of which measures 8 mm. No\nfollow-up is recommended per ACR guidelines. The bilateral lung apices are\nunremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is straightening of normal cervical lordosis. No fractures are\nidentified. Mild degenerative changes are most notable at C4-C5 with loss of\nintervertebral disc space height and osteophytosis. There is no significant\ncanal narrowing.There is no prevertebral edema.\n\nThere is an 8 mm hypodense left thyroid nodule. The included lung apices are\nunremarkable. Mildly enlarged cervical lymph nodes bilaterally are\nnonspecific and could be reactive in etiology.", "output": "No acute cervical fracture or traumatic malalignment.\n\nMildly enlarged cervical lymph nodes bilaterally are nonspecific and could be\nreactive in etiology." }, { "input": "There is no evidence for a fracture or prevertebral soft tissue swelling. \nThere is minimal anterolisthesis of C3 on C4 without evidence for disc space\nwidening. There is severe intervertebral disc space narrowing C4-C5, C6-C7\nand C7-T1. Disc protrusions and endplate osteophytes mildly indent the\nventral thecal sac at multiple levels. There is multilevel neural foraminal\nnarrowing by uncovertebral and facet osteophytes.\n\nVisualized lung apices are clear. Partially visualized thyroid is grossly\nunremarkable. Concurrent head CT is reported separately.", "output": "1. No evidence for a fracture.\n2. Minimal anterolisthesis of C3 on C4, of unknown chronicity in the absence\nof comparison exams, though most likely degenerative.\n3. Multilevel degenerative disease." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of any\nsignificant degenerative changes or spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling.The thyroid and imaged lung\napices are unremarkable.", "output": "1. No fracture or subluxation.\n2. No significant degenerative change of the cervical spine, no canal or\nneural foraminal narrowing." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. No significant\ndegenerative disease. No prevertebral edema. The aerodigestive tract appears\npatent. Lung apices are clear. Thyroid gland appears normal.", "output": "Normal cervical spine CT exam." }, { "input": "There is no evidence of fracture, or malalignment. There is no prevertebral\nsoft tissue swelling.\n\nModerate degenerative changes are seen, including anterior, and posterior\nosteophytosis worse from C6/C7. There is also multilevel intervertebral disk\nspace narrowing.\n\nThere is a large left thyroid nodule, for which a ultrasound is recommended\nfor further evaluation, measuring up to 3.5 cm. The visualized apices of lungs\nare clear. There is no cervical lymphadenopathy.", "output": "1. No cervical spine fractures identified.\n\n2. Large left thyroid gland nodule, for which a non urgent ultrasound may be\nhelpful for further evaluation." }, { "input": "There is no acute fracture or malalignment. Straightening of normal lordosis\nis likely related to the cervical collar. No prevertebral soft tissue\nabnormality is seen. There is no evidence of spinal canal or neural foraminal\nnarrowing. Within the limitations of this noncontrast study, is no evidence\nof infection or neoplasm.", "output": "No acute fracture, malalignment, or prevertebral soft tissue abnormality of\nthe cervical spine." }, { "input": "Dental amalgam streak artifact limits study. There is mild straightening of\nthe cervical lordosis, likely positioning. Again seen is right anterior and\nposterior C1 arch fractures with approximately 2-3 mm gap between the fracture\nline, not significantly changed from prior exam. Cortical irregularity at the\ninferior anterior corner of C1 is not well demonstrated on today's exam due to\nstreak artifacts from dental amalgam, though likely still present (602:44). \nThe fracture fragments are in overall anatomic alignment. New since ___, there is evidence of periosteal reaction along the anterior arch cortex\n(2:7). However, there is no bridging callus formation posteriorly. No new\nfractures are identified. Multilevel degenerative changes of the cervical\nspine with mild narrowing of the spinal canal with minimal remodeling of the\nthecal sac due to uncovertebral hypertrophy and minimal disc protrusion is\nmild, most notable at C2-3, C3-4 and C4-5. There is moderate to severe\nnarrowing of the neural foramen at right C3-4, moderate at bilateral C4-5,\nsevere at left C5-6, moderate at bilateral C6-7 and moderate to severe at left\nC7-T1 due to uncovertebral hypertrophy. There is no prevertebral soft tissue\nswelling. Rounded millimetric soft tissues are partially imaged in the\ncervical trachea (02:52, 53), the nonspecific and may represent secretions\nversus nodules.", "output": "1. Dental amalgam streak artifact limits study.\n2. Interval bridging callus formation at the anterior arch of C1 fracture.\nPosterior arch fracture does not demonstrate bridging callus formation. \nStable approximately 2-3 mm separation between the fragments.\n3. Within limits of study, no definite new fractures identified.\n4. Mild-to-moderate cervical spine degenerative changes with neural foraminal\nnarrowing, worst at C3-4 and C5-6." }, { "input": "Interval demonstration of continued osseous bridging of the right C1 anterior\nand posterior arch fractures when compared to prior examination with decreased\nconspicuity of fracture lucencies. The configuration of the fracture\nfragments are unchanged from prior examination. No evidence of new fracture. \nThe craniocervical junction and anterior atlantodental interval are within\nexpected limits. There is no evidence for acute subluxation or malalignment. \nThe prevertebral soft tissues are unremarkable. Multilevel cervical\nspondylosis are unchanged from prior examination, with moderate to severe\nright C3-C4, severe bilateral C4-C5 and severe left C5-C6 neural foraminal\nnarrowing. Re-identified are multiple soft tissue densities along the\ntrachea, which may represent secretions, clinical correlation is recommended..\nThe visualized lung apices are clear. There is no cervical lymphadenopathy by\nsize criteria.", "output": "1. Continue osseous bridging along the right C1 anterior and posterior arch\nfractures when compared to prior examination. The fracture lucencies are less\nconspicuous. Fracture alignment remains unchanged.\n2. No acute fractures or malalignment.\n3. Additional findings as described above." }, { "input": "The cervical spine alignment is normal. No acute cervical spine fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. The lung apices are clear, the thyroid gland appears\nunremarkable.", "output": "No evidence of acute cervical spine fracture or traumatic malalignment." }, { "input": "The study is somewhat limited by motion artifact. Alignment is normal. No\ncervical spine fractures are identified.There is no significant canal or\nforaminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. Left mandibular\nfracture is again noted.", "output": "1. Moderately limited by motion artifact. No convincing evidence for acute\nfracture.\n2. Left mandibular fracture." }, { "input": "There are postoperative changes of prior C5 corpectomy with C4 through C6\nanterior spinal fusion hardware. When compared to prior exam, the overall\nhardware position and alignment is unchanged; however, there is increased\nlucency about the tips of both the superior screws within C4 and the inferior\nscrews within C6, the appearance of which could represent artifact although\nwas not present on prior exam and hardware loosening is not excluded. The\npreviously described residual postoperative air and vacuum phenomenon has\nresolved. There is no evidence of osseous destruction.\n\nThere is multilevel cervical spondylosis including a large disc bulge at the\nC2-C3 level, along with severe bilateral facet arthropathy, greatest at the\nC2-C3 and C3-C4 levels, where there is likely severe neural foraminal stenosis\non the right at C2-C3 and bilaterally at C3-C4.\n\nThe intracranial contents appear unremarkable.\n\nThere is biapical pulmonary scarring.\n\nLinear metallic density/foreign body within the right cervical internal\ncarotid artery is unchanged when compared to prior exam though correlation\nwith history is recommended.", "output": "1. Postoperative change of C5 corpectomy with anterior spinal fusion hardware\nfrom C4 through C6. There is increased lucency about the tips of the screws,\nbothwithin C4 and C6, which could represent artifact although this was not\npresent on prior exam and hardware loosening is not excluded.\n2. Unchanged multilevel cervical spondylosis.\n3. Linear metallic density within the right cervical internal carotid artery\nis unchanged when compared to prior exam though correlation with history is\nrecommended.\n\nNOTIFICATION: These results were added to the critical communication\ndashboard at approximately 1350, ___." }, { "input": "The thecal sac was successfully accessed at the L3-L4 level with return of\nclear CSF.\n\nA total of approximately 10 mL of Isovue M 200 were uneventfully injected into\nthe thecal sac and fluoroscopic images were obtained documenting the\ndistribution of the contrast within the thecal sac.\n\nNo sedation was administered for the Procedure. The patient tolerated the\nProcedure well without complication.", "output": "1. Successful lumbar myelogram with access at L3-L4.\nI, Dr. ___ supervised the trainee during the key components of\nthe above procedure and I reviewed and agree with the trainee's findings and\ndictation." }, { "input": "Vertebral body height and alignment is maintained. Degenerative disc disease\nwith disc calcifications is seen at L5-S1. Postsurgical changes after\nposterior instrumented L5-S1 vertebral body fusion is noted. There is no\nevidence of hardware complication. There is a heterotopic ossification about\nthe posterior aspect of the screws with ossification of the posterior elements\nof the spine and facet joints.\n\nAt T12-L1, there is no spinal canal stenosis or osseous neural foraminal\nnarrowing.\n\nAt L1-L2, there is mild facet joint arthropathy, no spinal canal stenosis,\nmild bilateral osseous neural foraminal narrowing. Findings are similar to\n___.\n\nAt L2-L3, there is no spinal canal stenosis, mild facet joint arthropathy, no\nosseous neural foraminal narrowing.\n\nAt L3-L4, there is no spinal canal stenosis, mild facet joint arthropathy, or\nneural foraminal narrowing.\n\nAt L4-L5, there is a diffuse disc bulge causing mild anterior thecal sac\ndeformity and moderate bilateral neural foraminal narrowing, facet joint\narthropathy and ligamentum flavum hypertrophy. Findings are relatively stable\nwhen compared with the prior examination in ___.\n\nAt L5-S1, there is narrowing of the intervertebral disc space and mild\nspondylosis causing mild bilateral neural foraminal narrowing, there is\narticular joint facet arthropathy, no evidence of central spinal canal\nstenosis. Findings are similar and grossly unchanged from ___.\n\nBilateral degenerative changes of the sacroiliac joints are noted.\n\nOther findings: Note is made of mild-to-moderate atherosclerotic and\natheromatous changes of the abdominal aorta which is otherwise normal in\ncaliber.", "output": "1. No evidence of cauda equina compression or severe spinal canal stenosis.\n2. Stable postsurgical changes after posterior instrumentation fusion of the\nL5-S1 vertebral bodies. No evidence of hardware complication.\n3. Mild hypertrophic degenerative changes of the lumbar spine at L4-5 and\nL5-S1 levels, not significantly changed from ___." }, { "input": "Alignment is normal. No acute fractures are identified. There is mild to\nmoderate degenerative changes the cervical spine seen most prominently at\nC5-6. Air cyst is seen on the inferior endplate of C5. There is no\nprevertebral soft tissue swelling. Visualized lung fields are unremarkable.", "output": "1. No evidence of acute fracture or subluxation of the cervical spine." }, { "input": "There is no fracture or prevertebral fluid. The imaged cervical vertebral\nbodies are normally aligned. Incidentally noted is a lack of transverse\nforamen on the right at C4. There is moderate to severe multilevel cervical\nspine degenerative change, with large anterior intervertebral osteophytes. \nProminent posterior intervertebral osteophytes and a posterior disc bulge\nresults in moderate to severe spinal canal narrowing, worst at C4-5 and C5-6\n(series 3, image 52). Moderate canal narrowing is also seen at C3-4 due to a\nlarge posterior disc protrusion. Moderate neural foraminal narrowing due to\nuncovertebral osteophytes is most severe at C4-5 bilaterally (series 3, image\n45). Scattered bilateral cervical lymph nodes are mildly increased in number\nbut not pathologically enlarged. The thyroid is within normal limits. \nPartially imaged lung apices are clear.", "output": "1. No fracture or malalignment.\n2. Multilevel moderate cervical spine degenerative change resulting in\nmoderate to severe spinal canal and moderate neural foraminal narrowing, as\nabove." }, { "input": "Alignment is normal. No fractures are identified. Small posterior disc bulge\nresult in up to mild canal narrowing at C5-C6. There is no significant neural\nforaminal narrowing. There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or traumatic malalignment." }, { "input": "There is no acute fracture or malalignment of the cervical spine. There is no\nprevertebral soft tissue swelling. There are mild degenerative changes, worst\nat C6-7, with loss in disk height. The thyroid is unremarkable. The included\nlung apices are clear. Mild mucosal thickening is seen within the maxillary\nsinuses.", "output": "No acute fracture of the cervical spine." }, { "input": "Alignment is normal. No acute fractures are identified. Mild multilevel\ndegenerative changes of the cervical spine noted. There is no evidence of\nsignificant spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.", "output": "No evidence of acute fracture or traumatic malalignment." }, { "input": "Extensive streak artifact at the level of the sacrum due to the presence of 2\nthreaded screws traversing the posterior pelvis in similar overall position\nwhen compared with the most recent prior exam. There is also cement noted\nwithin the bilateral sacral ala also similar in position to the prior. On the\nsagittal reformations, there is kyphotic angulation of the sacrum with an\nangle of approximately 114 degree similar to prior. There is a soft tissue\nlesion again seen anterior to the right sacrum measuring approximately 6.5 x\n2.2 cm, better characterized on the prior contrast enhanced exam and similar\nin overall size. Again seen, is osseous destructive changes centered at the\nright sacral ala also involving the right SI joint and right posterior iliac\nbone at the level of the traversing screws.\n\nThere is no acute lumbar spine compression fracture or malalignment. Lucent\nbone lesion within the L2 and L3 vertebral bodies are again seen consistent\nwith vertebral body hemangiomas. There is also a vertebral body hemangioma\nwithin T12. There is persistent mild right hydronephrosis with small stones\nin the right distal ureter better seen on prior exam performed 3 weeks\nearlier. Additional nonobstructing stones are seen within bilateral renal\nlower pole calices. There has been interval placement of a left ureteral\nstent which is only partially imaged with severe left hydronephrosis.", "output": "1. Bilateral hydronephrosis, with left ureteral stent partially visualized. \nPreviously noted right distal ureteral stones better assessed on prior CT\nabdomen pelvis.\n2. Similar appearance of soft tissue lesion anterior to the right hemi sacrum\nwith postsurgical changes within the sacrum appearing unchanged with similar\nmarked kyphotic angulation at the level of sacral screws. Similar appearance\nof destructive bony lesion involving the right SI joint extending into the\nright sacral ala and right iliac bone. Evaluation for subtle differences from\nprior is limited given significant streak artifact.\n3. No acute lumbar spine fracture or malalignment. Similar appearance of\nvertebral body hemangiomas at T12, L2, and L3.\nPREVALENCE: Prevalence of lumbar degenerative disk disease in subjects\nwithout low back pain:\nOverall evidence of disk degeneration 91% (decreased T2 signal, height loss,\nbulge)\nT2 signal loss 83%\nDisk height loss 58%\nDisk protrusion 32%\nAnnular fissure 38%\nJarvik, et all. Spine ___ 26(10):1158-1166\nLumbar spinal stenosis prevalence- present in approximately 20% of\nasymptomatic adults over ___ years old\n___, et al, Spine Journal ___ 9 (7):545-550\n\nThese findings are so common in asymptomatic persons that they must be\ninterpreted with caution and in context of the clinical situation.\n\nNOTIFICATION: The findings were discussed with ___, M.D. by ___\n___, M.D. on the telephone on ___ at 1:53 pm, 15 minutes after\ndiscovery of the findings." }, { "input": "No acute fractures or malalignment is identified. Multilevel degenerate\nchanges are seen throughout the cervical spine. There is reversal of the\nnormal lordotic curvature. There is posterior disc bulge of unknown\nchronicity at C2-C3 and C6-C7. There is resultant encroachment upon the\nthecal sac with given the associated hypertrophy of ligamentum flavum at C2-3\nlevel, this patient may be predisposed to cord contusion in the correct\nclinical setting and clinical correlation is advised. There is no\nprevertebral edema.\n\nThe lung apices are unremarkable. Nodular enlargement of the right thyroid\nlobe is compatible with goiter.", "output": "1. No acute fracture or malalignment.\n2. Multilevel degenerative changes, detailed above.\n3. Prominent disc bulge and ligamentum flavum hypertrophy at C2-3 level,\nresulting in significant canal stenosis, if there is concern for cord\ncontusion at this level, consider MRI to further assess.\n4. Right thyroid goiter." }, { "input": "No fracture or traumatic malalignment. Degenerative changes in the cervical\nspine are most notable at C5-6 and C6-7, where there is disc height loss and\nanterior osteophytosis. There is no prevertebral edema.\n\nThe thyroid is unremarkable. There is a thick walled cyst in the right lung\napex.", "output": "No fracture or traumatic malalignment." }, { "input": "Alignment is normal. No fractures are identified.Posterior and uncovertebral\nosteophytes result in mild canal narrowing at C3-4, C4-5, and C5-6. There is\nmoderate neural foraminal narrowing at the right at C3-4 and C4-5. Mild left\nneural foraminal narrowing is present at C5-6.There is no prevertebral soft\ntissue swelling.\n\nThe imaged thyroid gland is unremarkable. Imaged lung apices are clear. No\ncervical lymphadenopathy by CT size criteria.", "output": "No fracture or traumatic subluxation." }, { "input": "There is 2 mm anterolisthesis of C4 on C5, almost certainly degenerative.No\nacute displaced fractures are identified. There are mild multilevel\ndegenerative changes, most pronounced at C5-6 where there is loss of\nintervertebral disc space height, endplate sclerosis, anterior posterior\nosteophyte formation and subcortical cystic change. There is mild-to-moderate\ncanal narrowing at C5-6 due to a disc osteophyte complex. There is multilevel\nmild-to-moderate neural foraminal narrowing due to uncovertebral osteophytes\nand facet hypertrophy, most pronounced on the left at C3-4. There is no\nevidence of severe spinal canal or neural foraminal stenosis. There is no\nprevertebral soft tissue swelling.\n\nThere are no suspicious pulmonary nodules in the visualized portion of the\nlungs. There is mild biapical pleuroparenchymal scarring. The visualized\nthyroid gland is unremarkable.", "output": "1. No acute displaced fracture or findings suspicious for traumatic\nmalalignment. 2 mm anterolisthesis of C4 on C5 is almost certainly\ndegenerative.\n2. Mild multilevel degenerative changes, as above. No high-grade spinal canal\nnarrowing." }, { "input": "Alignment is normal. No fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid demonstrates multiple nodules measuring up to at least 1 cm. Lung\napices were not included on the study. There is a questionable pulmonary\nnodule seen in the left upper to midlung on scout image for the CT. Recommend\ndedicated chest radiograph for further evaluation.", "output": "1. No acute fractures or traumatic malalignment.\n2. Multinodular thyroid. Consider thyroid ultrasound if clinically indicated.\n3. Questionable pulmonary nodule seen in the left upper to midlung on scout\nimage for the CT. Recommend dedicated chest radiograph for further evaluation." }, { "input": "No traumatic malalignment or fractures are identified.There is no significant\ncanal or foraminal narrowing.There is no prevertebral edema.\n\nThe thyroid and included lung apices are unremarkable. There is no cervical\nlymphadenopathy by size criteria. Visualized aerodigestive tract is\nunremarkable.", "output": "No traumatic malalignment or fractures are identified." }, { "input": "There is no acute fracture or malalignment in the cervical spine. The\nvisualized outline of the thecal sac is unremarkable. Degenerative disc\ndisease is notable at C6-7 level with significant endplate sclerosis and mild\nendplate concavity of the inferior endplate of C6. in addition, there is\nsubtle anterolisthesis of C6 relative to C7. Otherwise the alignment of the\ncervical spine is preserved. Facet arthropathy with apparent fusion involving\nC3 - 5 bilaterally. There is no critical central spinal canal or neural\nforaminal stenosis. No prevertebral edema. The aerodigestive tract appears\npatent. Emphysema is noted at the imaged lung apices. A left thyroid nodule\nmeasures 7 mm.", "output": "1. No acute fracture.\n2. Degenerative changes as stated with minimal anterolisthesis of C6 relative\nto C7, likely chronic.\n3. Severe emphysema at the lung apices." }, { "input": "Alignment is unchanged with minimal retrolisthesis of C4 on C5.No fractures\nare identified.Moderate to severe multilevel degenerative changes with\nintervertebral disc space narrowing, endplate sclerosis and cystic change, and\nanterior and posterior osteophyte formation, most pronounced from C4-C5\nthrough C6-C7. Multilevel mild to moderate central canal stenosis is most\nsevere at C3-C4 and C4-C5 due to combination of a disc bulge and posterior\nosteophyte. Bilateral mild-to-moderate neural foraminal narrowing due to\nuncovertebral spurring and facet hypertrophy is most pronounced C4-5. There\nis no prevertebral soft tissue swelling. There is no evidence of infection or\nneoplasm.\n\nThe esophagus is patulous. Visualized lung apices are clear. The thyroid\ngland is unremarkable. Partially imaged is a periapical lucency within the\nleft mandibular molar tooth.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate to severe cervical spondylosis." }, { "input": "Alignment is normal. No acute cervical spine fractures are identified.There is\nunchanged moderate to severe multilevel degenerative disease of the cervical\nspine with intervertebral disc height loss and endplate sclerosis at multiple\nlevels. Neural foraminal narrowing is most severe at C4-5 where uncovertebral\nhypertrophy and facet arthropathy cause moderate to severe bilateral neural\nforaminal narrowing and at C5-6 where there is moderate to severe right neural\nforaminal narrowing. There is no prevertebral soft tissue swelling.\n\nVascular atherosclerotic calcifications are seen in the carotid arteries.\n\nMild pleural scarring identified at the right lung apex, the thyroid gland\nappears unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Moderate to severe neural foraminal narrowing due to degenerative changes\nat C4-5 and C5-6 as above." }, { "input": "Alignment is normal. No fractures are identified. Bone mineralization appears\ndecreased. Incomplete fusion of the posterior elements at L5 and S1 is noted,\ndevelopmental variant.\n\nAt T12-L1 and L1-L 2, there is no spinal canal or neural foraminal stenosis.\n\nAt L2-L3, there is a mild disc bulge with ligamentum flavum infolding and\nfacet arthropathy which causes mild narrowing of the spinal canal. There is\nmild bilateral neural foraminal narrowing.\n\nAt L3-L4, there is a diffuse disc bulge with ligamentum flavum infolding and\nfacet arthropathy causing minimal spinal canal narrowing and no definite\nneural foraminal narrowing.\n\nAt L4-L5, there is a diffuse disc bulge with ligamentum flavum infolding and\nprominent left greater than right facet arthropathy which causes moderate\nnarrowing of the spinal canal, mild to moderate left, and mild-to-moderate\nright neural foraminal narrowing.\n\nAt L5-S1, there is a diffuse disc bulge with prominent facet arthropathy. The\ndisc bulge contacts the bilateral traversing S1 nerve roots without convincing\ndisplacement. There is no significant narrowing of spinal canal. There is\nmoderate left and no definite right neural foraminal narrowing.\n\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm. 1.1 cm left renal cyst is noted. Partially imaged\ncolonic diverticulosis. There are prominent vascular calcifications involving\nthe aorta and iliacs. Mild atelectasis is noted at the lung bases.", "output": "1. Degenerative changes of the lumbar spine as described above. The findings\nare most advanced at the L4-L5 and L5-S1 levels. Moderate left neural\nforaminal stenosis at L5-S1 appears increased compared to ___.\n2. Please refer to the separate CT of the pelvis for pelvic findings." }, { "input": "There are 5 non-rib-bearing lumbar-type vertebral bodies. The patient is\nstatus post posterior spinal fusion with rods and transpedicular screws at\nL4-5. Interbody device is noted at L4/L5. Grade 1 L4-5 anterolisthesis is\nunchanged from prior MRI. Aside from this, alignment of the lumbar spine is\nnormal. The left L5 transpedicular screw abuts/slightly traverses the\nanterolateral cortex of the vertebral body (2, 62). Otherwise, no\nhardware-related complication.\n\nThere is no evidence of acute fracture. Vertebral body heights are preserved.\nThere is no paraspinal edema or inflammation no significant spinal canal\nnarrowing. There is likely mild bony neural foraminal narrowing at L4-5. No\nworrisome focal osseous lesions. No periostitis. Imaged paraspinal\nmusculature is unremarkable. Scarring and focus of right-sided likely\ndystrophic calcification from prior posterior approach spinal fusion is noted\nin the subcutaneous soft tissues overlying the spine (see series 2, image 25).\n\nMild aortic calcifications are noted. No retroperitoneal lymphadenopathy. \nRemaining partially visualized structures of the retroperitoneum and abdomen\nare without acute focal abnormality on limited evaluation.", "output": "1. No acute fracture or new malalignment in the lumbar spine.\n2. Status post L4-5 posterior spinal fusion without hardware-related\ncomplication.\n3. Unchanged grade 1 L4-5 anterolisthesis." }, { "input": "The imaged thoracic vertebral bodies are normally aligned. There is no\nevidence of acute fracture. Vertebral body heights are preserved. There is\nmoderate multilevel thoracic spine degenerative change consisting of\nmultilevel disc height loss and confluent anterior intervertebral osteophytes,\nDISH, worst in the mid and lower thoracic spine. There is no significant bony\nspinal canal narrowing. No worrisome focal osseous lesions. The imaged\nparaspinal musculature is normal in bulk morphology. No paraspinal edema or\ninflammation identified.\n\n There is no concerning focal subcutaneous or musculoskeletal soft tissue\nabnormality. Postsurgical changes appearing related to prior Roux-en-Y\ngastric bypass are partially visualized. Otherwise, there is no acute focal\nabnormality in the imaged portions of the retroperitoneum, upper abdomen,\nchest or mediastinum.", "output": "1. No acute fracture or malalignment in the thoracic spine.\n2. Moderate multilevel thoracic spine degenerative changes worse in the mid\nand lower thoracic spine, including confluent multilevel anterior\nintervertebral osteophytes, DISH." }, { "input": "Alignment is normal. No fractures are identified.No critical central canal\nstenosis is seen.There is no prevertebral soft tissue swelling. Scattered\nbilateral cervical lymph nodes are not pathologically enlarged. The imaged\nthyroid gland is homogeneous. Partially imaged lung apices are clear.", "output": "1. No acute fracture or dislocation of the cervical spine." }, { "input": "Alignment is normal. No fractures are identified.There is minimal\ndegenerative changes of the cervical spine. There is no significant canal or\nforaminal narrowing.There is no prevertebral edema. Mild atherosclerotic\ncalcifications of the carotid bifurcations.\n\nThe thyroid contains a coarse calcification in the left thyroid gland. \nIncluded lung apices are unremarkable.", "output": "1. No acute cervical spine fracture or malalignment.\n2. Mild degenerative changes of the cervical spine." }, { "input": "No acute cervical spine fracture or traumatic malalignment is\nidentified.Severe multilevel degenerative changes are seen, notable for\nanterior fusion between C2-C3 and C4-C7 levels, and significant loss of\nintervertebral disc space from C4-C7 .There is no prevertebral edema.\n\nSeveral hypodense nodules measuring up to 1.8 cm in seen in the thyroid\nsuggest goiter. Scarring is noted in the imaged lung apices with possible\nbilateral pleural effusion, partially evaluated in this exam and better\ndepicted in the prior CT of the chest performed on the same date.\n\nPartially imaged endotracheal and enteric tubes are noted.", "output": "1. No acute cervical spine fracture or traumatic malalignment.\n2. Severe degenerative changes of the cervical spine.\n3. Thyroid nodules measuring up to 1.3 cm. If not previously evaluated,\ndedicated thyroid ultrasound may be performed.\n\nRECOMMENDATION(S): Thyroid nodules measuring up to 1.8 cm. If not previously\nevaluated, dedicated thyroid ultrasound may be performed.\n\n Thyroid nodule. Ultrasound follow up recommended.\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or ___, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "There is reversal of the cervical lordosis, which may be positional. No\nfractures are identified.There is no high-grade spinal canal or foraminal\nnarrowing.There is no prevertebral edema.\n\nThere is a 1.8 cm hypodense nodule in the right thyroid lobe. The included\nlung apices are unremarkable.", "output": "1. No evidence of acute cervical spine fracture traumatic malalignment.\n2. 1.8 cm hypodense nodule in the right thyroid lobe. See recommendations\nbelow.\n\nRECOMMENDATION(S): Thyroid nodule. Ultrasound follow up recommended.\n\n___ College of Radiology guidelines recommend further evaluation for\nincidental thyroid nodules of 1.0 cm or larger in patients under age ___ or 1.5\ncm in patients age ___ or older, or with suspicious findings.\n\nSuspicious findings include: Abnormal lymph nodes (those displaying\nenlargement, calcification, cystic components and/or increased enhancement) or\ninvasion of local tissues by the thyroid nodule.\n\n___, et al, \"Managing Incidental Thyroid Nodules Detected on Imaging: White\nPaper of the ACR Incidental Findings Committee\". J ___ ___\n12:143-150." }, { "input": "Alignment is normal. No fractures are identified. Mild degenerative disease\nis seen throughout the cervical spine most prominent at C5 vertebral body with\nlarge anterior osteophyte. There is no evidence of critical spinal canal or\nneural foraminal narrowing. No prevertebral soft tissue swelling is present.\n\nThe thyroid is notable for a 1.3 x 1.4 cm (02:57) left lower lobe hypodense\nnodule. Included lung apices are unremarkable.", "output": "1. No fracture or malalignment.\n2. Mild degenerative disease of the cervical spine with large anterior\nosteophyte at C5.\n3. 1.4 cm left thyroid lobe hypodense nodule. If clinically indicated and\nnot previously assessed consider non urgent thyroid ultrasound for further\nevaluation.\n\nRECOMMENDATION(S): 1.4 cm left thyroid lobe hypodense nodule. If clinically\nindicated and not previously assessed consider non urgent thyroid ultrasound\nfor further evaluation." }, { "input": "There is no cervical spine fracture. There is no prevertebral soft tissue\nswelling. There are mild to moderate multilevel degenerative changes most\npronounced at C6/C7 where there is disc space narrowing, disc bulging, mild\nbilateral neural narrowing. There is no critical canal central canal\nnarrowing. Mild anterolisthesis of C4-5 is most likely degenerative. The\nthyroid is unremarkable. The lung apices are clear. Round soft tissue\ndensity lesion measuring 16 mm in the posterior nasopharyngeal tissues may\nreflect a Tornwaldt cyst or polypoid lesion, and correlation with direct\nvisual inspection is recommended, though this finding appears similar to that\nseen on the prior head CT from ___.", "output": "1. No cervical spine fracture.\n2. Mild cervical spondylosis.\n3. Soft tissue density lesion measuring 16 mm in the posterior nasopharyngeal\ntissues may reflect a Tornwaldt cyst or polypoid lesion, and correlation with\ndirect visual inspection is recommended, though this finding appears similar\nto that seen on the prior head CT from ___." }, { "input": "There is no fracture or dislocation. Mild anterolisthesis of C4 on C5 is\nnoted, likely chronic and degenerative. Multilevel degenerative changes\ncharacterized by bilateral facet arthropathy and endplate osteophyte\nformation. No prevertebral soft tissue abnormality or lymphadenopathy seen.\nThe visualized lung apices are clear.", "output": "No acute fracture. Degenerative changes with mild anterolisthesis of C4. Lack\nof prior comparison studies limits evaluation for stability of this alignment\nabnormality. Please correlate clinically." }, { "input": "Alignment is normal. There is diffuse osseous demineralization. Compression\ndeformities with loss of vertebral body height are noted at C4, C5, C6, and\nT1, largely unchanged compared to previous study. No acute fractures are\nidentified. There is no evidence of spinal canal or neural foraminal stenosis.\nThere is no prevertebral soft tissue swelling. There is no evidence of\ninfection or neoplasm.\nEmphysematous changes are noted at the lung apices bilaterally.", "output": "1. Diffuse bone demineralization with compression deformities at C4, C5, C6\nand T1, similar to the previous study.\n2. No evidence of acute fractures or traumatic malalignment." }, { "input": "There is exaggerated lordosis of the cervical spine due to exaggerated\nkyphosis of the thoracic spine, which slightly limits evaluation of the\ncervical spine. No fractures are identified. There are multilevel\ndegenerative changes of the cervical spine most pronounced at the C5-6, C6-7\nand C7-T1 levels. There is 2 mm anterolisthesis of C4 on C5 and C7 on T1,\nwhich is likely chronic and degenerative in etiology. There is no evidence of\ncritical spinal canal or neural foraminal narrowing. There is no evidence of\ninfection or neoplasm.", "output": "1. Evaluation of the cervical spine is slightly limited due to exaggerated\nlordosis. Within this limitation, no acute fracture or malalignment is\nidentified.\n2. 2 mm anterolisthesis of C4 on C5 and C7 on T1 is likely chronic and\ndegenerative in etiology in the setting of degenerative changes at these\nlevels." }, { "input": "Alignment is normal. No fractures are identified. There is no prevertebral\nsoft tissue swelling. Degenerative changes notable for disc bulges and\nthickening of the ligamentum flavum. Disc protrusion at C2-3 and C3-4 effaces\nthe ventral CSF and may contact the ventral aspect of the cord.\n\nThyroid is small but grossly unremarkable. Lung apices are notable for a 3 mm\nright apical nodule (3:70), unchanged from prior.", "output": "No acute fracture or malalignment of the cervical spine.\nA 3 mm right apical pulmonary nodule unchanged since prior ___.\n\nRECOMMENDATION(S): If patient has risk factors such as smoking or malignancy,\n___ year followup suggested for followup of a 3 mm right apical pulmonary\nnodule. Otherwise no additional imaging necessary." }, { "input": "No acute fracture or malalignment. No prevertebral soft tissue swelling. \nThere is no evidence of spinal canal or neural foraminal stenosis. No\nsignificant degenerative disease. Thyroid gland is unremarkable.", "output": "No fracture or malalignment." }, { "input": "Alignment is normal. No fractures are identified.\n\nThere is no prevertebral edema. Degenerative changes are most notable at C5-6\nand C6-7 with intervertebral disc height loss, posterior osteophytes and\nuncovertebral joint hypertrophy. There is secondary mild to moderate canal\nnarrowing at these levels. Moderate two severe right foraminal narrowing\nnoted at the latter level. Moderate bilateral foraminal narrowing noted at\nC5-6 and on the left at C6-7.\n\nThe visualized lung and thyroid are unremarkable.", "output": "1. No acute fracture or traumatic malalignment.\n2. Multilevel degenerative changes as above." }, { "input": "Alignment is normal. No fractures are identified, and there is no\nprevertebral soft tissue swelling. There are multilevel degenerative changes\nincluding disc height loss, most significant at C5-C6 and C6-C7. Posterior\nosteophytes at C5-C6 and C6-C7 cause mild to moderate spine canal narrowing.\n\nThe thyroid and included lung apices are unremarkable.", "output": "No acute fracture or malalignment." }, { "input": "No fractures or traumatic malalignment identified. There is no prevertebral\nsoft tissue swelling. Congenitally short pedicles are noted. There are small\ndisc bulges at L4-5 and L5-S1 levels with minimal bilateral foraminal\nnarrowing at the later level. There is no evidence of significant spinal canal\nor neural foraminal narrowing. Additional is dorsally abdomen and pelvis are\nnormal.", "output": "No acute fracture or traumatic malalignment. Congenitally short pedicles and\nmild degenerative changes as above without significant overall canal or\nforaminal narrowing." }, { "input": "Alignment is normal. No fractures are identified. There is no evidence of\nhigh-grade spinal canal or neural foraminal stenosis. Mild multilevel\ndegenerative changes of the cervical spine with osteophyte formation and joint\nspace narrowing. There is no prevertebral soft tissue swelling.", "output": "No evidence of acute fracture or dislocation." }, { "input": "Patient status post L4 and L5 laminectomy. At the laminectomy bed, abutting\nthe posterior dura, is a 5.8 x 2.9 x 10 cm nonenhancing fluid collection that\ntracks posteriorly through the right and left erector spinae muscles into\noverlying subcutaneous fat and skin (8: 64) that may represent a postoperative\nseroma versus a pseudomeningocele. This fluid collection extends from L2\nvertebral level down to the S2 level (8: 34-74) And is the likely source of\nCSF leak.\n\nAlignment is normal. No fractures are identified. There is mild degenerative\nchanges noted in the lumbar spine, including multilevel facet arthropathy. \nThere is a 2.3 cm (03:35) sclerotic focus adjacent to the left sacroiliac\njoint is again seen, similar in appearance to prior ___ lumbar spine\nMRI. There is no evidence of spinal canal or neural foraminal stenosis.\n\nLower back skin staples from recent laminectomy are aligned and intact. \nMildly prominent small bowel loops with air/fluid levels may represent ileus. \nLeft sided SI joint sclerosis could be seen in the setting of degenerative\nchanges.", "output": "1. 5.8 x 2.9 x 10 cm fluid collection in the posterior laminectomy bed is\nlikely the source of reported CSF leak. Collection may represent a\npostoperative seroma versus pseudomeningocele, which cannot be completely\nevaluated CT; recommend MR lumbar spine for further evaluation.\n2. Mildly prominent small bowel loops may represent ileus.\n3. Asymmetric left sided SI joint sclerosis could be seen in the setting of\ndegenerative vs inflammatory changes.\n\nRECOMMENDATION(S): Recommend MR lumbar spine for further evaluation." }, { "input": "The patient is status post L4, L5 laminectomy. At the site of prior fluid\ncollection, there is interval postoperative changes there is a small amount of\nresidual fluid extending along the right margin of L3 spinous process\nmeasuring 3 cm x 3.5 cm x 1.6 cm, also present on prior. Trace fluid at the\nlaminectomy sites, significantly improved.\n\nAlignment is normal. No fractures are identified.Again noted are mild\nmultilevel degenerative changes, without significant spinal canal narrowing. \nMild-to-moderate bilateral L4-5, L5-S1 foraminal narrowing. There are\ndegenerative and probably erosive changes bilateral sacroiliac joints,\nstable.There is no prevertebral soft tissue swelling.\n\nSkin staples are intact. Soft tissue edema is noted overlying the surgical\nsite.", "output": "Interval postoperative changes, with near resolution of previously seen fluid\ncollection at the laminectomy bed. 3 cm x 3.5 cm x 1.6 cm residual fluid\ncollection along the right margin of L3 spinous process, also present on\nprior." } ] }